Ações participativas em saneamento rural: bases conceituais e diretrizes metodológicas / Participative actions in rural sanitation: conceptual bases and methodological guidelines

Resumo A participação social é um componente fundamental na promoção do saneamento rural. Entretanto, diferentes desafios conceituais e metodológicos sobre a utilização de metodologias participativas (MP) ainda despontam na literatura em relação a quem são os principais atores sociais envolvidos e como tais mecanismos de intervenção têm contribuído em ações de saneamento rural. Assim, esta pesquisa objetiva caracterizar a utilização das MP empregadas em soluções de saneamento rural por diferentes atores sociais, em nível estadual. Para tal, foram investigadas as experiências de saneamento rural no estado de Goiás realizadas com financiamento do poder público, entre 2007 e 2019, por intermédio de entrevista semiestruturada e aplicação de questionário a lideranças e/ou técnicos de entidades governamentais e da sociedade civil. Em síntese, as experiências investigadas apresentaram que ambas as categorias de atores sociais têm utilizado MP em suas abordagens, classificando-as por etapas e tipologias, em consonância com Geilfus. No estudo, concluiu-se que o emprego de MP contribuiu para o processo de sensibilização às questões socioambientais locais, bem como motivou uma reflexão crítica em relação à própria participação, estimulando, assim, maior intervenção e interação dos participantes com a agenda de discussão proposta.

Abstract Social participation is a fundamental component in the promotion of rural sanitation. However, different conceptual and methodological challenges on the use of Participatory Methodologies (PM) still emerge in the literature regarding who are the main social actors involved and how intervention mechanisms have contributed to rural sanitation actions. Thus, this research aims to characterize the use of PM employed in rural sanitation solutions by different social actors, at the state level. For this purpose, the experiences of rural sanitation in the state of Goiás carried ou with funding from the government, between 2007 and 2019, were investigated with semi-structured interviews and questionnaire application to leaders and/or technicians of government and civil society entities. In summary, the experiences investigated showed that both categories of social actors have used PM in their approaches, categorizing them by stages and typologies, in line with Geilfus. The study concluded that the use of PM contributed to the process of raising awareness about local socio-environmental issues and motivating a critical reflection regarding one's own participation, thus stimulating greater intervention and interaction of participants with the proposed discussion agenda.

Reflexão acerca dos critérios que podem contribuir para a disseminação da COVID-19 em comunidades quilombolas rurais do estado de Goiás, Brasil / Reflection on criteria that may contribute to the dissemination of COVID-19 in rural quilombolas communities in the state of Goiás, Brazil

RESUMO O SARS-CoV-2 é facilmente disseminado por aerossóis e contato direto com pessoas contaminadas. Logo, as condições adversas em áreas rurais podem influenciar a propagação do vírus. Desta forma, estabeleceu-se uma reflexão acerca da disseminação da COVID-19 em função do hábito de lavar as mãos, das condições de saneamento, dos aspectos socioeconômicos e das condições habitacionais em 26 comunidades quilombolas rurais do estado de Goiás. Para isso foram levantadas informações in loco em 533 domicílios e aplicou-se a Analytic Hierarchy Process, utilizando-se critérios selecionados com base na literatura. As comunidades apresentaram uma priorização para a disseminação da COVID-19 variando de 14,9 x 10-3 (pior condição) a 64,3 x 10-3 (melhor condição), na qual a Comunidade José Coleto ocupou a posição mais desfavorável. Buracão mostrou um resultado mais satisfatório, sendo esta menos susceptível à disseminação da COVID-19. A melhoria nas condições de saneamento pode aumentar o hábito da higiene com as mãos, o que reduziria a disseminação da COVID-19 e de outras doenças infecciosas. Assim, a partir dos resultados obtidos, é perceptível a importância do empoderamento quanto aos hábitos de higiene, acesso à informação, saneamento básico e à saúde. Os gestores devem ter uma maior disposição para implantar infraestrutura e melhorar as condições dos critérios apresentados e discutidos neste trabalho.

ABSTRACT SARS-CoV-2 is easily spread by aerosols and direct contact with contaminated people. Therefore, adverse conditions in rural areas can influence the spread of the virus. Thus, a reflection was established about the dissemination of COVID-19 due to the habits of wash hands, sanitation conditions, socioeconomic aspects, and habitability conditions in 26 rural quilombola communities in the state of Goiás. For this, informations were collected in 533 locals households and it was applied the Analytic Hierarchy Process using criteria selected based on the literature. The communities presented a priority for the dissemination of COVID-19 ranging from 14.9 x 10-3 (worst condition) to 64.3 x 10-3 (best condition), and the Community José Coleto has occupied the most unfavorable position. Community Buracão showed a more satisfactory result, being less susceptible to the spread of COVID-19. Improving sanitation conditions can increase hand hygiene habits, which would reduce the spread of COVID-19 and other infectious diseases. Thus, from the results obtained, it is noticeable the importance of empowerment regarding hygiene habits, access to information, basic sanitation and health. The managers should give greater attention to implement infrastructures and improve the conditions of the criteria presented and discussed in this paper.

Índice de desenvolvimento humano em municípios que possuem sistema integrado de saneamento rural: uma análise comparativa / Human development index in municipalities with the integrated rural sanitation system: a comparative analysis

Resumo Este estudo investigou o desenvolvimento humano de oito municípios cearenses rurais que possuem o Sistema Integrado de Saneamento Rural (SISAR) e 170 que não o possuem. Desenvolveu-se um estudo a partir de Indicadores de Desenvolvimento Humano Municipal (IDHM) que constam na plataforma Atlas do Desenvolvimento Humano, extraindo-se dados dos Censos Demográficos de 1991, 2000 e 2010. Contou-se com o auxílio do software R para realização das análises estatísticas. Os resultados encontrados para o IDHM geral mostraram uma diferença significativa entre as médias dos dois grupos, o que não ocorreu quando analisadas as dimensões renda, longevidade e educação. Em suma, verificou-se que, no geral, a implantação de sistemas de abastecimento de água contribui para o aumento dos níveis de desenvolvimento humano, mas, no que se refere às dimensões mais específicas, essa premissa não foi estatisticamente confirmada.

Abstract This study investigated the human development of eight rural municipalities in the state of Ceará that have the Integrated Rural Sanitation System (SISAR) and 170 that do not. The study was developed based on the Municipal Human Development Indicators (MHDIs), which feature in the Atlas of Human Development, by drawing data from the 1991, 2000 and 2010 Demographic Censuses. The R software was used to carry out the statistical analyses. The results found for the general MHDI showed a significant difference between the means of the two groups, which did not occur when the income, longevity, and education dimensions were analyzed. In sum, it was verified that, in general, implementing water supply systems contributes to increasing human development levels, but as regards the more specific dimensions, this premise was not statistically confirmed.

Factors associated with diarrheal disease in the rural Caribbean region of Colombia / Factores asociados con enfermedad diarreica en área rural del Caribe colombiano

ABSTRACT OBJECTIVE: To analyze factors associated with diarrheal disease in the rural Caribbean region of Colombia. METHOD: A cross-sectional study conducted in the rural area of the Cesar Department, Colombia, between November 2017 and June 2018. Self-reported cases of diarrheal disease were surveyed, and water samples from 42 households were collected and analyzed. Descriptive statistics were employed in the analysis of socioeconomic status, environmental and sanitary conditions, and we evaluated their association with the diarrheal disease using the Poisson regression models. Each model was adjusted with variables suggested by specific directed acyclic graphs. RESULTS: Poor water supply conditions, hygiene and basic sanitation were reported in the study area. All water samples were classified either as high risk for health problems or unfit for human consumption. The diarrheal disease had a prevalence of 7.5% across all ages and of 23.5% in children under five years old. The variables rainy season (PR = 0.24; 95%CI 0.07-0.85), children under five years old (PR = 4.05; 95%CI 1.70-9.68), water from deep wells (PR = 16.90; 95%CI 2.45-116.67), water from artificial ponds (PR = 11.47; 95%CI 1.27-103.29), toilets availability (PRA = 0.23; 95%CI 0.06-0.96), and swine presence (PR = 0.20; 95%CI 0.05-0.74) were significantly associated with the occurrence of diarrheal disease. CONCLUSION: Water supply, hygiene and basic sanitation conditions have been associated with the diarrheal disease, affecting almost a quarter of the population under five years old. There is an urge for the design of effective policies that improve environmental and sanitation conditions in rural areas.

RESUMEN OBJETIVO: Analizar factores asociados con enfermedad diarreica en área rural del Caribe colombiano. MÉTODO: Estudio transversal en área rural dispersa del departamento del Cesar, Colombia, entre noviembre de 2017 y junio de 2018. Se indagó sobre morbilidad auto-reportada de enfermedad diarreica y se recolectaron y analizaron muestras de agua en 42 domicilios. Fue realizado un análisis descriptivo de condiciones socioeconómicas, ambientales y sanitarias y evaluamos su asociación con enfermedad diarreica mediante modelo robusto de regresión de Poisson. Cada modelo fue ajustado con variables sugeridas por diagramas causales específicos. RESULTADOS: Se evidenciaron condiciones precarias de abastecimiento de agua, higiene y saneamiento básico en la zona de estudio. Todas las muestras de agua se clasificaron entre los niveles de riesgo alto e inviable sanitariamente. La prevalencia de enfermedad diarreica fue 7,5% en todas las edades y 23,5% en niños menores de cinco años. Las variables estación lluviosa (RP = 0,24; IC95% 0,07-0,85), niños menores de cinco años (RP = 4,05; IC95% 1,70-9,68), abastecimiento de agua desde pozo profundo (RP = 16,90; IC95% 2,45-116,67), abastecimiento de agua desde estanco (RP = 11,47; IC95% 1,27-103,29), tenencia de baño (RPA = 0,23; IC95% 0,06-0,96) y presencia de cerdos (RP = 0,20; IC95% 0,05-0,74) mostraron asociaciones estadísticamente significativas con la ocurrencia de enfermedad diarreica. CONCLUSIÓN: Condiciones de abastecimiento de agua, higiene y saneamiento básico estuvieron asociadas con la ocurrencia de enfermedad diarreica, afectando alrededor de un cuarto de la población menor de cinco años. Urge un diseño efectivo de políticas que contribuyan al mejoramiento de condiciones ambientales y saneamiento en áreas rurales.

A study regarding the availability and utilization of water supply and sanitation practices in rural Amritsar, Punjab, India

Background: Access to safe water and sanitation practices is an important issue of health and development at local, regional and national levels. The government has come up with various facilities regarding the water supply and sanitation but there are various factors which curtail their utilization. The present study deals with the extent of utilization and factors impeding the utilization of such services at the village level.Methods: The present impeding cross-sectional study was carried out in village Nagkalan, Amritsar, where the eldest adult member present in the house at the time of the visit was interviewed. Every house of the village was visited during the period of January 2017 to December 2017, and a total of 1123 families were included in the final analysis. Thereafter, data was compiled and analyzed.Results: Out of total 1123 families, only 31.4% were using government water supply (tap water); while 42.7% had no government connection at all and used submersible as their sole source of water supply. 20.2% did not have a toilet at their house and therefore practiced open defecation; out of which majority families belonged to lower socio-economic status (statistically significant). Out of total 896 families having a toilet at their house, there were only 30 families (3.4%) who responded that some of the family members practice open defecation. Also, only 6.1% of the respondents were aware about the functions of Village Health Sanitation and Nutrition Committee (VHSNC).Conclusions: More number of families (42.7%) were dependent on submersible pump as sole source of water supply. 20.2% lacked separate toilet facility, mostly belonging to lower socio- economic status. Only 6.1% were aware regarding the VHSNC. All the families disposed of their household waste on the roads.

O sertão na saúde e na formação de trabalhadores setoriais: contextos, atores e ideologias (1920-1970) / The backcountry in the health and the training of sector workers: contexts, actors, and ideologies (1920-1970)

RESUMO Artigo analisa a agenda das políticas e discursos sobre saneamento rural no Brasil (1920-1970). Temática tradicional dos sanitaristas será discutida com base nas experiências desenvolvidas, especialmente nas interações com a Organização Pan-Americana da Saúde/Organização Mundial da Saúde (Opas/OMS), organismo internacional que, com lideranças nacionais, retomará, sob renovados termos, o sertão na agenda sanitária e na formação de trabalhadores. Analisa-se a literatura e fontes documentais. Conclui que houve mudanças no teor dos discursos e práticas da chamada interiorização dos serviços de saúde no contexto do pós-guerra, sobretudo naquilo que tange à centralidade das discussões acerca do planejamento e formação de trabalhadores.

ABSTRACT The article analyzes the agenda of policies and speeches on rural sanitation in Brazil (1920-1970). This traditional theme of health workers will be discussed based on experiences developed, especially in interactions with Pan American Health Organization/World Health Organization (PAHO/WHO). It analyzes the literature and documentary sources. It concludes that there have been changes in the content of the discourse and practice of the so-called internalization of health services in post-war context, especially in what pertains to the centrality of the discussions regarding the planning and training of workers.

O sertão remediado: o embate entre a elite goiana e o pensamento sanitarista, 1910-1920 / The sertão remediated: the clash between the elite of Goiás and sanitation thinking, 1910-1920

Em meio à emergência da saúde como pauta do debate político nas primeiras décadas do século XX, Arthur Neiva e Belisário Penna viajaram pelo sertão goiano para diagnosticar o estado de saúde da população, destacando, sobretudo, a disseminação da doença de Chagas e a decadência do sertão. A elite política goiana reagiu ao diagnóstico dos sanitaristas. Este artigo acompanha a polêmica que ganhou as páginas da revista A Informação Goiana. O periódico assumiu a defesa dos interesses da região, pois seus articulistas estavam certos de que cabia aos goianos a missão de revelar a verdade sobre o sertão, sua gente e suas potencialidades.

In the early decades of the twentieth century, when health started becoming an issue on the political agenda, Arthur Neiva and Belisário Penna travelled to the sertão semi-arid region of Goiás state, Brazil, to diagnose the population’s state of health, particularly highlighting the spread of Chagas disease and the decadence of the sertão. The political elite in the state reacted to the sanitarians’ findings. This article observes the controversy played out in the pages of A Informação Goiana magazine. The publication supported the region’s interests, because its leaders were sure that it was down to the people of Goiás to reveal the truth about the sertão, its people, and its potentialities.

Characterization of the biomass of a hybrid anaerobic reactor (HAR) with two types of support material during the treatment of the coffee wastewater

This study investigated the microbiology of a hybrid anaerobic reactor (HAR) in the removal of pollutant loads. This reactor had the same physical structure of an UASB reactor, however with minifilters inside containing two types of support material: expanded clay and gravel. Two hydraulic retention times (HRT) of 24h and 18h were evaluated at steady-state conditions, resulting in organic loading rates (OLR) of 0.032 and 0.018 kgDBO5m-3d-1 and biological organic loading rates (BOLR) of 0,0015 and 0.001 kgDBO5kgSVT- 1d¹, respectively. The decrease in concentration of organic matter in the influent resulted an endogenous state of the biomass in the reactor. The expanded clay was the best support material for biofilm attachment.

Cisternas para armazenamento de água de chuva e efeito na diarreia infantil: um estudo na área rural do semiárido de Minas Gerais / Rainwater cisterns and its effect in children diarrhoea: a study in semi arid rural area at Minas Gerais

O estudo avaliou a prevalência de diarreia em crianças menores de 60 meses, segundo o tipo de abastecimento de água utilizado. Foi conduzido estudo epidemiológico, seguindo o delineamento quase-experimental, com 664 crianças, sendo 332 moradoras de residência que têm cisterna e 332 que utilizam água de outra fonte. A variável dependente foi a ocorrência de diarreia nas últimas 72 horas; as outras informações foram obtidas por meio da aplicação de questionários estruturados. A prevalência total de diarreia foi de 5%, porém sem diferença significativa entre os grupos. As variáveis que explicaram a morbidade foram o grupo, a idade da criança, a ingestão de vitamina ou fortificante, e o local de descarte das fraldas sujas com fezes da criança. Não houve diferença significativa entre os grupos na avaliação da qualidade microbiológica da água, ou seja, o uso de água de chuva pode não ter proporcionado melhorias no acesso à água de melhor qualidade quando comparado com as outras fontes utilizadas. No entanto, há que se considerar falhas nos cuidados, no manuseio e no tratamento da água adotados. Destaca-se a necessidade de melhoria das práticas sanitárias da população do meio rural para que a higiene pessoal, domiciliar e em relação à água consumida sejam incorporadas como hábitos rotineiros.

The present text evaluated the diarrhea prevalence in children under 60 months, according to water supply. An epidemic study was conducted with quasiexperimental design with 664 children, 332 who lived in residence that had cistern and 332 that use water from another source. Diarrhoea occurrence in the last 72 hours was the dependent variable, the others informations were obtained by structured questionnaires. Total diarrhoea prevalence was of 5%, however with no significant difference among the groups. The variables that explained the disease were child's age; if it was taking vitamin and where the dirty diapers with the child's feces were displaced. There were no significant difference among the groups in water microbiological analyses; in other words, the use of rainwater had might not provided improvements in the access of a better quality water supply when compared with the other alternative sources. However, it has to be considered faults in handling and water treatment. It stands out the need of sanitary practices improvement of rural area population, so that personal and home hygiene and in relation to consumed water could be incorporated as routine habits.

Impacto de la ivermectina sobre las geohelmintiasis en el foco de oncocercosis en Colombia / The effect of ivermectin on geohelminth frequency (i.e. as used in the onchocerciasis control program in Colombia)

Objetivo: Evaluar el efecto de la ivermectina sobre la frecuencia de infección por geohelmintos en una población colombiana incluida en el Programa para la Eliminación de la Oncocercosis en las Américas. Métodos: Estudio de evaluación de impacto con enfoque longitudinal como punto referente inicial, la población de Naicioná (1996) y como control, sujetos de la misma población (2008). Para el enfoque transversal se usó como referente la población de Naicioná en 2008 y como control, sujetos de Dos Quebradas en 2008. El procesamiento de las muestras de materia fecal se hizo por Ritchie-Frick modificado. Resultados: Ascaris lumbricoides fue el parásito más frecuente 49,6 % (60/121; IC 95 %:37,8-63,8) en Naicioná y 47,4 % (36/76; IC 95 %: 33,2-65,6) en Dos Quebradas. El mayor efecto de la ivermectina en mayores de 5 años fue la disminución del riesgo de infección, para Trichiuris trichiura, de 86 % (IC95 %:74-93) en la evaluación longitudinal y 63 % (IC 95 %:24-82) en la evaluación transversal. La disminución en la frecuencia de Strongyloides stercoralis fue 93 % (IC 95 %: 45-99), en la evaluación longitudinal y 85 % (IC95 %:-031 - 99) en la evaluación transversal. Conclusiones: El uso de la ivermectina en el contexto del Programa para la Eliminación de la Oncocercosis en las Américas no es suficiente para el control de la morbilidad de todas las geohelmintiasis, se requiere de programas integrales que incluyan los componentes de educación y saneamiento básico.

Objective: Evaluating the effect of ivermectin on soil-transmitted helminthes (STH) infection frequency in a Colombian population included in the Onchocerciasis Elimination Program for the Americas (OEPA). Methods: This was an impact evaluation study which adopted a longitudinal approach using the population of Naicioná (1996) as baseline for comparison to people from the same population as controls (2008). The cross-sectional approach involved comparing the reference population of Naicioná (2008) to the population of Dos Quebradas (2008) used as controls. Fecal samples were processed by a modified Ritchie-Frick method. Results: Ascaris lumbricoides was the most frequently found parasite in Naicioná (60/121; 49.6 %: 37.8-63.895%CI) and in Dos Quebradas (36/76; 47.4 %: 33.2-65.6 95 % CI). Ivermectin’s main effect on the population aged over 5 years was a decreased risk of Trichiuris trichiura infection in both longitudinal assessment (86 % reduction: 74-93 95 % CI) and cross-sectional assessment (63 %:24-82 95 % CI). A 93 % reduction (45-99 95 % CI) in Strongyloides stercoralis frequency was found in longitudinal assessment, compared to 85 % in cross-sectional assessment (-031-99 95 % CI). Conclusions: Ivermectin use in the OEPA is not sufficient for STH morbidity control. Integrated programs including education and basic sanitation are required.

Quality of water for human consumption in rural communities in Bandeirantes – PR / Qualidade da água utilizada para consumo humano de comunidades rurais do município de Bandeirantes

Human consumption water can be obtained from several different sources. One of these sources, the underground source, which due to its low cost, easy perforation and water capitation from the free water-bearing (flat well) is more frequently used in Brazil. The water’s good aspect gives the consumers a purity sensation, what leads them not to treat water, not even for a dis infection process, what would certainly minimize diseases spreading. Microbiologically contaminated water can cause a large variety of diseases. The goal of this study is to evaluate water quality relating PID (Parasite Infectious Diseases) medication consume. There were evaluated 385 water findings from rural communities from the city of Bandeirantes– PR, coming from artesian or flat wells (brute water), it was evaluated also the PID medication consume from Municipal Health Office from Bandeirantes – PR – SUS Drugstore of Bandeirantes – PR. The results have shown that the waters presented high Coliforms sample percentage...

Efficiency of Drinking Water Defluoridation Facilities Used in Rural High Fluoride Areas / 环境与健康杂志

Objective To understand the efficiency of defluoridation facilities used in drinking water defluoridation in the rural high fluoride areas in Tianjin and the sanitary characteristics of treated drinking water. Methods The raw water samples and treated water samples were collected from 4 water stations where the electrodialysis technics was applied and 6 water stations where the reverse osmosis technics was applied and the facilities had been operated for 2-3 years in a county, as well as 3 water stations applied activated aluminium oxide adsorption technics and 2 water stations applied nanofiltration membrane technics in the other counties in Tianjin in 2002-2004. The pH value,turbidity, total dissolved solids, total hardness, fluoride, sulfate, aluminium, in all water samples were determined and evaluated according to the Sanitary Standard for Drinking Water(2001). Results The treated water samples from electrodialysis and reverse osmosis defluoridation facilities showed lower fluoride level(below 1.0 mg/L with fluoride removal rates of 90.01% and 75.32%),and lower total dissolved solids and total hardness levels with removal rates of 75.83%-93.48%. The treated water samples from nanofiltration membrane defluoridation facilities also showed lower fluoride level(below 1.0 mg/L with fluoride removal rates of 75.16%,and lower total dissolved solids and total hardness levels with removal rates of 64.90% and 77.22% respectively. Conclusion The investigated electrodialysis, reverse osmosis and nanofiltration membrane defluoridation facilities show a reliable efficiency and are suitable for application of removal of fluoride in drinking water with different levels of total dissolved solids in the rural high fluoride areas. The effects of defluoridated water produced by reverse osmosis defluoridation facilities on human health need to be studied further more.