Tag Archives: Brazil

Emerging Contaminants in Brazil Drinking and Source Waters

Machado KC, Grassi MT, Vidal C, Pescara IC, Jardim WF, Fernandes AN, Sodré FF, Almeida FV, Santana JS, Canela MC, Nunes CR, Bichinho KM, Severo FJ. A preliminary nationwide survey of the presence of emerging contaminants in drinking and source waters in Brazil. The Science of the total environment. 2016 Aug 2;572:138-146. doi: 10.1016/j.scitotenv.2016.07.210.

This is the first nationwide survey of emerging contaminants in Brazilian waters. One hundred drinking water samples were investigated in 22 Brazilian state capitals. In addition, seven source water samples from two of the most populous regions of the country were evaluated. Samples were collected from June to September of 2011 and again during the same period in 2012. The study covered emerging contaminants of different classes, including hormones, plasticizers, herbicides, triclosan and caffeine. The analytical method for the determination of the compounds was based on solid-phase extraction followed by analysis via liquid chromatography electrospray triple-quadrupole mass spectrometry (LC-MS/MS). Caffeine, triclosan, atrazine, phenolphthalein and bisphenol A were found in at least one of the samples collected in the two sampling campaigns. Caffeine and atrazine were the most frequently detected substances in both drinking and source water. Caffeine concentrations in drinking water ranged from 1.8ngL-1 to values above 2.0μgL-1 while source-water concentrations varied from 40ngL-1 to about 19μgL-1. For atrazine, concentrations were found in the range from 2.0 to 6.0ngL-1 in drinking water and at concentrations of up to 15ngL-1 in source water. The widespread presence of caffeine in samples of treated water is an indication of the presence of domestic sewage in the source water, considering that caffeine is a compound of anthropogenic origin.

Fluoride in Milk, Infant Flormulae, and Soy-Based Products, Brazil

Fluoride in drinking water is also an important source of fluoride exposure in infants.

Nagata ME, Delbem AC, Kondo KY, de Castro LP, Hall KB, Percinoto C, Aguiar SM, Pessan JP. Fluoride concentrations of milk, infant formulae, and soy-based products commercially available in Brazil. J Public Health Dent. 2015 Oct 9. doi: 10.1111/jphd.12121.

OBJECTIVES: To assess the fluoride (F) content in commercially available milk formulae in Brazil and to estimate the F intake in children from this source in the first year of life.

METHODS: Samples of cow’s milk (n = 51), infant formulae (n = 15), powdered milk (n = 13), and soy-based products (n = 4) purchased in Araçatuba (Brazil) had their F content measured using an ion-specific electrode, after hexamethyldisiloxane-facilitated diffusion. Powdered milk and infant formulae were reconstituted with deionized water, while ready-to-drink products were analyzed without any dilution. Using average infant body masses and suggested volumes of formula consumption for infants 1-12 months of age, possible F ingestion per body mass was estimated. Data were analyzed by descriptive analysis.

RESULTS: Mean F content ranged from 0.02 to 2.52 mg/L in all samples. None of the cow’s milk provided F intake higher than 0.07 mg/kg. However, two infant formulae, one powdered milk, and one soy-milk led to a daily F intake above the suggested threshold for fluorosis when reconstituted with deionized water. Assuming reconstitution of products with tap water at 0.7 ppm F, two infant formulae, five powdered milk, and four soymilks led to daily F intake ranging from 0.108 to 0.851 mg/kg.

CONCLUSIONS: The results suggest that the consumption of some brands of infant formulae, powdered milk, and soy-based milk in the first year of age could increase the risk of dental fluorosis, reinforcing the need for periodic surveillance of the F content of foods and beverages typically consumed by young children.

Diarrhea Prevalence High for Indigenous Children in Brazil

BMC Public Health. 2015 Feb 27;15:191. doi: 10.1186/s12889-015-1534-7.
Diarrhea and health inequity among Indigenous children in Brazil: results from the First National Survey of Indigenous People’s Health and Nutrition.
Escobar AL, Coimbra CE Jr, Welch JR, Horta BL, Santos RV, Cardoso AM.

Background: Globally, diarrhea is the second leading cause of death among children under five. In Brazil, mortality due to diarrhea underwent a significant reduction in recent decades principally due to expansion of the primary healthcare network, use of oral rehydration therapy, reduced child undernutrition, and improved access to safe drinking water. The First National Survey of Indigenous People’s Health and Nutrition in Brazil, conducted in 2008-2009, was the first survey based on a nationwide representative sample to study the prevalence of diarrhea and associated factors among Indigenous children in the country.

Methods: The survey assessed the health and nutritional status of Indigenous children < 5 years of age based on a representative sample of major Brazilian geopolitical regions. A stratified probabilistic sampling was carried out for Indigenous villages. Within villages, children < 5 years of age in sampled households were included in the study. Interviews were based on a seven day recall period. Prevalence rates of acute diarrhea were calculated for independent variables and hierarchical multivariable analyses were conducted to assess associations.

Results: Information on diarrhea was obtained for 5,828 children (95.1% of the total sample). The overall prevalence of diarrhea was 23.5%. Regional differences were observed, with the highest rate being in the North (38.1%). Higher risk of diarrhea was observed among younger children and those who had less maternal schooling, lower household socioeconomic status, undernutrition (weight-for-age deficit), presence of another child with diarrhea in the household, and occurrence of upper respiratory infection.

Conclusions: According to results of the First National Survey of Indigenous People’s Health and Nutrition, almost a quarter of Indigenous children throughout the country had diarrhea during the previous week. This prevalence is substantially higher than that documented in 2006 for Brazilian children < 5 years generally (9.4%). Due to its exceedingly multicausal nature, the set of associated variables that remained associated with child diarrhea in the final multivariable model provide an excellent reflection of the diverse social and health inequities faced by Indigenous peoples in contemporary Brazil.

Click here for article (Open Access).

Can Drinking Water Quality be “Governed”? Not really…

I believe this article confuses “access” with “quality”. Access can certainly be opened or closed by government through laws and force. Water quality cannot. Government can impose rules and regulations on people and impose hardships on economies and citizens. But the contaminants in drinking water sources really do not care what government does. Pulling levers of government and society (e.g. taking a Marxist approach to “governing” water quality) by imposing laws and regulations may or may not result in improved water quality. [But it will certainly cause hardship.]

Georgia L. Kayser, Urooj Amjad, Fernanda Dalcanale, Jamie Bartram, Margaret E. Bentley. Drinking water quality governance: A comparative case study of Brazil, Ecuador, and Malawi Environmental Science and Policy April 2015 48:186-195

Human health is greatly affected by inadequate access to sufficient and safe drinking water, especially in low and middle-income countries. Drinking water governance improvements may be one way to better drinking water quality. Over the past decade, many projects and international organizations have been dedicated to water governance; however, water governance in the drinking water sector is understudied and how to improve water governance remains unclear. We analyze drinking water governance challenges in three countries – Brazil, Ecuador, and Malawi – as perceived by government, service providers, and civil society organizations. A mixed methods approach was used: a clustering model was used for country selection and qualitative semi-structured interviews were used with direct observation in data collection. The clustering model integrated political, economic, social and environmental variables that impact water sector performance, to group countries. Brazil, Ecuador and Malawi were selected with the model so as to represent the diversity of the clusters. This comparative case study is important because similar challenges are identified in the drinking water sectors of each country; while, the countries represent diverse socio-economic and political contexts, and the case selection process provides generalizability to our results. We find that access to safe water could be improved if certain water governance challenges were addressed: coordination and data sharing between ministries that deal with drinking water services; monitoring and enforcement of water quality laws; and sufficient technical capacity to improve administrative and technical management of water services at the local level. From an analysis of our field research, we also developed a conceptual framework that identifies policy levers that could be used to influence governance of drinking water quality on national and sub-national levels, and the relationships between these levers.

Dental Fluorosis Not Really That Bad, or is it?

This type of study is done every once and awhile and is intended prop up fluoridation to show that dental flourosis is not really that bad after all.  Cosmetic effects of fluoride (mottling of teeth) can occur in a portion of the population even at low fluoride levels in drinking water. Well, do the cosmetic effects from fluoride in drinking water negatively affect a child’s well being? That child will become an adult. Will it matter then?

Further, this and other studies typically infer that because the investigators did not find a problem using a particular statistical test that there is no problem. Such an inference is based certain assumptions that are not stated but are commonly assumed. It is simply not possible to prove a negative finding.

Moimaz SA, Saliba O, Marques LB, Garbin CA, Saliba NA. Dental fluorosis and its influence on children’s life. Braz Oral Res. 2015;29(1):1-7. doi: 10.1590/1807-3107BOR-2015.vol29.0014.

This study verified the prevalence of dental fluorosis in 12-year-old children and its association with different fluoride levels in the public water supply, and evaluated the level of perception of dental fluorosis by the studied children. To assess fluorosis prevalence, clinical examinations were performed and a structured instrument was used to evaluate the self-perception of fluorosis. The water supply source in the children’s area of residence since birth was used as the study criterion. In total, 496 children were included in the study. Fluorosis was diagnosed in 292 (58.9%) children; from these, 220 (44.4%) children were diagnosed with very mild fluorosis, 59 (11.9%) with mild fluorosis, 12 (2.4%) with moderate fluorosis, and 1 (0.2%) child with severe fluorosis. A significant association (p = 0.0004) was observed between the presence of fluorosis and areas with excessive fluoride in the water supply. Among the 292 children that showed fluorosis, 40% perceived the presence of spots in their teeth. The prevalence of fluorosis was slightly high, and the mildest levels were the most frequently observed. Although most of the children showed fluorosis to various degrees, the majority did not perceive these spots, suggesting that this alteration did not affect their quality of life.

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Litigation as a Method of Advancing Sanitation?

This study raises a number of important issues. The underlying philosophy of this particular publication promotes one particular point of view.

de Barcellos AP. Sanitation Rights, Public Law Litigation, and Inequality: A Case Study from Brazil. Health and Human Rights. 2014 Dec 11;16(2):E35-E46.

Public law litigation has been used in many places to advance human rights related to health. In Brazil, such lawsuits usually request that the government pay for pharmaceuticals to individuals. But could litigation play a role in shaping public health policies to benefit communities? To explore this question, this paper focuses on lawsuits involving determinants of health, namely water and sanitation public policies. This paper discusses the results of an empirical study of 258 Brazilian court orders, issued in a 10-year period, that address requests for sewage collection and treatment. The data show that the Brazilian judiciary is willing to improve access to sanitation services. However, litigation has addressed fewer than 177 out of the 2,495 Brazilian municipalities that lack both sewage collection and treatment systems, and lawsuits are concentrated in the richer cities, not in the poorest ones. This paper suggests that public law litigation can be used to foster public health policies similar to the way in which structural reform litigation and the experimentalism approach between courts and defendants have influenced public policies and achieved institutional reform in schools and prisons. However, greater effort is needed to target initiatives that would reach the most disenfranchised communities.

Diarrhoeal Illness in Households With and Without Cisterns, Brazil

Marcynuk PB, Flint JA, Sargeant JM, Jones-Bitton A, Brito AM, Luna CF, Szilassy E, Thomas MK, Lapa TM, Perez E, Costa AM. Comparison of the burden of diarrhoeal illness among individuals with and without household cisterns in northeast Brazil. BMC Infect Dis. 2013 Feb 4;13:65. doi: 10.1186/1471-2334-13-65.

BACKGROUND: Lack of access to safe and secure water is an international issue recognized by the United Nations. To address this problem, the One Million Cisterns Project was initiated in 2001 in Brazil’s semi-arid region to provide a sustainable source of water to households. The objectives of this study were to determine the 30-day period prevalence of diarrhoea in individuals with and without cisterns and determine symptomology, duration of illness and type of health care sought among those with diarrhoea. A subgroup analysis was also conducted among children less than five years old.

METHODS: A face-to-face survey was conducted between August 20th and September 20th, 2007 in the Agreste Central Region of Pernambuco State, Brazil. Households with and without a cistern that had at least one child under the age of five years were selected using systematic convenient sampling. Differences in health outcomes between groups were assessed using Pearson’s Chi-squared and two-way t-tests. Demographic variables were tested for univariable associations with diarrhoea using logistic regression with random effects. P-values of 0.05 or less were considered statistically significant.

RESULTS: A total of 3679 people from 774 households were included in the analysis (1863 people from 377 households with cisterns and 1816 people from 397 households without cisterns). People from households with a cistern had a significantly lower 30-day period prevalence of diarrhoea (prevalence = 11.0%; 95% CI 9.5-12.4) than people from households without a cistern (prevalence = 18.2%; 95% CI 16.4-20.0). This significant difference was also found in a subgroup analysis of children under five years old; those children with a cistern had a 30-day period prevalence of 15.6% (95% CI 12.3-18.9) versus 26.7% (95% CI 22.8-30.6) in children without a cistern. There were no significant differences between those people with and without cisterns in terms of the types of symptoms, duration of illness and health care sought for diarrhoea.

CONCLUSIONS: Our results indicate that the use of cisterns for drinking water is associated with a decreased occurrence of diarrhoea in this study population. Further research accounting for additional risk factors and preventative factors should be conducted.

Click here for paper (Open Access).