Análise da cobertura de abastecimento e da qualidade da água distribuída em diferentes regiões do Brasil no ano de 2019 / Analysis of the coverage of supply and of the water quality distributed in different regions of Brazil in 2019

Resumo Tendo em vista que a universalização dos serviços de saneamento é uma das metas do Plano Nacional de Saneamento Básico (PLANSAB) e um dos objetivos de desenvolvimento sustentável (ODS), esta pesquisa objetivou-se avaliar a cobertura do abastecimento e a qualidade da água distribuída no Brasil em 2019. Foram utilizados os dados do Sistema Nacional de Informações sobre Saneamento (SNIS) e do Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano (Sisagua). Verificou-se que 82% da população foi atendida por serviços de água, sendo este percentual ainda menor considerando apenas a região Norte (58%) e Nordeste (74%). A maioria da população é atendida por Sistemas de Abastecimento de Água (SAA); entretanto, na região Norte, 6,6% da população é atendida por SAA e 7,2% por Solução Alternativa Coletiva (SAC) sem tratamentos. Para o parâmetro Coliformes totais, 21,9% das amostras de SAC da região Norte estavam fora do padrão de potabilidade, enquanto para o residual de agente desinfetante, 40,6% de SAA da região Nordeste encontravam-se fora do padrão, sendo que deste total 19% das amostras apresentavam concentração do agente desinfetante acima de 5,0 mg/L e 81% das amostras apresentavam concentrações menores que 0,2 mg/L. Conclui-se que parte da população pode estar vulnerável aos riscos relacionados à qualidade da água.

Abstract Bearing in mind that universal access to sanitation services is one of the objectives of the Brazilian Plan for Basic Sanitation and one of the sustainable development goals (SDG), this research sought to evaluate the coverage of supply and of the quality of water distributed in Brazil in 2019. Data from the National Sanitation Information System (SNIS) and Water Quality for Human Consumption Surveillance Information System (Sisagua) databases were evaluated. It was found that 82% of the population has access to Water Supply Systems (WSS), this percentage only being lower in the North (58%) and Northeast (74%) regions. Most of the population is served by WSS; however, in the North region, 6.6% of the population is served by WSS and 7.2% by Collective Alternative Solution (CAS) without treatment. For the Total Coliforms parameter, 21.9% of CAS samples from the North region were outside the potability standard, while for the residual disinfectant agent, 40.6% of WSS from the Northeast region was outside this standard (with 19% of the samples having a concentration of the disinfectant agent above 5.0 mg/L, and 81% of the samples presenting concentration lower than 0.2 mg/L. The conclusion drawn is that part of the population may be vulnerable to water quality-related risks.

Environmental health effects associated with recycling of sewage for potable purposes: a literature review

This literature review has been drafted to explore and emphasise the potential environmental health risks and benefits of recycling wastewater especially in areas affected by prolonged drought. With limited water resources, recycled treated sewage water can be used to augment the fresh water supply. This review will provide an understanding of the importance of water recycling and the environmental impacts recycling can have on the environment. A comparison is also provided to understand the environmental effects of untreated sewage on the environment and the potential benefits associated with the recycling. Public health aspect is also elaborated to highlight whether recycled treated sewage is a viable option to be considered for the use as potable water. Literature suggests that recycled treated water has a purifying effect on the environment and can be used for potable and non-potable purposes.

Physicochemical and Microbiological Assessments of Newly Dug Borehole Water Sources in Rafi Local Government, Minna, Niger State

The quality of potable water depends not only on its physical and chemical characteristics but also on its biological characteristics. Potable water is often sourced from surface water, mainly rivers, streams, lakes and groundwater - boreholes and wells; of which boreholes are supposedly superior. In the present study, the physicochemical and microbiological status of six newly drilled boreholes in Rafi Local Government Area, Minna, Niger State was assessed. Twenty-two physicochemical parameters and coliform count were determined. Water samples were collected from newly drilled borehole water sources in Tsofomension 1, TsofoMension 2, Katako, Tunga Bako, Kagara and Kwana. The colour, odour, taste, temperature, turbidity, conductivity, pH, chloride and copper ions were within acceptable limits. Iron and manganese content of the three regions were highly elevated above the recommended level. It is of concern that the level of hydrogen sulphide (0.2 - 0.27) was far above the permissible level (0.05), being newly drilled sources of water. Only one of the studied boreholes was free of both total and faecal coliforms, other boreholes were contaminated with either total or faecal coliforms or both. The findings in this study necessitate a call for increased hygiene and construction of lined soak-away to eradicate indiscriminate discharge of human and animal wastes. Appropriate water treatment methods such as coagulation, filtration and boiling of water should be encouraged. Most importantly, newly dug water sources should be tested, monitored and elaborately treated before consumption.

Assessment of drinking water in a rural area of Patna (Bihar) with special reference to human health

Water quality of rural area of Patna was studied. The water samples from rural area of Patna were collected to assess the quality of potable water. A laboratory test was conducted for assessment of water quality. The physico-chemical and bacteriological parameters were studied. The results obtained were compared with WHO/ICMR standard. Results showed high TDS, hardness at some locations and coliform counts were high at some sampling sites. Conductivity increases with increase of hardness of water. The pH of drinking water samples were followed by the standards recommended by the ICMR or WHO. TDS of water samples showed wide range of variations. Hard water is responsible for cardiovascular diseases. Such quality of water can cause various diseases like diarrhoea, jaundice, typhoid, dysentery etc.

Community-acquired Legionnaires’ Disease in a Newly Constructed Apartment Building / 예방의학회지

OBJECTIVES: Legionnaires' disease (LD) is a severe type of pneumonia caused by inhalation of aerosols contaminated with Legionella. On September 22, 2016, a single case of LD was reported from a newly built apartment building in Gyeonggi province. This article describes an epidemiologic investigation of LD and identification of the possible source of infection. METHODS: To identify the source of LD, we interviewed the patient's husband using a questionnaire based on the Legionella management guidelines from the Korea Centers for Disease Control and Prevention. Water samples from the site were collected and analyzed. An epidemiological investigation of the residents and visitors in the apartment building was conducted for 14 days before the index patient's symptoms first appeared to 14 days after the implementation of environmental control measures. RESULTS: Legionella pneumophila serogroup 1 was isolated from the heated-water samples from the patient's residence and the basement of the apartment complex. Thirty-two suspected cases were reported from the apartment building during the surveillance period, yet all were confirmed negative based on urinary antigen tests. CONCLUSIONS: The likely source of infection was the building's potable water, particularly heated water. Further study of effective monitoring systems in heated potable water should be considered.

Protective role of diet supplements Spirulina and Tamarind fruit pulp on kidney in sodium fluoride exposed Swiss albino mice: Histological and biochemical indices.

Fluoride toxicity through potable water, particularly ground water, is not uncommon in countries such as India, China, Iran, Iraq, Turkey, parts of Africa and Afghanistan. Kidney being the main organ involved in fluoride removal, it accumulates considerable amount of fluoride. Here, we report toxic effects of oral exposure of Swiss albino mice to fluoride (sub-acute: 190 mg/kg body wt. for 7days; and sub-chronic: 94 mg/kg body wt. for 90 days) and recovery of sub-chronic fluoride exposed mice after 90 days of sodium fluoride (NaF) withdrawal. The role of diet supplements (Spirulina and tamarind fruit pulp @ 230 mg/kg body wt. independently as well as in combination) in amelioration of fluoride toxicity has also been screened. Compared with controls, feed intake decreased from 3-43%, body wt. 4-18%, and kidney wt. 5-12% in treated mice (except diet supplement groups of sub-chronic exposure) while their water intake increased from 4-43%. Histopathological changes in the cortical region of kidney in fluoride treated mice were as follows: dilation of bowman’s capsule and thickening of its parietal and visceral layer; alterations in glomeruli size and their sclerotization; increase in bowman’s space; proliferation of mesangial cells; reduction in podocyte counts; and dilation of proximal and distal tubules. Fluoride exposure altered tissue biochemistry (protein, acid phosphatase and alkaline phosphatase content) and increased urea (23-58%) and creatinine content (14-127%) in the serum. Sub-acute exposure was found more toxic. The diet modulation not only reduced fluoride toxicity but also led to better recovery of treated mice after withdrawal, especially in combination.

Relación entre la presencia de colifagos en agua para consumo humano, las lluvias y las diarreas agudas en Costa Rica / Relation between coliphages presence in drinking water, rain and acute diarrhea in Costa Rica

ResumenLa calidad del agua de consumo es una de las preocupaciones más grandes a las que se enfrentan los entes de salud. En Costa Rica, a pesar de la buena calidad de las fuentes de agua y del agua de consumo, se siguen registrando numerosos casos de diarrea anualmente. En este estudio se realizó un análisis de indicadores de contaminación virales y bacterianos, en dos comunidades del Valle Central con acueducto propio. Se analizaron en total 24 muestras de agua por cada comunidad, durante un año, 12 en la fuente de agua y 12 en el agua tratada. La frecuencia de diarreas en cada comunidad fue comparada con la calidad microbiológica del agua consumida, encontrándose ausencia de indicadores bacterianos en muestras de agua tratada, mientras que la presencia de indicadores virales en el agua de consumo (con cloro residual) se relaciona con un incremento en el número de casos de diarreas, adicionalmente se analizó el comportamiento de las diarreas de acuerdo a la precipitación promedio con el fin de observar posibles patrones de estacionalidad. Estos hallazgos respaldan la necesidad de ampliar el monitoreo de calidad microbiológica del agua con otro tipo de indicadores de contaminación que correlacionen mejor con otros agentes patógenos de transmisión hídrica, principalmente en época seca, periodo en que se observan más casos de diarrea.

AbstractThe quality of potable water is one of the most important issues of public health. In Costa Rica, in spite of having good sources of water and good quality of water for consumption, there continues to be a significant number of diarrhea cases annually. In this investigation, viral and bacterial analyses of indicators of contamination were conducted in two rural communities with their own aqueducts in the Central Valley of Costa Rica. Twenty-four samples were taken from each community during the year; 12 from the water sources and 12 from the treated waters. The frequency of diarrhea in each community was compared to the microbiological quality of the water being consumed, noting an absence of bacterial indicators in samples of treated water, while the presence of viral indicators in the water (with residual chlorine) were associated with an incremental increase in the number of cases of diarrhea. The analysis also included measurements of average monthly rainfall with the aim of observing possible associations between seasonal conditions and the incidence of diarrhea cases. These findings indicate the need to increase the monitoring of the microbiological quality of the water with other types of indicators of contamination that correlate better with other pathogens transmitted by water, especially in the dry seasons when a greater number of cases of diarrhea are observed.

Estudo da Qualidade das Águas Adicionadas de Sais Produzidas no Estado Do Ceará / Study on the Quality of Salt-Added Water Produced In the State of Ceará, Brazil

Avaliar a qualidade da água bruta utilizada comomatéria-prima e água envasada, obtida de indústriasprodutoras de Águas Adicionadas de Sais no Estado doCeará. Material e Métodos: Foram coletadas 270 amostrasamostras, em quinze empresas. Foram realizadas análisesmicrobiológicas de determinação de coliformes totais eEscherichia coli; Enterococcus, Pseudomonas aeruginosa,Clostridium perfringens; bactérias heterotróficas e análisesfísico-químicas de determinação de nitrato, nitrito; clororesidual e pH. Resultados: Verificou-se que a água bruta emonze (73,33%), das quinze empresas, não atendeu aospadrões de potabilidade da água para consumo humano.Com relação à água envasada constatou-se que quatorze(93,33%) empresas, não atenderam aos parâmetrosmicrobiológicos e físico-químicos para água mineral naturale água para consumo humano. Conclusao: A maioria dasamostras analisadas neste estudo nao atenderam aospadrões de potabilidade de água para consumo humano, deacordo com a legislação vigente. Dessa forma, se faznecessária a atualização da legislação sanitária da águaadicionada de sais envasada, visando à prevenção de danosà saúde da população...

To evaluate the quality of raw water used as rawmaterial and bottled water, obtained from “salt-added water”companies in the state of Ceará, Brazil. Material andMethods: A total of 270 samples of fifteen brands werecollected. Microbiological analyses were performed in orderto determine the countings of total coliforms and Escherichiacoli; Enterococcus, Pseudomonas aeruginosa, Clostridiumperfringens; and heterotrophic bactéria. Physicochemicalanalyses were performed to determine the product’s levelsof nitrate, nitrite, residual chlorine, and pH. Results: In eleven(73.33%) of the fifteen brands, the raw water did not meetthe standards for potable water for human consumption.With respect to bottled water, it was found that fourteen(93.33%) brands did not meet the microbiological and physicochemicalparameters for natural mineral water and water forhuman consumption. Conclusion: Most of the samplesanalyzed in this study did not meet the water potabilitystandards for human consumption. Thus, it is necessary toupdate the health legislation on salt-added bottled water, inorder to avoid damages to people’s health...

Qualidade da água para consumo humano e concentração de fluoreto / Drinking water quality and fluoride concentration / Calidad del agua para consumo humano y concentración de fluoruro

O artigo visa analisar a concentração de fluoreto na água para consumo humano, considerando o balanço entre benefícios e riscos à saúde, e produzir subsídios para atualização da legislação brasileira. Estudos de revisão sistemática, documentos oficiais e dados meteorológicos foram examinados. As temperaturas nas capitais brasileiras indicam que o fluoreto deveria variar de 0,6 a 0,9 mg/L para prevenir cárie dentária. Concentração de fluoreto natural de 1,5 mg/L é tolerável para consumo no Brasil se não houver tecnologia de custo-benefício aceitável para ajuste/remoção do seu excesso. A ingestão diária de água com fluoreto em concentração > 0,9 mg/L representa risco à dentição em menores de oito anos de idade e os consumidores deveriam ser expressamente informados desse risco. Considerando a expansão do programa nacional de fluoretação da água para regiões de clima tipicamente tropical, deve-se revisar a Portaria 635/75, relacionada ao fluoreto adicionado às águas de abastecimento público.

This paper aimed to analyze the fluoride concentration in drinking water, taking into account the balance between the benefits and risks to health, in order to produce scientific backing for the updating of the Brazilian legislation. Systematic reviews studies, official documents and meteorological data were examined. The temperatures in Brazilian state capitals indicate that fluoride levels should be between 0.6 and 0.9 mg F/l in order to prevent dental caries. Natural fluoride concentration of 1.5 mg F/l is tolerated for consumption in Brazil if there is no technology with an acceptable cost-benefit ratio for adjusting/removing the excess. Daily intake of water with a fluoride concentration > 0.9 mg F/l presents a risk to the dentition among children under the age of eight years, and consumers should be explicitly informed of this risk. In view of the expansion of the Brazilian water fluoridation program to regions with a typically tropical climate, Ordinance 635/75 relating to fluoride added to the public water supply should be revised.

El artículo busca analizar la concentración de fluoruro en el agua para consumo humano considerando el balance entre beneficios y riesgos a la salud y producir subsidios para actualización de la legislación brasileña. Estudios de revisión sistemática, documentos oficiales y datos meteorológicos fueron examinados. Las temperaturas en las capitales brasileñas indican que el fluoruro debería variar de 0,6 a 0,9 mg/L para prevenir caries dentaria. Concentración de fluoruro natural de 1,5 mg/L es tolerable para consumo en Brasil si no hay tecnología de costo-beneficio aceptable para ajuste/remoción de su exceso. La ingestión diaria de agua con fluoruro en concentración > 0,9mg/L representa riesgo para la dentición en menores de ocho años de edad y los consumidores deberían ser expresamente informados de este riesgo. Considerando la expansión del programa nacional de fluorificación del agua para regiones de clima típicamente tropical se debe revisar el Documento Público 635/75, relacionado con el fluoruro adicionado a las aguas de abastecimiento público.

Impacto do uso da água de cisternas na ocorrência de episódios diarréicos na população rural do agreste central de Pernambuco, Brasil / The impact of the use of water from water-tanks on the occurrence of diarrhea in the rural population of the Central Agreste region of the Brazilian State of Pernambuco

OBJETIVOS: avaliar o impacto do uso da água de cisternas na ocorrência de episódios diarréicos comparando o número e a duração de episódios entre moradores de domicílios com e sem cisternas, numa mesma área geográfica. MÉTODOS: estudo longitudinal prospectivo aninhado a um estudo de corte transversal com dois grupos de comparação (domicílios com e sem cisternas) realizado, em 21 municípios do Agreste Central de Pernambuco, em 2007. O período de coleta foi de 60 dias, e incluiu 1765 indivíduos. Para análise descritiva utilizou-se modelos mistos hierárquicos, Mann-Whitney e Kaplan-Meyer com nível de significância de 5 por cento. RESULTADOS: entre os 949 indivíduos com cisternas, obteve-se uma redução no risco de ocorrência de episódios diarréicos de 73 por cento quando comparados aos 816 indivíduos sem cisternas (RR=0,27; p<0.001). O número médio de episódios registrados nos residentes de domicílios sem cisternas foi de 0,48 (DP=1,17), contra 0,08 (DP=0,32) nos domicílios com cisternas(z=-10,26; p<0,001). A duração média dos episódios foi 1,5 vezes maior nos domicílios sem cisternas (χ²=8,99; p=0,003). CONCLUSÕES: os achados deste estudo destacam a importância do acesso à água potável na redução de doenças. A ocorrência de diarréia, bem como, seus indicadores de gravidade - número de episódios e duração da diarréia foram consistentemente maiores nos residentes de domicílios sem cisternas.

OBJECTIVES: to evaluate the impact of the use of water-tanks on the occurrence of episodes of diarrhea, comparing the number and duration of episodes among the residents of households with and without water-tanks in the same geographical area. METHODS: a longitudinal prospective study, nested in a cross-section study comparing two groups (households with and without water-tanks), was carried out in 21 municipalities in the Central Agreste region of the Brazilian State of Pernambuco, in 2007. Data was gathered over 60 days and included 1,765 individuals. Descriptive analysis was carried out using mixed hierarchical models, Mann-Whitney and Kaplan-Meyer with the level of significance set at 5 percent. RESULTS: among the 949 individuals with water-tanks, there was a reduction in the risk of the occurrence of episodes of diarrhea of 73 percent compared with the 816 individuals without water-tanks (RR=0.27; p<0.001). The mean number of episodes registered among residents of households without water-tanks was 0.48 (SC=1.17), compared with 0.08 (SC=0.32) among households with water-tanks (z=-10.26; p<0.001). The mean during of episodes was 1.5 times greater in households without water-tanks (χ2=8.99; p=0.003). CONCLUSIONS: the findings of this study point to the importance of access to drinking water for the reduction of disease. The occurrence of diarrhea and its concomitant severity indicators-number of episodes and duration-were consistently higher among residents of households without water-tanks.

Análise da concentração de flúor na água em Curitiba, Brasil: comparação entre técnicas / Analysis of water fluoride concentration in Curitiba, Brazil: comparison of techniques

OBJETIVO: Avaliar a adequação dos níveis de fluoreto nas águas de abastecimento público em Curitiba, Estado do Paraná, Brasil, de acordo com duas técnicas (SPADNS e eletrométrica). MÉTODOS: Foram levantados os dados do heterocontrole na Cidade de Curitiba de janeiro de 2000 a julho de 2008 no banco de dados da Secretaria Municipal da Saúde para cálculo das médias anuais. Na sequência, foram comparadas as concentrações de fluoreto fornecidas pela companhia de saneamento SANEPAR (técnica eletrométrica) com as concentrações obtidas pelo heterocontrole (SPADNS) em 1 470 amostras de água coletadas e analisadas entre 2006 e 2007. Foi calculada a proporção de amostras dentro do padrão ideal de fluoretação para a Cidade (0,8 ppmF), abaixo do ideal e acima do ideal para ambas as metodologias. Foram exploradas diferenças na fluoretação entre distritos sanitários, meses do período dezembro de 2007 a julho de 2008 e estações de tratamento de água (ETA). RESULTADOS: A média geral de flúor entre 2000 a 2008 foi de 0,7 ppmF conforme os dados do heterocontrole. A comparação das técnicas eletrométrica e SPADNS revelou que o valor médio de fluoreto na água é maior quando avaliado pela técnica eletrométrica (0,743 ppmF ± 0,133) quando comparado com a técnica SPADNS (0,637 ppmF ± 0,164). A proporção de amostras dentro do padrão ideal de fluoretação foi de 15,05 por cento para SPADNS e 63,97 por cento para eletrométrica; de 62,03 e 22,85 por cento para amostras abaixo do ideal; e de 21,10 e 13,18 por cento para amostras acima do ideal, respectivamente. Houve diferença estatisticamente significativa na fluoretação entre os distritos sanitários (P < 0,001) e os meses pesquisados. CONCLUSÕES: A escolha da técnica analítica interfere significativamente no processo do heterocontrole. O heterocontrole deve utilizar a mesma técnica de determinação de flúor utilizada pela empresa de tratamento de água. Novos estudos devem definir qual técnica é a mais adequada para medir o teor de flúor.

OBJECTIVE: To evaluate the adequacy of fluoride levels in the public water system in Curitiba, state of Paraná, Brazil, as determined by two techniques (colorimetric and electrometric). METHODS: Data from independent measurements of fluoride in the public water system in Curitiba routinely performed by the city government were obtained for the period between January 2000 and July 2008. Mean levels of fluoride concentration were calculated for each of these years. After that, fluoride concentrations measured in 1 470 samples by the state water utility (SANEPAR) using the electrometric technique in 2006 and 2007 were compared with the corresponding levels measured by the city using the colorimetric method. The rate of samples meeting the standard for the city (0.8 ppmF), and below and above the standard, was calculated for both methods. Fluoride levels were compared between sanitary districts, months for the period between December 2007 and July 2008, and water treatment facilities. RESULTS: The overall mean fluoride level between 2000 and 2008 was 0.7 ppmF based on the independent measurements. The comparison between techniques showed a higher mean fluoride level with the electrometric technique (0.743 ppmF ± 0.133) vs. the colorimetric technique (0.637 ppmF ± 0.164). The rate of samples meeting the ideal standard of 0.8 ppmF was 15.05 percent for the colorimetric and 63.97 percent for the electrometric technique; 62.03 percent and 22.85 percent of the samples were below that standard and 21.10 percent and 13.18 percent were above that standard, respectively. Fluoride levels were statistically significant (P < 0.001) for the comparison between sanitary districts and months. CONCLUSIONS: The choice of technique significantly influences the resulting levels of fluoride. Independent monitoring of fluoride levels should employ the same technique used by the water utility. Further studies should aim at defining which technique is the most adequate to determine fluoride concentration in public water systems.

Criticisms of chlorination: social determinants of drinking water beliefs and practices among the Tz'utujil Maya / Críticas a la cloración: factores sociales determinantes de las creencias y prácticas con respecto al agua potable de la población Maya Tz'utujil

OBJECTIVE: To explore social determinants of drinking water beliefs and practices among the Tz'utujil Maya of Santiago Atitlán, Guatemala, through analysis of demographics, socioeconomic status, memory of historical events, sensory experience, and water attitudes. METHODS: Parallel mixed (qualitative and quantitative) methods, including participant observation, in-depth interviews based on a purposive sample, and 201 semi-structured interviews based on a regional quota sample, were used to collect data from March 2007 to August 2008. Data analysis included the use of grounded theory methodology and Pearson's chi-square test for independence. RESULTS: Qualitative results based on grounded theory highlighted how memory of the Guatemalan Civil War and Hurricane Stan, attitudes about Lake Atitlán water, and the taste and smell of chlorine influenced Tz'utujil Maya drinking water beliefs. Quantitative survey results revealed that differences in ethnicity, literacy, years of schooling, distrust of the water supply during the Civil War and Hurricane Stan, and current beliefs about Lake Atitlán and tap water quality were associated with significantly different water self-treatment practices. CONCLUSIONS: In accordance with social determinants of health paradigms, demographic, socioeconomic, social, cultural, political, and historical factors continue to be significant determinants of water-related health. Public health water interventions must address inequalities related to these underlying factors in order to achieve maximum effectiveness.

OBJETIVO: Explorar los factores sociales determinantes de las creencias y prácticas con respecto al agua potable de la población maya tz'utujil, que habita en Santiago Atitlán (Guatemala), mediante el análisis de la información demográfica, la situación socioeconómica, la memoria de hechos históricos, la experiencia sensorial y las actitudes con respecto al agua. MÉTODOS: De marzo del 2007 a agosto del 2008, se recopilaron datos por medio de métodos paralelos mixtos (tanto cualitativos como cuantitativos), como la observación de participantes, entrevistas en profundidad basadas en un muestreo intencionado y 201 entrevistas semiestructuradas basadas en un muestreo por cuota regional. En el análisis de los datos se usó el método de la teoría fundamentada o muestreo teórico y la prueba de la chi al cuadrado de Pearson para la independencia. RESULTADOS: Los resultados cualitativos basados en la teoría fundamentada pusieron de relieve que los recuerdos de la guerra civil guatemalteca y del huracán Stan, las actitudes acerca del agua del Lago Atitlán, y el gusto y el olor del cloro influían las creencias de los tz'utujiles con respecto al agua potable. Los resultados cuantitativos de la encuesta indicaron que las diferencias a raíz del grupo étnico, el alfabetismo, los años de escolaridad, la desconfianza del abastecimiento de agua durante la guerra civil y el huracán Stan, y las creencias actuales acerca de la calidad del agua del Lago Atitlán y del agua de grifo estaban asociadas con prácticas de autotratamiento del agua sumamente diferentes. CONCLUSIONES: En consonancia con el paradigma de los factores sociales determinantes de la salud, los factores demográficos, socioeconómicos, sociales, culturales, políticos e históricos siguen siendo determinantes significativos de la salud en relación con el agua. Para que puedan lograr la mayor eficacia posible, las intervenciones de salud pública con respecto al agua deben abordar las desigualdades relacionadas con estos factores fundamentales.

Avaliação de solução à base de NaOCl 0, 2% na desinfecção das tubulações de água dos equipos odontológicos / Evaluation of NaOCl 0. 2% solution for disinfection of dental equipment waterlines

Objetivo: Avaliar o efeito do hipoclorito de sódio a 0,2% na desinfecção da tubulações de água de equipos odontológicos, previamente contaminadas. Método: Foram obtidas amostras de água dos reservatórios, das mangueiras que suprem as turbinas de alta-rotação e das seringas tríplice de 34 equipos com tubulações desinfetadas com hipoclorito de sódio a 0,2% e de 31 equipos do grupo controle. As amostras foram semeadas em "Plate Count Agar" (ACOMIDIA®) e incubadas em aerobiose a 35oC, durante 48 horas, para avaliar a presença e contagem das unidades formadoras de colônias (UFC) de bactérias heterotróficas por mililitro de água.Utilizou-se como parâmetro para a avaliação das amostras as normatizações do Ministério da Saúde referentes à presença dessas bactérias na água de consumo para humanos. Foram comparados os níveis de contaminação da água dos diversos pontos de coleta e entre os equipos com e sem sistema de desinfecção, através do teste qui-quadrado de Pearson com significância de 5%. Resultados: Nos equipos que sofreram desinfecção das tubulações de água, as amostras estavam contaminadas em 41,2% dos reservatórios, 67,7% das mangueiras alta-rotação e 64,7% das seringas tríplices. Não houve diferença significativa na contaminação entre os diversos pontos de coleta e entre os equipamentos com e sem sistema de desinfecção (p maior que 0,05). Conclusão: O método proposto foi ineficaz na desinfecção das tubulações de água de equipos odontológicos, previamente contaminadas. Com base nos resultados obtidos, sugere-se novos estudos para o desenvolvimento de um protocolo padrão para a desinfecção das tubulações de água de equipos odontológicos.

Objective: To evaluate a method that uses 0.2% sodium hypochlorite as disinfectant agent for disinfection of dental equipment waterlines. Method: Water samples were obtained from different sources, which include: water reservoirs, high-speed turbine supply hoses, triple syringe pipes of 34 devices disinfected with 0.2% sodium hypochlorite, and 31 dental equipment units in the control group. The samples were plated onto plate count agar (ACOMIDIA®) and incubated aerobically at 35oC for 48 hours to assess the presence and counting of colony forming units (CFU) of heterotrophic bacteria per milliliter of water. The regulations of the Ministry of Health were used as parameter to assess the presence of heterotrophic bacteria in drinking water for humans. Comparison of the water contamination levels was performed between the various collection points and between the different devices with and without disinfection system, using the chi-square test at 0.05 significance level. Results: Dental equipment disinfected with 0.2% sodium hypochlorite showed contamination in 41.2% of the reservoirs, 67.7% of high-speed handpiece waterlines and 64.7% of air/water syringes. There was no significant difference between contamination of the various collection points, and between the different equipments with and without disinfection system (p greater than 0.05). Conclusion: The proposed method was ineffective in disinfecting previously contaminated dental equipment waterlines. Based on the results, further studies are suggested to develop a standard protocol for the disinfection of dental equipment waterlines.

Correlación entre agua y saneamiento e indicadores de salus y desarrollo 2008: Costa Rica en el mundo / Correlation between potable water, sanitation and development health indicators 2008: Costa Rica in the world

Describir las coberturas con las diferentes modalidades de acceso a agua para consumo humano y disposición adecuada de excretas, definidas en los conceptos de fuentes de agua potable mejoradas e instalaciones de saneamiento mejoradas, en 147 países del mundo, y su relación con los indicadores básicos de salud y desarrollo. Por otro lado, se busca ubicar a Costa Rica en el contexto mundial durante el año 2008 en estos aspectos. Método: los datos se obtuvieron de documentos publicados por la Organización Mundial de la Salud y el Programa de las Naciones Unidas para la Infancia. Se realizaron análisis de correlación lineal, al 95 por ciento de confianza, entre los datos, para determinar la asociación entre los respectivos pares de variables; además, se establecieron escalafones o ranking de acceso a los diferentes tipos de coberturas, para identificar la ubicación de nuestro país en cada una de ellas. Conclusiones: los resultados demuestran que las variables de acceso a fuentes de agua potable mejoradas total e instalaciones de saneamiento mejoradas, explican mejor los avances de las naciones en los indicadores básicos de salud y desarrollo

Corrosión e incrustaciones en los sistemas de distribución de agua potable: Revisión de las estrategias de control / Corrosion and incrustations in the drinking water distribution systems: Review of control strategies

La presente revisión tuvo como propósito analizar las estrategias para el control de la contaminación debida a la formación de la corrosión e incrustaciones, basado en los factores que afectan el deterioro de los sistemas de distribución de agua potable, así como, su influencia sobre la calidad del agua suministrada al consumidor. Los sistemas de distribución pueden afectar la calidad del agua potable debido a las condiciones de la tubería y a la operación del sistema. La corrosión, las incrustaciones y los depósitos en la red de distribución, son otros de los problemas con mayor importancia en la industria del agua potable; esto puede afectar a la salud, la aceptación pública del suministro de agua y el costo de proveer un agua digna de confianza. Se concluye y se recomienda que como estrategias para controlar la corrosión y la formación de incrustaciones se deben seleccionar apropiadamente los materiales y el diseño del sistema, realizar el tratamiento químico adecuado (ajuste de pH, alcalinidad, oxigeno, uso de inhibidores de corrosión) y usar revestimientos y pinturas resistentes a la corrosión para proteger las paredes de las tuberías.

The aim of this review was to analyze control strategies of contamination caused by the formation of corrosion and incrustations based on factors affecting deterioration of distribution systems of potable water as well as its influence on the quality of water supplied to the consumer. Distribution systems can affect the quality of drinking water due to the conditions of the pipes and the system’s operation. Corrosion, incrustations, and deposits in the distribution network major problems in the drinking water industry. These may affect health, public acceptance of the water supply and the cost of supplying reliable water. We conclude and recommend that, in order to control corrosion and the formation of incrustations, one must select appropriate materials and a sound system design, apply proper chemical treatment (adjusting pH, alkalinity, oxygen, the use of corrosion inhibitors) and use coatings and paints resistant to corrosion in order to protect the walls of the pipes.

Comportamento da diarréia infantil antes e após consumo de água pluvial em município do semi-árido brasileiro / Behavior of childhood diarrhea before and after consumption of rainwater in the city of semi-arid of Brazil / Comportamiento de la diarrea infantil antes y después del consumo del agua de la lluvia en una ciudad brasileña de región semi-árida

Objetivou-se investigar a correlação entre consumo de água das cisternas e comportamento da diarréia infantil. Estudo quantitativo, transversal, realizado em Canindé-CE, com 56 famílias. As principais fontes de água utilizadas antes da construção das cisternas foram cacimbão (21-37,5 por cento) e açude (17-30,4 por cento). Verificou-se correlação linear, inversamente proporcional e estatisticamente significante, entre a taxa de diarréia infantil e o número de cisternas construídas por ano (r=-0,943; p=0,001). A cloração foi o principal tipo de tratamento da água, antes (46-82,1 por cento) e depois (37-66 por cento) da aquisição das cisternas, porém com diluição incorreta (41-89,2 por cento). As cisternas de captação de água pluvial refletiram na melhoria da saúde infantil na região, contudo a população ainda necessita melhorar as medidas de tratamento da água consumida.

Aimed to investigate the correlation between water tanks and infant diarrhea. Quantitative and transversal study, held in Canindé-CE, Brazil, with 56 families. The main sources of water used before the construction of tanks were "cacimbão" (21-37.5 percent) and dam (17-30.4 percent). There was a linear inverse correlation and relation statistically significant between the rates of infant diarrhea and the number of tanks built (r =-0.943; p=0.001). Chlorination was the main type of water treatment before (46-82,1 percent) and after (37-66 percent) of the acquisition of the tank, but with incorrect dilution (41-89,2 percent). Tanks to capture rainwater reflected in an improvement of child health in the region, but people still need to improve the treatment steps of water to be consumed.

El estudio tuvo como objetivo investigar la correlación entre el consumo de agua de los tanques y el comportamiento de la diarrea infantil. Es un estudio cuantitativo, transversal, realizado en Canindé-CE, Brasil, con 56 familias. Las principales fuentes de agua utilizadas antes de la construcción de los tanques, fueron "cacimbão" (21-37,5 por ciento) y presa (17-30,4 por ciento). Se verificó una correlación linear inversa y estadísticamente significativa entre las tasas de diarrea infantil y el número de tanques construidos por año (r= -0,943; p=0,001) y estadísticamente significativa (p= 0,001). La cloración fue el principal tratamiento del agua antes (46-82,1 por ciento) y después (37-66 por ciento) de la adquisición del tanque, pero con dilución incorrecta (41-89,2 por ciento). El uso de las cisternas para captar el agua de la lluvia se refleja en la mejora de la salud infantil en la región, sin embargo, las personas todavía necesitan mejorar las medidas para el tratamiento del agua potable.

Cárie dentária e fluorose em município na Região Norte sem água fluoretada / Dental cavity and fluorosis in a city of the North Region without fluorinated water

Introdução: Manaus não apresenta fluoretos na água de abastecimento público, mesmo sendo a oitava cidade mais populosa do Brasil. Objetivo: O objetivo neste trabalho foi conhecer as condições de saúde bucal de escolares aos 12 anos de idade, em relação à cárie dentária, nesse município de grande porte sem fluoretação da água de abastecimento público, no ano de 2003. Métodos: Os dados neste estudo foram obtidos do Projeto SB Brasil (MS) de 2003. Foi aplicada uma técnica de amostragem por conglomerados em três estágios que permitiu a produção de inferências para cada uma das macrorregiões brasileiras, por porte do município e para cada idade ou grupo etário. Foram examinadas 102 crianças de 12 anos das escolas públicas de Manaus. Resultados: O CPOD em Manaus (2003) foi 3,20. Conclusão: Portanto, atingir a meta para o ano de 2010 de CPOD menor que 1,0 está distante da real condição do Município de Manaus.

Introduction: Manaus has no fluoride in public water supply, even though is the eighth most populated city in Brazil. Objective: The aim in this paper was to know the oral health status of the 12-year-old scholars in relation to dental caries, in this large city without fluoridation of public water supply in the year 2003. Methods: The data of this study were obtained from the SB Brazil Project (MS) 2003. It was applied a technique of cluster sampling in three stages that allowed the production of inferences for each of the Brazilian regions, by size of municipality and for each age or age group. We examined 102 school children (12 years), from public schools in Manaus. The CPO-D in Manaus (2003) was 3.20. Conclusion: Therefore, the target for the year 2010 of a CPOD less than 1.0 is distant from the real condition of the city of Manaus.

Contaminación del agua en fuentes cercanas a campos petrolíferos de Bolivia / Water pollution in sources close to oil-producing fields of Bolivia

OBJETIVO: Determinar las concentraciones de compuestos petroquímicos en las fuentes de agua de consumo para comunidades cercanas a campos petrolíferos del Chaco Boliviano. MÉTODOS: Se recogieron datos sobre concentraciones de hidrocarburos totales de petróleo (HTP), 16 hidrocarburos aromáticos policíclicos (HAP), incluidos el benceno, tolueno, etilbenceno y xilenos (BTEX), y 22 metales en muestras de 42 fuentes de agua de consumo humano situadas a menos de 30 km de un campo de extracción de petróleo. Se analizó la distribución de la concentración y el cumplimiento de los estándares definidos en las normativas boliviana, europea y estadounidense, así como en las recomendaciones de la Organización Mundial de la Salud. RESULTADOS: En 76,19 por ciento de las muestras se halló algún contaminante petroquímico en concentraciones superiores a alguna de las cuatro normativas de referencia. Las muestras de agua que presentaron mayor contaminación fueron las provenientes de grifos y ríos. Los contaminantes más frecuentes fueron HTP, HAP, aluminio, arsénico, manganeso y hierro. CONCLUSIONES: Las comunidades del Chaco Boliviano ubicadas en un radio de 30 km alrededor de los campos de extracción de petróleo consumen agua con concentraciones de HTP, HAP y metales muy por encima de los niveles permitidos por la normativa boliviana y los estándares internacionales, poniendo en grave riesgo la salud pública de sus habitantes.

OBJECTIVE: To determine the concentrations of petrochemical compounds in the drinking water sources of communities located near oil-producing fields in the Bolivian Chaco region. METHODS: Data were collected on total petroleum hydrocarbons (TPH), 16 polycyclic aromatic hydrocarbons (PAH), including benzene, toluene, ethylbenzene, and xylenes (BTEX), and 22 metals in samples from 42 sources of water for human consumption located less than 30 km from an oil-producing field. Distribution of the concentration and adherence to the standards contained in the Bolivian, European, and United States regulations, as well as the recommendations of the World Health Organization, were analyzed. RESULTS: In 76.19 percent of the samples, some petrochemical contaminant was found in concentrations higher than permissible in any of the four sets of regulations mentioned. The water samples with the highest contamination levels were from faucets and rivers. The most common contaminants were TPH, PAH, aluminum, arsenic, manganese, and iron. CONCLUSIONS: Communities within a 30 km radius of the oil-producing fields in the Bolivian Chaco region consume water with TPH, PAH, and metal concentrations well above the levels permitted in the Bolivian regulations and international standards, putting the public health of their residents at serious risk.

Comparación y manejo de los diferentes riesgos el agua, en los aspectos social, económico y de la salud general / Comparison and aanagement of different water-reated risks, including social, eeconomic and health aspects

El agua en exceso o déficit es perjudicial para los seres vivos y para el desarrollo social y económico de las comunidades. Desastres naturales relacionados con el agua, como las inundaciones y los maremotos son dos ejemplos claros de catástrofes relacionadas con el agua que pueden afectar seriamente el desarrollo integral de ciudades y países, en cualquier esfera productiva. Además de los daños en la actividad económica o en el aspecto social y habitacional, el agua presenta un gran riesgo para las comunidades desde el punto de vista de la salud en general. El agua no potable, la cual desafortunadamente se consume en muchas naciones del mundo, es causante de gran cantidad de enfermedades en pacientes de todas las edades, viéndose más afectada la comunidad infantil de los países en vías de desarrollo. Considerando que en contra del agua y los desastres naturales la fortaleza humana es débil; sí se debe tener claro que hay muchas otras instancias y acciones que las comunidades pueden ejecutar con el objetivo de mitigar daños que tengan relación con el agua, la salud general y el desarrollo de las poblaciones. El manejo e identificación de las posibilidades para mejorar las anteriores situaciones negativas deben ser producto de la acción y trabajo en conjunto de las administraciones, la academia y los sectores privados, en busca de un beneficio general e integral.

Excess or deficit of water affects living beings, as well as social and economical development inof communities. Natural disasters related to water, such as flooding and tsunamis are two clear examples of risks catastrophes to influencing integral development of cities and countries at any productivity level. Besides the damage to economical, social or constructing aspects, water threatens general health in different communities, from the general health point of view. Non-potable water, which unfortunately is drank in many countries, causes great variety of diseases in patients of all ages, drastically affecting more drastically infants in underdeveloped countries. Considering that against water and natural disasters, humans men is are not strong enough; it is necessary to highlight that in other cases there are many actions communities can undertake to diminish water -related damage, health risks and general development. Identifying and managing different possibilities to improve these negative situations is must be the result of a joint effort that includes public administration, the academic area and all private institutions in order aware of the need and aiming to achieve a general and integral benefit.

Paired comparison between water and nutrient drink tests in healthy volunteers / Teste de bebidas: comparação entre água e solução de nutrientes em voluntários sadios

Context: Drink tests constitute an inexpensive and non-invasive tool, which has been proposed to discriminate individuals with altered fluid intake, as dyspeptics. However, their use in everyday clinical practice is still limited as standardization still lacks. Objective: To perform a direct, paired comparison between the water and the nutrient drink test in normal volunteers. Methods: Thirty eight normal volunteers (19 males, 19 females, mean age 24.4 ± 0.4 years) underwent drink test with water and nutrient (Nutridrink) within 7-10 days. Both tests included a loading (consumption of 100 mL/min for water and 15 mL/min for Nutridrink for the longest possible period of time) and a recuperation phase (observation after cessation of fluid intake), being separated by the maximal saturation point. During phases, satiety, fullness, discomfort, bloating, belching, nausea, pain and burning sensation (epigastric and thoracic) were recorded using a 0-100 visual analogue scale score (VAS). For the purpose of configuration, four variables were considered: time (t), VAS score (V), VAS slope (S) for a given time period, and probability of participation (Q) at a given timepoint. Results: The loading phase lasted for 11.6 ± 1.7 min in water (total VAS: 879 ± 123, total VAS slope 72.6 ± 10.9 min-1) and 93.3 ± 18.4 min in Nutridrink test (total VAS: 1462 ± 411, total VAS slope 15.9 ± 3.2 min-1); P<0.001. The mean ingested volume recorded was 1155 ± 164 mL for water and 1399 ± 276 mL for nutrient; P = 0.076. Cessation of fluid intake was mainly attributed to fullness (76.3 percent) in water and satiety (69.2 percent) in Nutridrink test. Nausea was recorded only in Nutridrink test (15.4 percent). No volunteer reported substantial, persistent pain or burning sensation. The recuperation phase lasted 63.6 ± 7.8 min in water (total VAS: 278 ± 75, total VAS slope 3.97 ± 0.95 min-1) and 123.2 ± 17.5 min in Nutridrink test (total VAS: 841 ± 126, total VAS slope...

Contexto: Os testes de bebidas se constituem em meios baratos e não-invasivos propostos para distinguir diferenças de volume ingeridos por indivíduos, como os dispépticos, por exemplo. Entretanto, seu uso na prática clínica ainda é limitado pela falta de parâmetros lineares. Objetivos: Realizar comparação entre ingestão de água e solução de nutrientes em voluntários, utilizando-se o teste de bebidas e escala analógica visual. Métodos: Trinta e oito voluntários (19 homens, 19 mulheres, com média de idade: 24,4 ± 0,4 anos) submeteram-se a teste de bebidas com água e Nutridrink, em intervalo de 7 a 10 dias. Ambos os testes incluíram a fase de ingestão (consumo de 100 mL/min para água e 15 mL/min para o Nutridrink, pelo maior tempo possível), e pela fase de recuperação (observação após o término da ingestão), separados pelo máximo ponto de saturação. Durante as fases observou-se a saciedade, a plenitude, o desconforto, a eructação, os borborigmos, a náusea, a queimação epigástrica ou torácica e a dor, que foram anotadas utilizando-se um escore de escala analógica visual (EAV) variando entre 0-100. Para este propósito quatro variáveis foram consideradas: tempo (T), escore EAV (V), e curva EAV (S), para o período de tempo e a probabilidade de participação a um tempo determinado (Q). Resultados: O tempo de ingestão durou 11,6 ± 1,7 min para a água (total EAV: 879 ±123, total S: 72,6 ± 10,9 min-1) e 93,3 ± 18,4 min para o Nutridrink (total EAV: 1462 ± 411, total S: 15,9 ± 3,2 min-1); P<0.001. O volume médio ingerido foi de 1155 ± 164 mL para água e 1399 ± 276 mL para o nutriente; P = 0.076. A parada de ingestão do líquido foi atribuída à sensação de plenitude em 76,3 por cento para a água e a saciedade em 69,2 por cento para o Nutridrink. Náusea foi relatada em 15,4 por cento somente para o teste de nutriente. Nenhum voluntário reportou dor substancial persistente ou sensação de queimação. A fase de recuperação durou 63,6 ± 7,8 min para a água...