Cobertura de saneamento básico, áreas alagáveis e a prevalência de doenças de veiculação hídrica no dique da Vila Gilda e na Zona Noroeste de Santos/SP

Abstract

Data from the National Sanitation Information System (SNIS) reveal that despite leading the sanitation ranking, Santos-SP shows disparities, especially in the Vila Gilda Dike. The study aimed to assess the prevalence of Waterborne Diseases (WD) in four neighborhoods in the northwest region that differ in basic sanitation infrastructure from 2015 to 2021, according to age group, gender, year, WD, and flood risk. Health care data from Basic Health Units (UBS's) and Emergency Care Units (UPA's) were collected from the Municipal Health Department of Santos, while hospitalization information was obtained through the Hospital Information System of the Unified Health System (SIH-SUS). Percentage calculations were made to assess the frequency of cases in each region - with stilt houses (RCP) and without stilt houses (RSP) - for each variable, type of care, and flood risk - Floodable Areas (AA) and Non-Floodable Areas (ANA). Prevalence rates (PR) of WD per 10,000 inhabitants were calculated, and proportion comparison tests were conducted to evaluate differences between them, adopting a significance level of 5%. The Quantum Geographic Information System (QGIS) was used to analyze the geographical distribution of cases considering the flood risk in residential areas - classified as floodable and non-floodable. No statistically significant differences were observed between RSP and RCP in UBS's (PR = 41.4; PR = 40.2; p-value = 0.980). In UPA's, the highest WD rate was in RSP (PR = 628.9; p-value <0.001). However, hospitalizations for WD were more frequent in RCP (PR = 9.8). Women from RSP had the highest rates in UBS cases (PR = 46.3) and UPA cases (PR = 770.5) compared to women from RCP. There was no difference between men in both regions in UBS care (PR = 41.9; PR = 41.7; p-value = 0.970), and in UPA's, residents of RSP had a higher proportion (PR = 602.7). When comparing genders in both regions, in UBS, women from RSP predominated (PR = 46.3), but there was no difference between genders in RCP (PR = 38.9; 41.7; p-value = 0.183). In UPA's, rates were higher in women in RSP (PR = 770.5) and in men in RCP (PR = 550.8). Men were more hospitalized, especially in stilt houses (PR = 13.9). In UBS's and UPA's, children aged 05 to 09 had the highest rates, especially in RSP (PR = 985.5; 8130.6). Adolescents aged 10 to 19 in RCP had a higher hospitalization rate (PR = 31.7). The years 2019 and 2020 had the highest proportions of cases. In 2019, the highest values were in cases attended at UBS's in RCP (PR = 14.7), in UPA cases in both regions (PR = 223.9; 183.2), while in 2020, the highest rates were in UBS in RSP (PR = 8.0) and in hospitalizations in both regions (PR = 1.72). Diarrhea and gastroenteritis were the most prevalent WDs in UBS and UPA care, especially in RSP (PR = 65.6; 1074.7). Leptospirosis was the leading cause of hospitalizations, especially in RCP (PR = 4.9), followed by diarrhea and gastroenteritis (PR = 2.58; 2.94; p-value <0.001). Floodable Areas showed a higher geographic concentration of cases and WD frequency in UBS (83.4%), UPA (77.9%), and hospitalizations (81.4%), indicating that even in non-stilted areas but flood-prone, the incidence of WD is notable. It was concluded that only the presence of basic sanitation may not be enough to prevent waterborne diseases, as other factors may be involved, such as floods. Floods, combined with a lack of sanitation, contribute to more severe forms of waterborne diseases requiring hospitalization, such as leptospirosis. Thus, implementing public policies to expand sanitation in stilted areas and improve drainage in flood-prone regions can be an effective preventive measure against waterborne diseases.

Data from the National Sanitation Information System (SNIS) reveal that despite leading the sanitation ranking, Santos-SP shows disparities, especially in the Vila Gilda Dike. The study aimed to assess the prevalence of Waterborne Diseases (WD) in four neighborhoods in the northwest region that differ in basic sanitation infrastructure from 2015 to 2021, according to age group, gender, year, WD, and flood risk. Health care data from Basic Health Units (UBS's) and Emergency Care Units (UPA's) were collected from the Municipal Health Department of Santos, while hospitalization information was obtained through the Hospital Information System of the Unified Health System (SIH-SUS). Percentage calculations were made to assess the frequency of cases in each region - with stilt houses (RCP) and without stilt houses (RSP) - for each variable, type of care, and flood risk - Floodable Areas (AA) and Non-Floodable Areas (ANA). Prevalence rates (PR) of WD per 10,000 inhabitants were calculated, and proportion comparison tests were conducted to evaluate differences between them, adopting a significance level of 5%. The Quantum Geographic Information System (QGIS) was used to analyze the geographical distribution of cases considering the flood risk in residential areas - classified as floodable and non-floodable. No statistically significant differences were observed between RSP and RCP in UBS's (PR = 41.4; PR = 40.2; p-value = 0.980). In UPA's, the highest WD rate was in RSP (PR = 628.9; p-value <0.001). However, hospitalizations for WD were more frequent in RCP (PR = 9.8). Women from RSP had the highest rates in UBS cases (PR = 46.3) and UPA cases (PR = 770.5) compared to women from RCP. There was no difference between men in both regions in UBS care (PR = 41.9; PR = 41.7; p-value = 0.970), and in UPA's, residents of RSP had a higher proportion (PR = 602.7). When comparing genders in both regions, in UBS, women from RSP predominated (PR = 46.3), but there was no difference between genders in RCP (PR = 38.9; 41.7; p-value = 0.183). In UPA's, rates were higher in women in RSP (PR = 770.5) and in men in RCP (PR = 550.8). Men were more hospitalized, especially in stilt houses (PR = 13.9). In UBS's and UPA's, children aged 05 to 09 had the highest rates, especially in RSP (PR = 985.5; 8130.6). Adolescents aged 10 to 19 in RCP had a higher hospitalization rate (PR = 31.7). The years 2019 and 2020 had the highest proportions of cases. In 2019, the highest values were in cases attended at UBS's in RCP (PR = 14.7), in UPA cases in both regions (PR = 223.9; 183.2), while in 2020, the highest rates were in UBS in RSP (PR = 8.0) and in hospitalizations in both regions (PR = 1.72). Diarrhea and gastroenteritis were the most prevalent WDs in UBS and UPA care, especially in RSP (PR = 65.6; 1074.7). Leptospirosis was the leading cause of hospitalizations, especially in RCP (PR = 4.9), followed by diarrhea and gastroenteritis (PR = 2.58; 2.94; p-value <0.001). Floodable Areas showed a higher geographic concentration of cases and WD frequency in UBS (83.4%), UPA (77.9%), and hospitalizations (81.4%), indicating that even in non-stilted areas but flood-prone, the incidence of WD is notable. It was concluded that only the presence of basic sanitation may not be enough to prevent waterborne diseases, as other factors may be involved, such as floods. Floods, combined with a lack of sanitation, contribute to more severe forms of waterborne diseases requiring hospitalization, such as leptospirosis. Thus, implementing public policies to expand sanitation in stilted areas and improve drainage in flood-prone regions can be an effective preventive measure against waterborne diseases.