Agostino Strina
Federal University of Bahia
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The Lancet | 2007
Mauricio Lima Barreto; Bernd Genser; Agostino Strina; Ana Marlucia de Oliveira Assis; Rita de Cássia Franco Rêgo; Carlos A. Teles; Matildes da Silva Prado; Sheila M. A. Matos; Darci Neves dos Santos; Lenaldo Azevedo dos Santos; Sandy Cairncross; Maria da Glória Lima Cruz Teixeira
Summary Background A city-wide sanitation intervention was started in Salvador, Brazil, in 1997 to improve sewerage coverage from 26% of households to 80%. Our aim was to investigate the epidemiological effect of this city-wide sanitation programme on diarrhoea morbidity in children less than 3 years of age. Methods The investigation was composed of two longitudinal studies done in 1997–98 before the intervention (the sanitation programme) and in 2003–04 after the intervention had been completed. Each study consisted of a cohort of children (841 in the preintervention study and 1007 in the postintervention study; age 0–36 months at baseline) who were followed up for a maximum of 8 months. Children were sampled from 24 sentinel areas that were randomly chosen to represent the range of environmental conditions in the study site. At the start of each study an individual or household questionnaire was applied by trained fieldworkers; an environmental survey was done in each area before and after introduction of the sanitation programme to assess basic neighbourhood and household sanitation conditions. Daily diarrhoea data were obtained during home visits twice per week. The effect of the intervention was estimated by a hierarchical modelling approach fitting a sequence of multivariate regression models. Findings Diarrhoea prevalence fell by 21% (95% CI 18–25%)—from 9·2 (9·0–9·5) days per child-year before the intervention to 7·3 (7·0–7·5) days per child-year afterwards. After adjustment for baseline sewerage coverage and potential confounding variables, we estimated an overall prevalence reduction of 22% (19–26%). Interpretation Our results show that urban sanitation is a highly effective health measure that can no longer be ignored, and they provide a timely support for the launch of 2008 as the International Year of Sanitation.
BMC Public Health | 2008
Darci Neves dos Santos; Ana Marlucia de Oliveira Assis; Ana Cecília de Sousa Bastos; Letícia Marques dos Santos; Carlos Antônio S. T. Dos Santos; Agostino Strina; Matildes da Silva Prado; Naomar Almeida-Filho; Laura C. Rodrigues; Mauricio Lima Barreto
BackgroundThere is evidence that poverty, health and nutrition affect childrens cognitive development. This study aimed to examine the relative contributions of both proximal and distal risk factors on child cognitive development, by breaking down the possible causal pathways through which poverty affects cognition.MethodsThis cohort study collected data on family socioeconomic status, household and neighbourhood environmental conditions, child health and nutritional status, psychosocial stimulation and nursery school attendance. The effect of these on Wechsler Pre-School and Primary Scale of Intelligence scores at five years of age was investigated using a multivariable hierarchical analysis, guided by the proposed conceptual framework.ResultsUnfavourable socioeconomic conditions, poorly educated mother, absent father, poor sanitary conditions at home and in the neighbourhood and low birth weight were negatively associated with cognitive performance at five years of age, while strong positive associations were found with high levels of domestic stimulation and nursery school attendance.ConclusionChildrens cognitive development in urban contexts in developing countries could be substantially increased by interventions promoting early psychosocial stimulation and preschool experience, together with efforts to prevent low birth weight and promote adequate nutritional status.
Memorias Do Instituto Oswaldo Cruz | 2005
Marcia Regina Franzolin; Rosely Cabette Barbosa Alves; Rogéria Keller; Tânia A. T. Gomes; Lothar Beutin; Mauricio Lima Barreto; Craig A. Milroy; Agostino Strina; Hugo Ribeiro; Luiz R. Trabulsi
We report the frequency of the different diarrheagenic Escherichia coli (DEC) categories isolated from children with acute endemic diarrhea in Salvador, Bahia. The E. coli isolates were investigated by colony blot hybridization with the following genes probes: eae, EAF, bfpA, Stx1, Stx2, ST-Ih, ST-Ip, LT-I, LT-II, INV, and EAEC, as virulence markers to distinguish typical and atypical EPEC, EHEC/STEC, ETEC, EIEC, and EAEC. Seven of the eight categories of DEC were detected. The most frequently isolated was atypical EPEC (10.1%) followed by ETEC (7.5%), and EAEC (4.2%). EHEC, STEC, EIEC, and typical EPEC were each detected once. The strains of ETEC, EAEC, and atypical EPEC belonged to a wide variety of serotypes. The serotypes of the others categories were O26:H11 (EHEC), O21:H21 (STEC), O142:H34 (typical EPEC), and O:H55 (EIEC). We also present the clinical manifestations and other pathogenic species observed in children with DEC. This is the first report of EHEC and STEC in Salvador, and one of the first in Brazil.
Parasitology | 2005
Matildes da Silva Prado; Sandy Cairncross; Agostino Strina; Mauricio Lima Barreto; Ana Marlúcia Oliveira-Assis; S. Rego
This study sought to assess the effect of giardiasis on growth of young children. In Salvador, northeast Brazil, 597 children initially aged 6 to 45 months were followed for a year in 1998/9, measured anthropometrically thrice, every 6 months, and monitored for diarrhoea prevalence twice weekly. Stool samples were collected and examined during the second round of anthropometry, and infected children were treated 39 days later, on average (S.D. 20 days). For each 6-month interval, the gains in z-scores of infected and uninfected children were compared, after adjustment for potential confounding factors, including longitudinal prevalence of diarrhoea. No significant difference was found for the first interval but in the second, the gain in adjusted height-for-age z-score was 0.09 less in infected than uninfected children, equivalent to a difference in height gain of 0.5 cm. The shortfall in growth was greater in children who remained free of diarrhoea, and was significantly correlated with the proportion of the second interval during which the child had remained untreated. We conclude that Giardia can impede child growth even when asymptomatic, presumably through malabsorption. This finding challenges the view that young children found to have asymptomatic giardiasis in developing countries should not be treated.
Epidemiology | 2006
Bernd Genser; Agostino Strina; Carlos A. Teles; Matildes da Silva Prado; Mauricio Lima Barreto
Background: Several longitudinal studies have investigated factors associated with childhood diarrhea in developing countries. However, most studies have neglected important dynamic features of the longitudinal design and hierarchical interrelationships among the potential risk factors. Methods: We conducted a longitudinal study of 902 children, age 0 to 36 months at baseline, in a large urban center in northeastern Brazil. Diarrhea data were collected by following children from October 2000 until January 2002 with biweekly home visits. We used a dynamic time-to-event analysis to account for several longitudinal features. We applied an effect-decomposition strategy to quantify direct and indirect effects of risk factors grouped in different blocks. Results: Childs age and an autoregressive effect of past diarrhea episodes explained some of the decline of diarrhea incidence observed throughout the study (from more than 14 episodes to 2 episodes per child-year), a phenomenon already observed but not explained in other longitudinal diarrhea studies. We identified the following major diarrhea determinants: low socioeconomic status, poor sanitation conditions, presence of intestinal parasites, and absence of prenatal examination. The effect of socioeconomic status was mediated mostly by living and sanitation conditions. Conclusion: Our study shows important advantages of applying a dynamic analysis approach to longitudinal observational studies of diarrhea or other acute diseases and highlights the complex interrelationships of diarrhea determinants. Our results confirm the importance of sanitation as a major determinant of child health in urban settings of developing countries.
Epidemiology and Infection | 2003
Matildes da Silva Prado; Agostino Strina; Mauricio Lima Barreto; Ana Marlúcia Oliveira-Assis; Lívia Maria Paz; Sandy Cairncross
A cross-sectional study of 694 children aged 2 to 45 months selected from 30 clusters throughout the city of Salvador, Bahia (pop. 2.3 million) was carried out as part of a longitudinal study of diarrhoea in order to identify risk factors for infection with Giardia duodenalis. Variables studied included three social and demographic factors (such as mothers education and marital status), five relating to the peri-domestic environment (rubbish disposal, open sewers, paving of the street), seven relating to the home itself (house construction, susceptibility to flooding, water supply and sanitation) as well as a score for hygiene behaviour based on structured observation. After multivariate analysis using a hierarchical model, only four significant risk factors were found: (a) number of children in the household under five years (b) rubbish not collected from the house (c) presence of visible sewage nearby, and (d) absence of a toilet. All four were significant at the 1% level.
Environmental Health Perspectives | 2010
Mauricio Lima Barreto; Bernd Genser; Agostino Strina; Maria da Glória Lima Cruz Teixeira; Ana Marlucia de Oliveira Assis; Rita de Cássia Franco Rêgo; Carlos A. Teles; Matildes da Silva Prado; Sheila M. A. Matos; Neuza Maria Alcântara-Neves; Sandy Cairncross
Background Sanitation affects health, especially that of young children. Residents of Salvador, in Northeast Brazil, have had a high prevalence of intestinal parasites. A citywide sanitation intervention started in 1996 aimed to raise the level of sewer coverage from 26% to 80% of households. Objectives We evaluated the impact of this intervention on the prevalence of Ascaris lumbricoides, Trichuris trichuria, and Giardia duodenalis infections in preschool children. Methods The evaluation was composed of two cross-sectional studies (1998 and 2003–2004), each of a sample of 681 and 976 children 1–4 years of age, respectively. Children were sampled from 24 sentinel areas chosen to represent the range of environmental conditions in the study site. Data were collected using an individual/household questionnaire, and an environmental survey was conducted in each area before and after the intervention to assess basic household and neighborhood sanitation conditions. Stool samples were examined for the presence of intestinal parasites. The effect of the intervention was estimated by hierarchical modeling, fitting a sequence of multivariate regression models. Findings The prevalence of A. lumbricoides infection was reduced from 24.4% to 12.0%, T. trichuria from 18.0% to 5.0%, and G. duodenalis from 14.1% to 5.3%. Most of this reduction appeared to be explained by the increased coverage in each neighborhood by the sewage system constructed during the intervention. The key explanatory variable was thus an ecological measure of exposure and not household-based, suggesting that the parasite transmission prevented by the program was mainly in the public (vs. the domestic) domain. Conclusion This study, using advanced statistical modeling to control for individual and ecological potential confounders, demonstrates the impact on intestinal parasites of sanitation improvements implemented at the scale of a large population.
Cadernos De Saude Publica | 2002
Maria da Glória Lima Cruz Teixeira; Mauricio Lima Barreto; Maria da Conceição Nascimento Costa; Agostino Strina; David Martins Jr.; Matildes da Silva Prado
Resumo As tecnicas disponiveis para monitoramento da situacao de saude tem-se mostrado insuficientes, razao pela qual se discute a necessidade de aperfeicoa-las com base no desenvolvimento de novas estrategias de coleta de informacoes, de modo a permitir seu uso pelos sistemas locais de saude. Este artigo apresenta as bases metodologicas de uma estrategia de monitoramento de problemas de saude que emprega espacos intra-urbanos delimitados – areas sentinelas – para coleta de informacoes sociais, economicas, comportamentais e biologicas fundamentais para a Saude Publica, por permitirem uma maior aproximacao com a realidade de espacos sociais complexos. Os autores apresentam uma experiencia que esta sendo desenvolvida em Salvador/Bahia, Brasil, para avaliacao de impacto epidemiologico resultante da implantacao de um programa de saneamento ambiental. Discutem-se os criterios de selecao das areas e as potencialidades de uso dessa estrategia para possibilitar o emprego agil dos recursos epidemiologicos pelos servicos de saude de forma agil e a aplicacao oportuna de seus resultados na reorientacao e aprimoramento das praticas de intervencao em saude. Palavras-chave: areas sentinelas; monitoramento; saude publica; vigilância sentinela. Summary Because available techniques for monitoring the health situation have shown to be insufficient, this article discusses methods to improve these techniques based on the development of new strategies of data collection that permit their use by local health systems. The methodological basis of a strategy of health monitoring using well-defined inner-urban spaces, called sentinel areas, is presented. The proposed strategy permits the collection of social, economic, behavioral, and biological information essential for public health practice, including a better approach to the reality of complex social spaces. The authors present an experience developed in the city of Salvador, the capital of Bahia state, Brazil, which has been used to evaluate the epidemiological impact of an environment sanitation program. Criteria for area selection are discussed, as well as the potential use of this strategy by health services, as it allows the use of epidemiological resources and their results for improving health intervention programs in a timely manner.
International Journal of Epidemiology | 2008
Bernd Genser; Agostino Strina; Lenaldo Azevedo dos Santos; Carlos A. Teles; Matildes da Silva Prado; Sandy Cairncross; Mauricio Lima Barreto
BACKGROUND Poor socioeconomic status (SES) increases diarrhoea risk, mostly mediated by lack of sanitation, poor infrastructure and living conditions. The effectiveness of a city-wide sanitation intervention on diarrhoea in a large urban centre in Northeast Brazil has recently been demonstrated. This article aims to explore how this intervention altered the magnitude of relative and attributable risks of diarrhoea determinants and the pathways by which those factors affect diarrhoea risk. METHODS We investigated determinants of prevalence of diarrhoea in two cohort studies conducted before and after the intervention. Each study enrolled pre-school children followed up for 8 months. For both cohorts, we calculated relative, attributable and mediated risks of diarrhoea determinants by a hierarchical effect decomposition strategy. RESULTS The intervention reduced diarrhoea and also changed attributable and relative risks of diarrhoea determinants by altering the pathways of mediation. Before the intervention SES was a major distal diarrhoea determinant (attributable risk: 24%) with 90% of risk mediated by other factors, mostly by lack of sanitation and poor infrastructure (53%). After the intervention, only 13% of risk was attributed to SES, with only 42% mediated by other factors (18% by lack of sanitation and poor infrastructure). CONCLUSION The intervention reduced diarrhoea risk by reducing direct exposure to unfavourable sanitation conditions. At the same time it altered the effect and mediation pathways of most distal diarrhoea determinants, especially SES. This finding corroborates the importance of public sanitation measures in reducing the impact of poverty on diarrhoea. It also underlines the value of studying the impact of public health interventions to improve our understanding of health determinants.
Respiratory Research | 2010
Mauricio Lima Barreto; Sérgio Souza da Cunha; Rosemeire Leovigildo Fiaccone; Renata Esquivel; Leila Denise Alves Ferreira Amorim; Sheila Alvim; Matildes da Silva Prado; Alvaro A. Cruz; Philip J. Cooper; Darci Neves dos Santos; Agostino Strina; Neuza Maria Alcantara-Neves; Laura C. Rodrigues
BackgroundThe causation of asthma is poorly understood. Risk factors for atopic and non-atopic asthma may be different. This study aimed to analyze the associations between markers of poverty, dirt and infections and wheezing in atopic and non-atopic children.Methods1445 children were recruited from a population-based cohort in Salvador, Brazil. Wheezing was assessed using the ISAAC questionnaire and atopy defined as allergen-specific IgE ≥0.70 kU/L. Relevant social factors, environmental exposures and serological markers for childhood infections were investigated as risk factors using multivariate multinomial logistic regression.ResultsCommon risk factors for wheezing in atopic and non-atopic children, respectively, were parental asthma and respiratory infection in early childhood. No other factor was associated with wheezing in atopic children. Factors associated with wheezing in non-atopics were low maternal educational level (OR 1.49, 95% CI 0.98-2.38), low frequency of room cleaning (OR 2.49, 95% CI 1.27-4.90), presence of rodents in the house (OR 1.48, 95% CI 1.06-2.09), and day care attendance (OR 1.52, 95% CI 1.01-2.29).ConclusionsNon-atopic wheezing was associated with risk factors indicative of poverty, dirt and infections. Further research is required to more precisely define the mediating exposures and the mechanisms by which they may cause non-atopic wheeze.