Doenças de veiculação hídrica e a sua relação com aspectos socioambientais no Centro-Oeste do Estado de São Paulo (Brasil)

Abstract

Waterborne diseases are a public health problem, causing several hospitalizations and deaths annually. Research assists in the action’s formulation, and support decision-making. This study aimed to evaluate the association between socioeconomic/environmental variables and waterborne diseases in two hydrographic basins inserted in the midwest of the São Paulo State, Brazil. This is an epidemiological-ecological study, focusing on the association between socioeconomic/environmental with the number of hospitalizations related to cholera and diarrhea/gastroenteritis of presumed infectious origin, in the Medium-Tietê Water Resources Management Unit (WRMU 10) and Piracicaba/Capivari/Jundiaí (WRMU 5), between 2012 and 2019. Information was collected from Environmental Company of the São Paulo State (CETESB) reports, the Information System on Notification Problems (SINAN) and the State Statistical Data Analysis System Foundation (SEADE). It was analyzed that: the number of hospitalizations, the days of hospital stay, the total amount spent, deaths, average income (R$) of the municipalities, urban population, sewage collection (%), sewage treatment (%), remaining polluting load (kg of Biochemical Oxygen Demand/day), percentage distribution of the categories of the Water Quality Index – WQI, and the Indicator of Sewage Collection and Treatment of the Urban Population of municipality (ICTEM). Pearson's correlation (p-value: 0.05) and a Principal Component Analysis (PCA) were performed in language R. The units showed population growth in the evaluated interval, the average individual income ranged between R$ 2,600.00 and R$ 3,070.00. Sewage treatment (%), the remaining polluting load, ICETEM presented stability over the period, except for improvements in ICETEM and sewage treatment (%) in WRMU 10. Cholera caused 164 hospitalizations in the units, 624 days of hospital stay, R$ 63,595.42 spent on hospitalizations and nine deaths, the incidence was less than 1 per 100,000 inhabitants. Diarrhea/gastroenteritis of presumed infectious origin resulted in an expenditure of R$ 3,827,238.58 on hospitalizations, 26,653 days of hospital stay and 125 deaths, in addition to an incidence rate ranging from 8-31 per 100,000 inhabitants. Positive relationships (p-value: 0.05) were observed between remaining polluting load and cholera hospitalizations; and the percentage of the WQI indicative of the regular category with hospitalizations due to cholera. Negative relationships (p-value: 0.05) include sewage collection and remaining polluting load; percentage of optimal category of WQI and deaths from cholera; ICETEM and remaining polluting load; sewage collection (%) and hospitalizations for diarrhea/gastroenteritis of presumed infectious origin. The PCA explained approximately 67% of the data variation and demonstrated an association between urban population, occurrence of hospitalizations for diarrhea and WQI (percentage of poor category), in addition to an opposite association between WQI (percentage of optimal category), ICETEM and sewage treatment (%) with hospitalizations/deaths from cholera. This study showed that WRMU 10 had a higher incidence of diarrhea/gastroenteritis of presumed infectious origin compared to WRMU 5, while in the case of cholera the situation is reversed. The findings contribute to epidemiological surveillance of the evaluated diseases.