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None of our current EWB projects deal with sanitation, but the studies
cited below are evidence that we need to keep it in mind.

Maggie


Margaret Ramalho McMorrow, P.E.
Staff Associate
ARD, Inc.
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802/658-3890

-----Original Message-----
From: Campbell, Dan
Sent: Monday, November 12, 2007 11:05 AM
Subject: Effect of city-wide sanitation programme on reduction in rate
of childhood diarrhoea in northeast Brazil: assessment by two cohort
studies

FYI, a study from the  Nov 10, 2007 Lancet The Lancet 2007;
370:1622-1628 which concludes 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."

This can be downloaded from http://www.thelancet.com  or I can email you
the pdf file if needed.

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Effect of city-wide sanitation programme on reduction in rate of
childhood diarrhoea in northeast Brazil: assessment by two cohort
studies

Mauricio L Barreto, Bernd Genser, Agostino Strina, Maria Gloria
Teixeira, Ana Marlucia O Assis, Rita F Rego, Carlos A Teles, Matildes S
Prado, Sheila M A Matos, Darci N Santos, Lenaldo A dos Santos, Sandy
Cairncross

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 eff
ect 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 fi
eldworkers; 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 fi tting
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.