Characteristics of sanitation companies associated to water fluoridation of the supply systems of Brazilian municipalities, 2008

Silva, Franklin Barbosa da; Frazão, Paulo

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 23 • 2020 • https://doi.org/10.1590/1980-549720200086 copy

Characteristics of sanitation companies associated to water fluoridation of the supply systems of Brazilian municipalities, 2008^* * Article derived from a doctoral thesis entitled Contextual characteristics associated to the fluoridation of public water supply in Brazil in 2008, presented by Franklin Barbosa da Silva to the Graduate Program in Public Health at Universidade de São Paulo, in 2019.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Introduction:

The adjusted effect of the characteristics of sanitation companies on the provision of fluoridation into public water supply in Brazilian municipalities was evaluated.

Methods:

Cross-sectional and ecological study based on the 2010 Demographic Census, 2008 National Survey on Basic Sanitation (PNSB), and 2010 Atlas of Human Development. The independent variables were the characteristics of utilities and municipalities, and the outcome was the lack of provision of fluoridation. Prevalence ratio was estimated with Poisson regression with robust variance.

Results:

5,565 Brazilian municipalities were included. In the adjusted analysis, the outcome was independently and positively associated to municipalities in the North, Northeast, Central-West and Southeast macro-regions, with coverage rates for water and sewage services below the median value, with less than 10,000 inhabitants, medium and low/very low in human development. Regarding the independent effect of the utilities’ characteristics, they were more likely not to provide fluoridation, all the companies that were not classified as indirect administration of the government or mixed-capital company or mixed-capital company of public character; municipal and intermunicipal (PR=1.21; 95%CI 1.19-1.23); and when the municipal government is the only provider (PR=1.22; 95%CI 1.20-1.25).

Conclusion:

The lack of provision of water fluoridation was greater when the service was mainly provided by municipal administrations and private companies associated or not to public entities, regardless of the characteristics of the municipalities.

Keywords:
Fluoridation; Sewerage enterprises; Multivariate analysis; Ecological studies; Environmental health

Variables	Municipalities			Simple	Model 1	Model 2	Model 3	Model 4
	Total	No provision		Simple	Model 1	Model 2	Model 3	Model 4
	n	n	(%)	95%CI	95%CI	95%CI	95%CI	95%CI
Region
South	1,188	145	12.2	1.00	1.00	1.00	1.00	1.00
Southeast	1,668	235	14.1	0.99 - 1.04	1.04 - 1.09*	1.03 - 1.07*	1.03 - 1.07*	1.02 - 1.06**
Central-West	466	212	45.5	1.25 - 1.34*	1.23 - 1.32*	1.21 - 1.29*	1.22 - 1.30*	1.21 - 1.29*
Northeast	1,794	1,218	67.9	1.46 - 1.53*	1.42 - 1.50*	1.42 - 1.50*	1.43 - 1.50*	1.45 - 1.53*
North	449	404	90.0	1.66 - 1.73*	1.58 - 1.67*	1.46 - 1.59*	1.50 - 1.60*	1.54 - 1.64*
Water supply
≥ 72.6%	2,780	765	27.5	1.00	1.00	1.00	1.00	1.00
< 72.6%	2,780	1,444	51.9	1.17 - 1.21*	1.02 - 1.06*	1.03 - 1.06*	1.03 - 1.07*	1.02 - 1.06*
Sewage coverage
≥ 17.5%	2,727	654	24.0	1.00	1.00	1.00	1.00	1.00
< 17.5%	2,727	1,484	54.4	1.22 - 1.27*	1.03 - 1.08*	1.01 - 1.05**	1.01 - 1.05*	1.02 - 1.06*
Demographic size (inhabitants)
More than 50,000	608	156	25.7	1.00	1.00	1.00	1.00	1.00
From 10,000 to 50,000	2,444	1,003	41.0	1.09 - 1.16*	1.00 - 1.05***	0.98 - 1.04	1.00 - 1.06***	0.99 - 1.04
Less than 10,000	2,513	1,055	39.8	1.10 - 1.17*	1.07 - 1.13*	1.03 - 1.09*	1.07 - 1.13*	1.04 - 1.10*
2010 MHDI
Very high/high	1,933	240	12.4	1.00	1.00	1.00	1.00	1.00
Medium	2,233	985	44.1	1.26 - 1.31*	1.04 - 1.09*	1.04 - 1.09*	1.05 - 1.09*	1.05 - 1.09*
Low/Very low	1,399	989	70.7	1.49 - 1.55*	1.03 - 1.10*	1.03 - 1.10*	1.04 - 1.10*	1.02 - 1.08*
Legal nature
Indirect public administration/Mixed-capital company of public character	3,524	977	27.7	1.00		1.00
Mixed-capital company of private character	309	128	41.4	1.06 - 1.15*		1.07 - 1.13*
Direct public administration	924	571	61.8	1.24 - 1.30*		1.22 - 1.28*
Direct public administration + indirect/ Direct public administration + private entity	299	186	62.2	1.23 - 1.32*		1.09 - 1.16*
Mixed-capital company + public entity + private entity	266	167	62.8	1.23 - 1.32*		1.10 - 1.17*
Private entity	209	151	72.2	1.30 - 1.39*		1.11 - 1.20*
Administrative sphere
State + Federal	2,125	550	25.9	1.00			1.00
Association of only public entities	1,067	362	33.9	1.04 - 1.09*			0.98 - 1.02
Municipal + Intermunicipal	1,383	712	51.5	1.18 - 1.23*			1.19 - 1.23*
Association between public and provate entities	748	405	54.1	1.19 - 1.26*			1.11 - 1.16*
Private	208	151	72.6	1.32 - 1.42*			1.11 - 1.21*
Service performance form
Other entities perform the service	3,220	1,033	32.1	1.00				1.00
The city council and other entities perform the service	1,368	580	42.4	1.05 - 1.10*				0.99 - 1.02
The city council is the only service performer	943	567	60.1	1.18 - 1.24*				1.20 - 1.25*

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[1] Corresponding author: Franklin Barbosa da Silva. Rua 3, 81, Conjunto Castelo Branco, Parque 10 de Novembro, CEP: 69055-210, Manaus, AM, Brazil. E-mail: frank_barbosa@usp.br