Assessment of contributing factors to the reduction of diarrhea in rural communities of Para, Brazil

In developing communities the occurrence of diarrhea has been reported at elevated levels as compared to those communities in more developed regions. Diarrheal diseases were linked to over one million deaths in 2012 throughout the world. While multiple pathways are present for the transmission of diarrheal diseases, water has been the focus for many aid organizations. Point-of-use (POU) water treatment methods are a common tool used by aid organizations in efforts to provide potable water. The CAWST biosand filter is a POU tool that has shown removal effectiveness of pathogenic microorganisms ranging from 90-99%. However, minimal literature was found that reported on the effectiveness of the filter within the larger body of the complex system found in all communities. Therefore a hypothesis was derived to confirm that the intervention of a CAWST biosand filter is the most significant factor in the reduction of the diarrheal health burden within households in developing regions. Communities located along the Amazon River in Para, Brazil were selected for study. Structural Equation Modeling (SEM) was utilized to aid in representing the complex set of relationships within the communities. The Mahalanobis-Taguchi Strategy (MTS) was also used to confirm variable significance in the SEM model. Results show that while the biosand filter does aid in the reduction of diarrheal occurrences it is not the most significant factor. Results varied on which factor influenced diarrheal occurrences the greatest but consistently included education, economic status, and sanitation. Further, results from the MTS analysis reported education as the largest factor influencing household health. Continued work is needed for further understanding of these factors and their relationships to diarrhea reduction.