Proposition and application of an environmental salubrity index in rural agglomerations

Braga, Débora de Lima; Bezerra, Nolan Ribeiro; Scalize, Paulo Sérgio

doi:10.11606/s1518-8787.2022056003548

Brasil

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Original Article • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056003548 linkcopy

Proposition and application of an environmental salubrity index in rural agglomerations

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE Propose an Índice de salubridade ambiental (ISA_Rural– environmental salubrity index) that expresses the conditions experienced in rural agglomerations, including indicators and subindicators for its subsequent application in rural communities in the state of Goiás.

METHODS We developed the research in three phases: 1) previous analysis for the proposition of an ISA_Rural, with the participation of seven specialists; 2) proposition of the ISA_Rural by means of the Delphi method, starting with 168 specialists from 26 federative units of Brazil and Distrito Federal; and 3) application of the ISA_Rural in 43 rural communities in the state of Goiás.

RESULTS The proposed ISA_Rural resulted in the composition of eight indicators, four of which related to basic sanitation, and the others to health, socioeconomic conditions, public services offered, and housing conditions. The weight assigned to each indicator ranged from 22.82% for the water supply indicator to 6.35% for the service indicator, it is possible to apply the ISA_Rural fully or to evaluate each indicator individually. The application of ISA_Rural in communities of Goiás classified 86% of them with low salubrity, highlighting the worst conditions for quilombola communities. The sanitary sewage had the lowest score among the ISA_Rural indicators, requiring greater attention from public authorities.

CONCLUSIONS This study contributed to the proposition of an index in line with the concept of environmental salubrity, useful in the scope of public policies as a conditioner for the prioritization of actions needed to improve the salubrity conditions identified. The proposed ISA_Rural can be fully applied or used in the individual evaluation of each indicator of its composition. The results of its application made it possible to identify the communities with the worst environmental salubrity conditions and the indicators that require greater priority attention in the communities studied.

Indicators (Statistics; Environmental Salubrity; Rural Areas; Social Planning; Environment and Public Health

Community name and typology	I_AB	I_ES	I_MRS	I_MAP	I_Health	I_SE	I_Services	I_CM	ISA_Rural
Julião Ribeiro^a	64.55	65.92	32.59	75.27	82.99	36.50	55.70	85.69	62.71
Povoado Veríssimo^c	77.23	5.26	65.18	48.30	74.88	50.37	98.48	80.51	58.41
Tarumã^a	70.22	55.93	22.09	59.93	70.02	29.73	71.36	80.85	57.81
Monte Moriá^a	60.67	48.09	19.70	52.97	71.47	37.70	56.66	75.68	52.72
Itajá II^a	57.45	25.12	32.70	58.60	79.48	34.60	71.09	82.89	51.97
João de Deus^a	75.10	0.00	33.07	60.07	78.97	27.13	84.72	83.54	51.49
Vazante^b	42.12	18.91	64.24	61.01	65.28	36.92	84.72	82.63	50.87
Mesquita^b	55.18	7.38	38.54	64.04	75.36	46.92	71.60	76.43	49.20
Extrema^b	70.01	2.65	34.91	44.34	71.23	30.25	83.89	79.86	48.77
Povoado Vermelho^b	64.88	19.52	18.72	62.36	69.14	22.96	80.83	73.92	48.52
Engenho da Pontinha^a	64.88	0.00	31.85	55.56	74.97	19.03	84.72	91.42	48.16
Lageado^a	64.88	4.23	24.16	48.51	67.98	23.96	100.00	79.97	46.89
Castelo, Retiro e Três Rios^b	53.69	3.63	23.41	60.28	79.37	28.38	97.62	80.03	46.71
Fio Velasco^c	46.84	37.64	46.24	28.72	64.30	14.34	56.66	74.44	46.08
Registro do Araguaia^c	49.49	6.57	42.09	57.32	65.25	26.13	84.72	82.87	46.03
Fortaleza^a	64.88	0.00	24.86	53.96	70.20	21.50	84.72	82.36	45.90
Santa Fé da Laguna^a	56.46	1.81	24.70	69.48	68.08	31.48	83.89	79.46	45.81
Arraial das Pontes^c	49.71	0.00	56.51	78.21	59.77	18.89	56.66	88.08	45.71
Forte^b	64.88	0.00	17.57	57.72	70.50	32.70	84.72	70.97	45.21
Fazenda Santo Antônio da Laguna^b	53.50	0.00	22.19	58.56	80.06	16.57	83.52	88.87	44.64
Queixo Dantas^b	61.88	0.00	19.70	60.28	72.53	13.45	84.72	80.79	44.48
Landi^c	69.28	0.00	19.70	48.66	70.08	23.65	56.66	84.80	44.42
Povoado Moinho^b	40.61	6.80	33.56	60.08	75.13	28.44	84.72	78.78	44.21
Sumidouro^b	51.93	2.44	30.84	57.55	75.37	26.74	56.66	84.75	44.03
Rochedo^a	37.26	0.00	29.98	57.87	77.70	34.77	100.00	80.19	43.44
Céu Azul^a	43.43	0.00	22.88	52.65	73.95	43.32	100.00	76.32	43.43
São Lourenço^a	44.71	0.00	27.66	57.48	78.33	21.05	99.24	75.32	43.20
Piracanjuba^a	42.12	0.00	37.52	47.25	76.01	31.73	84.72	79.33	43.19
Almeidas^b	58.01	0.00	31.05	51.99	64.06	18.02	84.72	71.90	42.96
São Sebastião da Garganta^a	42.04	0.00	29.62	64.73	66.55	33.46	84.72	80.81	42.60
Madre Cristina^a	51.30	3.97	28.05	50.46	68.45	27.76	74.17	65.89	41.87
Olhos d’água^c	49.14	0.00	19.70	50.74	79.33	4.92	84.72	84.33	41.26
Água Limpa^b	51.30	0.00	24.35	51.87	75.44	23.11	55.76	76.12	40.96
Rafael Machado^b	35.64	0.00	30.84	54.94	70.21	36.60	83.18	77.27	40.84
Taquarussu^b	37.68	0.00	19.70	54.06	77.48	31.75	81.09	60.42	38.59
São Domingos^b	49.99	3.53	19.15	60.26	76.53	18.08	64.13	39.13	38.16
Canabrava^b	24.69	0.00	19.70	55.39	80.48	25.45	83.21	78.95	37.39
Quilombo do Magalhães^b	36.10	0.00	16.89	59.75	73.29	6.27	53.80	84.33	36.02
José de Coleto^b	32.76	0.00	17.51	65.81	63.96	24.48	83.12	42.40	34.24
Arraial da Antas^a	34.80	0.00	24.16	52.76	69.20	6.27	100.00	37.27	34.24
Baco Pari^b	7.02	2.44	20.09	50.01	72.92	14.18	84.72	59.69	29.86
Porto Leucádio^b	8.42	0.00	19.70	56.96	74.59	20.52	56.66	67.14	29.86
Pelotas^b	5.52	0.00	19.70	63.58	83.84	14.68	56.66	51.69	28.96
Mean	49.35	7.49	28.78	56.75	72.90	25.92	78.46	75.30	44.23

Stages of the Delphi method		Number of invited experts	Feedback from the experts (%)	Period (days)	Participation of UF representatives (%)	UF without answer back
1ª	1st round for choosing and suggesting indicators and suggesting subindicators	168	38.1	52	85.2	MT, MS, PA and PE
1ª	2nd round for choosing the indicators	64	84.4	46	77.8	MT, MS, PA, PE, AM and RS
2ª	Weighting of indicators	54	87.0	37	70.4	MT, MS, PA, PE, AM, RS, ES and SE
3ª	1st round for analysis, choice and weighting of subindicators	66	60.6	60	74.1	MT, MS, PA, PE, AM, AL and ES
3ª	2nd round for analysis and weighting of subindicators	40	87.5	40	70.4	MT, MS, PA, PE, AM, AL, ES and RS

$I_{A B} = 0.4212 I_{A A} + 0.3512 I_{Q A} + 0.2277 I_{F A}$
Subindicator	Formula	Score	Description
Adequate water supply at home (I_AA)	$I_{A A} = \frac{Draa}{D r t} \times 100 %$	By formula	D_raa = number of households in the rural agglomeration supplied by a water distribution network, with indoor plumbing at the residence or on the property, or by a well, water source, or rainwater collection cistern, with indoor plumbing D_rt = number of households in the rural agglomeration
Water quality (I_QA)	$I_{Q A} = \frac{N A A}{N R A} \times 100 %$	$\begin{matrix} I_{Q A} = 100 % - Score = 100 \\ I_{Q A} = 95 to 100 % - Score = 80 \\ I_{Q A} = 85 to 95 % - Score = 60 \\ I_{Q A} = 70 to 85 % - Score = 40 \\ I_{Q A} = 50 to 70 % - Score = 20 \\ I_{Q A} < 50 % - Score = 0 \end{matrix}$	N_AA = quantity of samples in accordance with acceptable water quality values for colimetry, chlorine and turbidity N_RA = number of samples performed
Frequency of water supply (I_FA)	$I_{F A} = \frac{Drfa}{D r t} \times 100 %$	By formula	D_rfa = number of rural households that never or rarely lack water (1 time per month) D_rt = number of households in the rural agglomeration
$I_{E S} = 0.6349 I_{D E} + 0.3651 I_{D A S}$
Subindicator	Formula	Score	Description
Adequate disposal of excreta (I_DE)	$I_{D E} = \frac{Dre}{Drt} \times 100 %$	By formula	D_re = number of households in the rural agglomeration served by a collecting system followed by treatment, septic tank or sewage treatment technologies in the rural area for excreta D_rt = number of households in the rural agglomeration
Adequate disposal of wastewater (I_DAS)	$I_{D A S} = \frac{Dras}{Drt} \times 100 %$	By formula	D_ras = number of households in the rural agglomeration served by a collecting system followed by treatment, septic tank or rural sewage treatment technologies for wastewater D_rt = number of households in the rural agglomeration
$I_{MRS} = 0.2817 I_{CRS} + 0.2985 I_{DRS} + 0.1970 I_{SRS} + 0.2228 I_{D E A}$
Subindicator	Formula	Score	Description
Adequate collection of solid waste (I_CRS)	$I_{C R S} = \frac{D r c}{D r t} \times 100 %$	By formula	D_rc = number of households in the rural agglomeration served by direct or indirect solid waste collection systems with a frequency of at least once a week D_rt = number of households in the rural agglomeration
Adequate disposal of solid waste (I_DRS)	$I_{D R S} = (1 - \frac{D r d}{D r t}) \times 100 %$	By formula	D_rd = number of households in the rural agglomeration that bury, burn or dispose openly solid waste D_rt = number of households in the rural agglomeration
Separation of solid waste (I_SRS)	$I_{S R S} = \frac{D r S}{D r t} \times 100 %$	By formula	D_rs = number of households in the rural agglomeration that separate their solid waste D_rt = number of households in the rural agglomeration
Proper disposal of pesticide packaging (I_DEA)	$I_{D E A} = \frac{Drea}{Drta} \times 100 %$	By formula	D_rea = number of households in the rural agglomeration that return their pesticide packages to the producer, the seller of the product, or to a voluntary delivery point D_rta = number of households in the rural agglomeration using pesticides
$I_{M A P} = 0.1639 I_{A P V} + 0.1308 I_{U V} + 0.1580 I_{C E S} + 0.2133 I_{I A} + 0.1721 I_{E} + 0.1619 I_{U S}$
Subindicator	Formula	Score	Description
Adequate rainwater management on roads (I_APV)	$I_{A P V} = \frac{D r v p}{D r t} \times 100 %$	By formula	D_rvp = number of households in the rural agglomeration located on roads with pavement, curbs, and manholes D_rt = number of households in the rural agglomeration
Difficult or impossible to use access roads (I_UV)	$I_{U V} = \frac{D r a c}{D r t} \times 100 %$	By formula	D_rac = number of households in the rural agglomeration that did not experience access difficulties to their homes in the last five years D_rt = number of households in the rural agglomeration
Control of surface runoff (I_CES)	$I_{C E S} = \frac{Drce}{D r t} \times 100 %$	By formula	D_rce = number of households in the rural agglomeration with excess runoff control devices, such as contour lines, channels or ditches, or others D_rt = number of households in the rural agglomeration
Occurrence of flooding and inundation (I_IA)	$I_{I A} = \frac{Dria}{D r t} \times 100 %$	By formula	D_ria = number of households in the rural agglomeration without flooding in the last five years and inundation D_rt = number of households in the rural agglomeration
Erosions (I_E)	$I_{E} = \frac{Dre}{D r t} \times 100 %$	By formula	D_re = number of properties in the rural agglomeration that did not show erosion D_rt = number of households in the rural agglomeration
Soil use (I_US)	$I_{U S} = CuS \times 100 %$	By formula	Predominant soil use of rural agglomeration (C_us), criteria: native vegetation: 1; pasture: 0.5; agriculture: 0.25; exposed soil: 0
$I_{Health} = 0, 1557 I_{D D} + 0, 1292 I_{D H} + 0, 1038 I_{V D} + 0, 1018 I_{V E} + 0, 0941 I_{V L} + 0, 1710 I_{M I} + 0, 1414 I_{P T A} + 0, 1030 I_{P H M}$
Subindicator	Formula	Score	Description
Diarrhea occurrence (I_DD)	$I_{D D} = (1 - \frac{H r d d}{H r t}) \times 100 %$	By formula	H_rdd = number of inhabitants living in the rural agglomeration with diarrhea in the last month. H_rt = number of inhabitants living in the rural agglomeration
Hepatitis A Occurrence (I_DH)	$I_{D H} = (1 - \frac{H r d h}{H r t}) \times 100 %$	By formula	H_rdh = number of inhabitants living in the rural agglomeration diagnosed with hepatitis A H_rt = number of inhabitants living in the rural agglomeration
Dengue (I_VD)	$I_{V D} = (1 - \frac{H r v d}{H r t}) \times 100 %$	By formula	H_rvd = number of residents in the rural agglomeration diagnosed with dengue, zika, chikungunya or yellow fever H_rt = number of inhabitants living in the rural agglomeration
Schistosomiasis (I_VE)	$I_{V E} = (1 - \frac{Hrve}{H r t}) \times 100 %$	By formula	H_rve = Number of inhabitants living in the rural agglomeration diagnosed with schistosomiasis H_rt = number of inhabitants living in the rural agglomeration
Leptospirosis (I_VL)	$I_{V L} = (1 - \frac{H r v l}{H r t}) \times 100 %$	By formula	H_rvl = number of inhabitants living in the rural agglomeration diagnosed with leptospirosis H_rt = number of inhabitants living in the rural agglomeration
Infant Mortality (I_MI)	$I_{M I} = (1 - \frac{C r m i}{C r t}) \times 100 %$	By formula	C_rmi = number of children under 1 year old living in the rural agglomeration with death in the last year C_rt = total number of children under 1 year old residing in the rural agglomeration
Domestic water treatment (I_PTA)	$I_{P T A} = \frac{D r t a}{D r t} \times 100 %$	By formula	D_rta = number of households in the rural agglomeration performing some treatment on their drinking water, such as filtration, boiling or disinfection D_rt = number of households in the rural agglomeration
Hand hygiene (I_PHM)	$I_{P H M} = \frac{\frac{H r m r}{H r t} + \frac{H r m b}{H r t}}{2} \times 100 %$	By formula	H_rmr = number of residents in the rural agglomeration who always wash their hands with soap and water before meals H_rmb = number of inhabitants living in the rural agglomeration who always wash their hands with soap and water after using the toilet H_rt = number of inhabitants living in the rural agglomeration
$I_{S E} = 0, 4389 I_{R F} + 0, 2556 I_{E C F} + 0, 3056 I_{E D}$
Subindicator	Formula	Score	Description
Per capita family income (I_RF)	$I_{R F} = \frac{Drrf}{D r t} \times 100 %$	By formula	D_rrf = number of households in the rural agglomeration with monthly per capita family income greater than or equal to one minimum wage D_rt = number of households in the rural agglomeration
Education of the head of household (I_ECF)	$I_{E C F} = \frac{Drecf}{Drt} \times 100 %$	By formula	D_recf = number of households in the rural agglomeration whose head of household has at least completed elementary school D_rt = number of households in the rural agglomeration
Education (I_ED)	$I_{E D} = \sqrt[4]{E p a * F p j^{2}}$	By formula	Schooling of the adult population (E_pa) = percentage of the rural agglomeration’s inhabitants aged 18 years or more with complete elementary education School attendance rate of the young population (F_pj): arithmetic mean (1) of the percentage of children between 5 and 6 years old attending school; (2) of the percentage of young people between 11 and 13 years old attending the final years of regular elementary school; (3) of the percentage of young people between 15 and 17 years old with complete elementary school, and (4) of the percentage of young people between 18 and 20 years old with complete high school
$I_{services} = 0, 2222 I_{E} + 0, 2806 I_{S} + 0, 2000 I_{E E} + 0, 1444 I_{M C} + 0, 1528 I_{T P}$
Subindicator	Formula	Score	Description
Education (I_E)	$I_{E} = E \times 100 %$	By formula	Basic education in the rural agglomeration (E), criterion: rural agglomeration is served by basic education service (school in the rural agglomeration or availability of school transport to a basic education unit) = 1; rural agglomeration is not served by public education service = 0
Health (I_S)	$I_{S} = S x 100 %$	By formula	Health in the rural agglomeration (S), criterion: rural agglomeration is served by a health service (health center or community health workers) = 1; rural agglomeration is not served by a public health service = 0
Electric power (I_EE)	$I_{E E} = \frac{Dree}{Drt} \times 100 %$	By formula	D_ree = number of households in the rural agglomeration with electric power. D_rt = number of households in the rural agglomeration
Means of communication (I_MC)	$I_{M C} = \frac{D r m c}{D r t} \times 100 %$	By formula	D_rmc = number of rural agglomeration households with access to telephone, radio, television or internet D_rt = number of households in the rural agglomeration
Public Transportation (I_TP)	$I_{T P} = T p \times 100 %$	By formula	Public transport in the rural agglomeration (T_p), criterion: rural agglomeration is served by public transport service = 1; rural agglomeration is not served by public transport service = 0
$I_{C M} = 0, 1430 I m p + 0, 1505 I_{P A} + 0, 1555 I_{C A} + 0, 3125 I_{B} + 0, 2385 I_{R A}$
Subindicator	Formula	Score	Description
Material used on the wall (I_MP)	$I_{M P} = \frac{D r m p}{D r t} \times 100 %$	By formula	D_rmp = number of households in the rural agglomeration with masonry and plaster walls D_rt = number of households in the rural agglomeration
Adequate flooring (I_PA)	$I_{P A} = \frac{Drpa}{Drt} \times 100 %$	By formula	D_rpa = number of households in the rural agglomeration with an impermeable floor or one that facilitates adequate cleaning D_rt = number of households in the rural agglomeration
Adequate Coverage (I_CA)	$I_{C A} = \frac{Drca}{D r t} \times 100 %$	By formula	D_rca = number of households in the rural agglomeration with tile roofing or other adequate rainwater insulation and thermal insulation D_rt = number of households in the rural agglomeration
Bathroom (I_B)	$I_{B} = \frac{D r b}{D r t} \times 100 %$	By formula	D_rb = number of households in the rural agglomeration that have a bathroom with toilet and shower D_rt = number of households in the rural agglomeration
Adequate Internal Water Reservation (I_RA)	$I_{R A} = \frac{Drra}{Drt} \times 100 %$	By formula	D_rra = number of households in the rural agglomeration with an internal water reservoir (water tank) that is capped and sanitized every six months mD_rt = number of households in the rural agglomeration with an internal reservoir

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[TFN2] ^a Agglomeration.

[TFN3] ^bQuilombola .

[TFN4] ^c Riverside.

[TFN5] Note: environmental salubrity conditions: blue = salubrity (from 76 to 100 points), green = medium salubrity (from 51 to 75 points), orange = low salubrity (from 26 to 50 points), and red = insalubrity (0 to 25 points).