RESUMO
The objectives of this study were to examine the seasonal changes in the risk of gastrointestinal (GI) illness of beachgoers in the tropics, to compare the association between GI illness and water quality using various indicator organisms, and to study other beach health hazards. A prospective cohort study during two seasonal periods (summer and autumn) was conducted in a beach surrounded by intensive residential development. Analyses demonstrated that although densities of indicators were well below water quality standards throughout the study, they were significantly higher during the autumn season. The incidence of GI illness among beachgoers was also higher during the rainy season. A higher incidence of GI illness was observed for bathers during the autumn season when compared to non-bathers, while a somewhat lower incidence was observed during the summer. This study showed that rainfall contributes to higher levels of microbial contaminants and GI risk to beachgoers. The association between GI illness and Enterococcus using culture counts showed the highest odds ratio among all indicator parameters including those using molecular methods. A much higher risk of GI illness among children under 5 years was observed among all beachgoers.
Assuntos
Bactérias/isolamento & purificação , Praias , Gastroenteropatias/epidemiologia , Água do Mar/microbiologia , Adolescente , Adulto , Fatores Etários , Bactérias/genética , Bactérias/crescimento & desenvolvimento , Criança , Pré-Escolar , Estudos de Coortes , Contagem de Colônia Microbiana , DNA Bacteriano/análise , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Reação em Cadeia da Polimerase , Estudos Prospectivos , Porto Rico/epidemiologia , Estações do Ano , Análise de Sequência de DNA , Clima Tropical , Qualidade da Água , Adulto JovemRESUMO
INTRODUCTION: Two hundred and thirty nine (239) drinking water systems in Puerto Rico are not connected to the Puerto Rico Aqueducts and Sewers Authority (PRASA), and are thus known as Non-PRASA drinking water systems. Population served estimates by Non-PRASA systems are in the 100,000 to 300,000 range. OBJECTIVES: To identify the determinants of compliance with drinking water standards by rural drinking water systems in Puerto Rico. To identify the best analytical methods for studying the problem of non-compliance with drinking water standards in Puerto Rico and its generalization to similar communities elsewhere. METHODS: We reviewed capacity development and drinking water system evaluations performed by governmental and academic institutions between 1993 and 2004. Community and system variables were used to fit a multilevel model to predict compliance with drinking water standards. Data was obtained from the Environmental Protection Agency' Safe Drinking Water Information System and the Puerto Rico Health Department drinking water database for 231 systems, serving 90,000 persons. RESULTS: There was an 11% increase in compliance (1996 = 4%; 2000=15%), a decrease of 13,634 people served by non-compliant systems (1996 = 86,169; 2000 = 72,535) and a 6% decrease in the number of non-compliant systems which had installed treatment equipment (1996 = 93%; 2000=87%). The prevalence of compliance among those systems that had installed treatment equipment was higher than among those systems that did not have treatment equipment, after adjusting by the time period (est. POR = 2.2, 95% CI, 1.40 - 3.44). CONCLUSIONS: Our findings suggest alternative public health strategies are needed to ensure sustained safe water capacity in rural communities.