Primary Factors Statistically Associated with Diarrheal Occurrences

To successfully prevent diarrheal pathogen transmission, a variety of causal pathways should be considered. This study utilized a suite of tools to identify primary factors associated with diarrheal occurrences in a set of communities in Para, Brazil that had received a biosand filter (BSF). First, existing Demographic and Health Survey data sets from the departments of Para and Amazonas, Brazil were analyzed using three statistical techniques, namely: Mahalanobis-Taguchi Strategy, canonical correlation analysis, and latent factor regression. Second, results of statistical analyses were combined with a literature review and field observations to locally adapt a previously validated structural equation model (SEM) originally developed for Quiche, Guatemala. Third, a randomized household survey was used to collect data - including water sources, sanitation facilities, hygiene practices, socioeconomic statuses, education levels, BSF maintenance, and diarrheal occurrences - in Para, Brazil and analyzed with the hypothesized SEM. Household education level had the largest significant negative effect size on diarrheal occurrence, while improved water source had the largest positive significant effect size on diarrheal occurrence. Maintenance of the BSF in the home had a negligible effect size on diarrheal occurrence. Complex associations observed in the SEM between diarrheal occurrence and a variety of causal pathways support the view that a multibarrier intervention is warranted