Old indicators for new problems: the relationship between sanitation and health

Objective. To review the literature published from 1995-2004 on the relationship between sanitation and health and to identify the main variables analyzed and the diseases or injuries used as markers of effect or environmental health. Method. A search of Medline, SciELO, and LILACS on sanitation and health and "indicator" and "water" produced 103 articles, 17 of which were considered relevant for the analysis. We identified the study design and the sanitation and health variables analyzed in each of the 17 studies. Results. The most common study design was ecological and was employed in seven of the 17 studies. In most (10 studies), the health variable was diarrhea and sanitation variable was water quality. Fifteen studies reported a positive association between the health and sanitation variables. Conclusions. There are still many gaps in our understanding of sanitation and its role, especially in large urban centers that are dependent on water and sewerage systems and often lack alternative water sources. Ecological studies based on secondary data and specific surveys have been shown to be a good option for analyses correlating sanitation and health.