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Doctoral Thesis
DOI
https://doi.org/10.11606/T.6.2005.tde-10022021-155714
Document
Author
Full name
Clarice Umbelino de Freitas
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2005
Supervisor
Committee
Gouveia, Nelson da Cruz (President)
Franco Netto, Guilherme
Capitani, Eduardo Mello de
Cardoso, Maria Regina Alves
Jacobi, Pedro Roberto
Title in Portuguese
Vigilância de população exposta a chumbo no município de Bauru - São Paulo: investigação de fatores de risco de exposição e avaliação da dinâmica institucional
Keywords in Portuguese
Áreas Contaminadas
Chumbo
Criança
Epidemiologia
Intersetorialidade
Vigilância
Abstract in Portuguese
Introdução: Por requisição da Secretaria de Meio Ambiente realizou-se estudo de exposição em população de área contaminada por chumbo no município de Bauru. Objetivos: Realizar diagnóstico de exposição de crianças residentes no entorno da empresa contaminadora para propor medidas de controle, avaliar o impacto destas medidas e descrever a dinâmica institucional entre os atores envolvidos, buscando dar subsídios para casos similares. Métodos: Estudo transversal com aplicação de questionário aos genitores e dosagem de chumbo no sangue (PbS) em todas as crianças menores de 13 anos no raio de 1 km da empresa. Foram feitas comparações das médias de chumbo antes e após as medidas de controle e regressão logística para identificação de fatores de risco. Analisaram-se as funções e atividades das instituições a partir do arcabouço legal da intersetorialidade, noções de redes e governança. Resultados: Das 850 crianças investigadas, 311 apresentaram níveis de plumbemia acima do estabelecido pela Organização Mundial de Saúde. Os fatores de risco identificados foram: morar em área não asfaltada, genitor trabalhar na empresa, distância da fonte, brincar na terra, comer terra, tomar leite local, número de crianças no domicilio. Após as medidas de controle houve queda de 46% nas médias de PbS, considerando 241 crianças reavaliadas, das 311 com PbS >= a 10µg/dL. A análise da dinâmica institucional levanta a necessidade do estabelecimento de formas mistas de gerenciamento. Conclusões: O estudo subsidiou a tomada de decisões relativas à remediação e abordagem utilizada indica novas formas de gerenciamento de áreas contaminadas no Estado de São Paulo.
Title in English
Surveillance of lead exposure in the city of Bauru - SP: investigating risk factors and evaluating the institutional dynamics
Keywords in English
Child
Contaminated Areas
Epidemiology
Intersectorial Approaches
Lead
Surveillance
Abstract in English
Introduction: the Secretary of Environment of the State of São Paulo demanded an evaluation of lead exposure in an area of Bauru. Objectives: to ascertain the lead exposure of children to propose control measures, evaluate the impact of these measures, and to describe the institutional dynamics among the partners invoved in order to advise other similar cases. Methods: cross-sectional study of all children < 13 years old in a radius of 1 km from the plant responsible for the contamination. Blood Lead Levels (BLL) were determined for each child and questionnaires were applied to their parents. Mean BLL were compared before and after the control measures. Logistic regression identified risk factors of lead esposure. The role and activities of the partners were described and analyzed through the legal framework of intersectoral approaches, and the concepts of networks and governance. Results: of the 850 investigated children, 311 presented BLL above the limits established by the World Health Organization. The risk factors identified were: to live in unpaved areas, parent working in the plant, distance from the plant, to play on the ground, to eat earth, and to drink local milk. After control measures a reduction of 46% in BLL was identified considering 241 re-evaluated children with BLL >= 10µg/dL. The analysis of the institutional dynamics points towards a need to establish hybrid forms of management. Conclusions: this study informed the decision-making process regarding management of contaminated areas. The institutional dynamics point towards new arrangements for the different actors involved.
 
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Publishing Date
2021-02-10
 
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