Socioeconomic inequities and hepatitis A virus infection in Western Brazilian Amazonian children: spatial distribution and associated factors

Saulo A. S. Mantovani, Breno Matos Delfino, Antonio C. Martins, Humberto Oliart-Guzmán, Thasciany M. Pereira, Fernando L. C. C. Branco, Athos Muniz Braña, José A. Filgueira-Júnior, Ana P. Santos, Rayanne A. Arruda, Andréia S. Guimarães, Alanderson A. Ramalho, Cristieli Sergio de Menezes Oliveira, Thiago S. Araújo, Nancy Arróspide, Carlos H. M. L. Estrada, Cláudia T. Codeço, Mônica da Silva-Nunes

Hepatitis A is still a neglected health problem in the world. The most affected areas are the ones with disadvantaged socioeconomic conditions. In Brazil, seroprevalence studies showed that 64.7 % of the general population has antibodies against HAV (hepatitis A virus), and the Amazon region has the highest seroprevalence in the country. In the present study the seroprevalence of total HAV antibodies in children between 1 and 5 years old residing in the urban area of Assis Brasil, Acre was measured and spatial distribution of several socioeconomic inequities was evaluated. In the year of 2011, seroprevalence rate was 16.66 %. Factors associated with having a positive serology identified by multivariate analysis were being of indigenous ethnicity [adjusted Odds Ratio (aOR) = 3.27, CI 1.45-7.28], usage of water from the public system (aOR = 8.18, CI 1.07-62.53), living in a house not located in a street (aOR = 3.48, CI 1.54-7.87), and child age over 4 years old (aOR = 2.43, CI 1.23-4.79). The distribution of seropositive children was clustered in the eastern part of the city, where several socioeconomic inequities (lack of flushed toilets, lack of piped water inside the household and susceptibility of the household to flooding during rain, low maternal education, having wood or ground floor at home, and not owning a house, lack of piped water at home, and type of drinking water) also clustered. The findings highlight that sanitation and water treatment still need improvement in the Brazilian Amazon, and that socioeconomic development is warranted in order to decrease this and other infectious diseases.