Infectious diarrhea remains a significant cause of childhood morbidity in developing countries. In Brazil, beyond etiological agents, structural factors such as limited access to clean water and sanitation contribute to its persistence. Regions such as the North and Northeast, as well as Indigenous and Brown (parda) populations, exhibit greater vulnerability, reflecting long-standing historical inequities. Most hospitalized children are Brown, illustrating how racial and territorial inequalities overlap. The objective of this study is to analyze the relationship between sewerage coverage and hospital morbidity from infectious diarrhea in children up to 4 years of age in Brazil, considering regional and racial disparities. This is a descriptive ecological study using secondary DATASUS data (2019–2022) on hospitalizations for diarrhea in children aged 1 to 4 years, stratified by race/color and region. Data were compared with average sewer network service indices from SNIS, based on indicator IN056. Between 2019 and 2022, the North and Northeast regions accounted for most hospital hospitalizations. In 2019, there were 33,542 admissions (Northeast: 12,027; North: 8,919; Southeast: 6,964; Center-West: 2,879; South: 2,753). In 2020, there were 18,687 (Northeast: 7,383; North: 6,068; Southeast: 2,840; Center-West: 1,188; South: 1,208). In 2021, there were 21,805 (Northeast: 7,440; North: 6,916; Southeast: 3,959; Center-West: 1,960; South: 1,530). In 2022, the total reached 24,314 (Northeast: 9,130; North: 6,536; Southeast: 4,416; Center-West: 2,283; South: 1,949). Sewerage coverage gradually increased over the years but remained unequal: in 2022, the final year evaluated, coverage was 14.7% in the North, 31.4% in the Northeast, 49.7% in the South, 62.3% in the Center-West, and 80.9% in the Southeast. Most hospitalizations occurred among Brown children, reflecting greater exposure to social vulnerability. An inverse relationship was observed between sewerage coverage and morbidity, although factors such as health education, hygiene practices, and access to clean water also influenced outcomes. Childhood diarrhea remains associated with inadequate sanitation and structural inequities. Infrastructure investments must prioritize the North and Northeast, particularly areas with higher concentrations of Brown populations. Educational initiatives and the use of geographic tools may strengthen the territorial targeting of interventions.
Lourenço et al. (Sun,) studied this question.