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Figures & Tables

Figure 1

Total number of cisterns built since 2003 in Brazil.

Source: Brazil, 2023 [12].

Table 1

Summary of articles describing cisterns’ impact on health outcomes in the Brazilian semi‑arid region.

REFERENCE AND LOCATIONDATA AND METHODSHEALTH OUTCOMEMAIN CONTRIBUTIONMAIN RESULTS
Luna et al. [25]. 21 municipalities of Pernambuco stateData was gathered from over 60 days and included 1,765 individuals
Longitudinal prospective study, nested in a cross‑sectional study comparing two groups (households with and without water tanks)
Occurrence of diarrheal episodesThe findings of this study point to the importance of access to drinking water for the reduction of diseaseAmong the 949 individuals with water tanks, there was a reduction in the risk of the occurrence of episodes of diarrhea by 73% compared with the 816 individuals without water tanks (RR = 0.27; p < 0.001)
Marcynuk et al. [26]. Agreste Central Region of Pernambuco stateLogistic regression using a face‑to‑face survey with 3,679 people from 774 households.Determine the 30‑day prevalence of diarrheaThis indicates that using cisterns for drinking water is associated with a decreased occurrence of diarrhea in this study population. Further research should be conducted to account for additional risk factors and preventative factorsPeople from households with a cistern had a significantly lower 30‑day period prevalence of diarrhea (prevalence = 11.0%; 95% CI 9.5–12.4) than people from households without a cistern (prevalence = 18.2%; 95% CI 16.4–20.0)
Silva, Heller and Carneiro* [30]. Two municipalities in the Médio Vale do Jequitinhonha, Minas Gerais: Berilo and Chapada do NorteQuasi‑experimental, using survey‑based analysis with 664 children under five years oldOccurrence of diarrhea in the last 72 hThe authors highlight the need to improve the sanitary practices of the rural population so that personal and household hygiene and hygiene concerning consumed water are incorporated into routine habitsThe total prevalence of diarrhea was 5% but no significant difference between the groups
Fonseca et al. [27]. Berilo and Chapada do Norte (Minas Gerais state)Quasi‑experimental study cohort with 664 childrenThe prevalence of G. duodenalis in children under 5 yearsThe study suggests the necessity of complementing physical interventions with personal and domestic hygiene actions to further reduce parasite infections, which mainly affect underprivileged populationsThey showed a higher risk of G. duodenalis infection in children who did not have access to rainwater cisterns when compared to children who did (OR 1.72; 95% CI 1.14–2.59)
Da Mata et al. [28]. All semi‑arid regionsAdministrative data from P1MC, CadÚnico, and SINASC. Fixed effects panel regression modelsBirth weightThe paper studies how in utero exposure to a large‑scale climate adaptation program affects birth outcomesAccess to cisterns during early pregnancy increased birth weight, particularly for more educated mothers. We show that each additional week of in utero exposure to cisterns is associated with a positive effect on an average birth weight of about 1.7 g.
Passador and Passador [14]. Municipality of Juazeiro, Bahia34 interviews with benefited familiesBeneficiaries’ perception of improved healthFamilies reported that water‑related illnesses, such as diarrhea, vomiting, and cramps, were quite common in families when they consumed poor‑quality water of dubious origin. However, since using water collected in the cistern, such diseases occur very sporadicallyUsing cisterns positively influences the quality of life of these families in terms of health, free time, income, and gender issues
Gomes and Heller [13]. 63 municipalities of Minas GeraisSurvey‑based analysis with 623 beneficiariesBeneficiaries’ perception of improved healthEmphasize that public water supply policies in semi‑arid rural areas must associate technical issues with management elements that consider local social, climatic, and economic specificitiesImprovements in the perception of the health of the benefited families and a reduction in the time spent searching for drinking water, but the challenges remain significant in precariousness and socioeconomic conditions and those related to an adequate supply of water in quantity and quality
Fagundes et al.* [29]. Alagoas stateSurvey‑based analysis with 29 familiesFood and nutritional securityThis study highlights the importance of water access programs for food production within public policies to guarantee FNSFood Insecurity Scale showed that food insecurity occurs in 75% of these families
However, focus groups showed that families positively perceive Boardwalk Cisterns for their food security. They believe that agricultural production has improved, offering a wider range of foods and improving food security

[i] Source: Authors’ own. *Not focused on the P1MC.

Figure 2

The conceptual analysis of the P1MC based on the DPSEEA framework.

Source: Authors’ own elaboration.

Table 2

Qualitative indicators supporting action on P1MC.

LEVELDETERMINANTS OR DRIVERSINDICATORSACTIONS
DriverClimate changeIncrease in rate of temperatureDevelopment and monitoring of a heat‑health action plan for the semi‑arid region
Pressure factorsIncreased frequency and intensity of droughts
  1. Precipitation level

  2. Drought duration and frequency

  3. Water reservoir levels

Monitoring to prevent deforestation
Environmental education on how to avoid soil pollution
Support for family farming
Social cash transfer program
Desertification
  1. Decline vegetation area between time intervals

  2. Decrease in soil organic matter content between time intervals

Increased demand for water
  1. Number of water trucks

Economic development
  1. GDP

  2. Poverty rate

  3. HDI

StateSemi‑arid region
  1. Region

ExposurePopulated rural areas
  1. Population in drought areas

  2. Rate of migration

  3. Number of children, adults and elderly (cohort data)

Educational policy for youth in the territories
Sustainable economic development policies
P1MC improvements
Health promotion actions and educational materials to preserve technology
Socioeconomic status
  1. Income rates

  2. Education rates

  3. Access to healthcare

  4. Age

  5. Gender

  6. Race‑color (cohort data)

Infrastructure
  1. Water coverage and sources

Water shortage
  1. Number of houses without cisterns

  2. Time to access water

Cultural identity
  1. Changes in hygiene practices

  2. Building capacity in managing cistern water

Water quality
  1. Perception of water quality by beneficiaries

  2. Water indicators (pH level, turbidity, etc.)

  3. Frequency of water quality tests

EffectsWater‑related diseases: Diarrhea, cholera, hepatitis A, parasitic diseases
  1. Disease rates

  2. Mortality

  3. Hospitalization

Health surveillance and promotion programs
Improvements of PHC
Diseases related to malnutrition: Childhood malnutrition, anemia, vitamin and mineral deficiencies
  1. Malnutrition disease rates

  2. Morbidity and mortality caused by these diseases

  3. Food diversity index (cohort data)

Psychological impacts: stress, anxiety, depression, and trauma related to forced migration
  1. Disease rates

  2. Behavior changes

  3. Testimonies on psychological distress (cohort data)

Health and well‑being
  1. Perception of life satisfaction

  2. HDI

[i] Source: Authors’ own.

DOI: https://doi.org/10.5334/aogh.4754 | Journal eISSN: 2214-9996
Language: English
Submitted on: Mar 28, 2025
Accepted on: Jun 2, 2025
Published on: Jul 22, 2025
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2025 José Firmino de Sousa Filho, Walisson Angélico de Araújo, Mariana Sebastião, Adalton Fonseca, Raíza Tourinho, Denise Pimenta, Gervásio Santos, Lucas Emanuel, Roberto F. S. Andrade, Gustavo Casais, Gisele Paixão, Andrea Ferreira, Rachel Coelho, Maria Yuri Ichihara, Júlia Pescarini, Joanna M. N. Guimarães, Paulo Victor da Costa, Ismael Silveira, Rafael Silva, Rita Ribeiro, Maurício L. Barreto, On behalf of the SEDHI team, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.