Sanitation Gaps, Health Knowledge, and Cultural Resignation: Mapping Parasitic Infections and Diarrhea in a Vulnerable Urban Area of Itacoatiara, Brazilian Amazon

Intestinal parasitic infections and diarrheal diseases remain entrenched public health challenges in neglected corners of the Global South, particularly within the socio-environmental margins of the Brazilian Amazon. This cross-sectional mixed-methods study explored the burden and determinants of these conditions in two vulnerable urban neighborhoods of Itacoatiara, a midsize municipality in Amazonas State. Data collection involved 373 household surveys, 27 semi-structured interviews stratified by health literacy levels, and parasitological analyses of both stool and drinking water samples. The findings depict a striking paradox: while most homes are masonry-built, they exist amid open sewage, sporadic waste collection, and systemic infrastructural neglect. High rates of untreated water consumption, frequent diarrheal episodes, and contamination of household water sources were documented. Qualitative insights further revealed widespread misconceptions about disease transmission, precarious health knowledge, and a pervasive sense of cultural resignation, fueled by institutional absence. Crucially, the persistence of these preventable diseases is not rooted in individual choices, but in structural failures that reproduce health inequities. By illuminating the interwoven roles of infrastructural gaps, cognitive dissonance, and state disengagement, this study calls for more than conventional public health responses—it urges intersectional, territory-aware interventions tailored to the Amazon’s urban peripheries. Introduction