Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection and malnutrition in India

Abstract

The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, how, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people's lives. 3ie impact evaluations3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report3ie accepted the final version of this report, Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection and child malnutrition in India, as partial fulfilment of requirements under grant OW2.063 issued under Open Window 2. The content has been copy-edited and formatted for publication by 3ie. Due to unavoidable constraints at the time of publication, some figures and tables are not optimal. All of the content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its board of commissioners. Any errors and omissions are the sole responsibility of the authors. Any comments or queries should be directed to the corresponding author, Thomas Clasen, thomas.f.clasen@emory.edu Summary BackgroundA third of the 2.5 billion people worldwide without access to improved sanitation live in India, as do two-thirds of the 1.1 billion practising open defecation and a quarter of the 1.5 million who die annually from diarrhoeal diseases. We aimed to assess the effectiveness of a rural sanitation intervention, within the context of the Government of India's Total Sanitation Campaign, to prevent diarrhoea, soil-transmitted helminth infection and child malnutrition. MethodsWe did a cluster-randomised controlled trial between 20 May 2010 and 22 December 2013, in 100 rural villages in Odisha, India. Households within villages were eligible if they had a child younger than four years or a pregnant woman. Villages were randomly assigned (1:1), with a computer-generated sequence, to undergo latrine promotion and construction or to receive no intervention (control). Randomisation was stratified by administrative block to ensure an equal number of intervention and control villages in each block. Masking of participants was not possible because of the nature of the intervention. However, households were not told explicitly that the purpose of enrolment was to study the effect of a trial intervention, and the surveillance team was different from the intervention team. The primary endpoint was seven-day prevalence of reported diarrhoea in children younger than five years. We did intention-to-treat and per-protocol analyses. This trial is registered with ClinicalTrials.gov, no. NCT01214785. FindingsWe randomly assig...

WASH and Nutrition Synergies: The Case of Tunisia

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