I get height with a little help from my friends: herd protection from sanitation on child growth in rural Ecuador

Fuller, James A.; Villamor, Eduardo; Cevallos, William; Trostle, James; Eisenberg, Joseph N. S.

doi:10.1093/ije/dyv368

Cited by 84 publications

(88 citation statements)

References 40 publications

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“…Few studies have examined the relationship between community sanitation usage and health outcomes 16 , 41 – 44 . The conclusions from this study are strengthened by its size, population-based estimates and consideration of latrine use rather than latrine ownership.…”

Section: Discussionmentioning

confidence: 81%

Active trachoma and community use of sanitation, Ethiopia

Oswald

Stewart

Kramer

et al. 2017

Bull. World Health Organ.

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ObjectiveTo investigate, in Amhara, Ethiopia, the association between prevalence of active trachoma among children aged 1–9 years and community sanitation usage.MethodsBetween 2011 and 2014, prevalence of trachoma and household pit latrine usage were measured in five population-based cross-sectional surveys. Data on observed indicators of latrine use were aggregated into a measure of community sanitation usage calculated as the proportion of households with a latrine in use. All household members were examined for clinical signs, i.e. trachomatous inflammation, follicular and/or intense, indicative of active trachoma. Multilevel logistic regression was used to estimate prevalence odds ratios (OR) and 95% confidence intervals (CI), adjusting for community, household and individual factors, and to evaluate modification by household latrine use and water access.FindingsIn surveyed areas, prevalence of active trachoma among children was estimated to be 29% (95% CI: 28–30) and mean community sanitation usage was 47% (95% CI: 45–48). Despite significant modification (p < 0.0001), no pattern in stratified ORs was detected. Summarizing across strata, community sanitation usage values of 60 to < 80% and ≥ 80% were associated with lower prevalence odds of active trachoma, compared with community sanitation usage of < 20% (OR: 0.76; 95% CI: 0.57–1.03 and OR: 0.67; 95% CI: 0.48–0.95, respectively).ConclusionIn Amhara, Ethiopia, a negative correlation was observed between community sanitation usage and prevalence of active trachoma among children, highlighting the need for continued efforts to encourage higher levels of sanitation usage and to support sustained use throughout the community, not simply at the household level.

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Section: Discussionmentioning

confidence: 81%

Active trachoma and community use of sanitation, Ethiopia

Oswald

Stewart

Kramer

et al. 2017

Bull. World Health Organ.

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“…16 For all outcomes, we also completed the analysis using a radius of 500 m and 1 km. Radii of less than 200 m were not useful in the study area due to low household density.…”

Section: Resultsmentioning

confidence: 99%

Community-Level Sanitation Coverage More Strongly Associated with Child Growth and Household Drinking Water Quality than Access to a Private Toilet in Rural Mali

Harris

Alzúa

Osbert

et al. 2017

Environ. Sci. Technol.

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Sanitation access can provide positive externalities; for example, safe disposal of feces by one household prevents disease transmission to households nearby. However, little empirical evidence exists to characterize the potential health benefits from sanitation externalities. This study investigated the effect of community sanitation coverage versus individual household sanitation access on child health and drinking water quality. Using a census of 121 villages in rural Mali, we analyzed the association of community latrine coverage (defined by a 200 m radius surrounding a household) and individual household latrine ownership with child growth and household stored water quality. Child height-for-age had a significant and positive linear relationship with community latrine coverage, while child weight-for-age and household water quality had nonlinear relationships that leveled off above 60% coverage (p < 0.01; generalized additive models). Child growth and water quality were not associated with individual household latrine ownership. The relationship between community latrine coverage and child height was strongest among households without a latrine; for these households, each 10% increase in latrine coverage was associated with a 0.031 (p-value = 0.040) increase in height-for-age z-score. In this study, the level of sanitation access of surrounding households was more important than private latrine access for protecting water quality and child health.

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“…Most likely, context-level contamination also plays an important role in child health. In a study in rural Ecuador, neighbourhood sanitation was a stronger predictor of child growth than house sanitation coverage 39. Neighbourhood-level data on sanitation, water access and hygiene would help identify the specific effect of neighbourhood contamination on child stunting, within the broader effect of residential setting.…”

Section: Discussionmentioning

confidence: 99%