Village Sanitation and Children's Human Capital: Evidence from a Randomized Experiment by the Maharashtra Government

Hammer, Jeffrey S.; Spears, Dean

doi:10.1596/1813-9450-6580

Cited by 58 publications

(64 citation statements)

References 35 publications

(34 reference statements)

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“…In a recent analysis of data from 140 Demographic and Health Survey (DHS) from 65 countries, open defecation explains 54% of the variation in average child height among poor and middle-income countries, and 65% when the population density of open defecation is considered, because poor sanitation is a larger threat when children live nearer to it [17]. A second paper, released by the World Bank Water and Sanitation Program, presents the findings from a cluster randomized controlled trial of a community-level government sanitation program in a district of Maharashtra, India and reports a protective effect on child height adjusted for age [18]. …”

Section: Introductionmentioning

confidence: 99%

Open Defecation and Childhood Stunting in India: An Ecological Analysis of New Data from 112 Districts

Ghosh²,

2013

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Poor sanitation remains a major public health concern linked to several important health outcomes; emerging evidence indicates a link to childhood stunting. In India over half of the population defecates in the open; the prevalence of stunting remains very high. Recently published data on levels of stunting in 112 districts of India provide an opportunity to explore the relationship between levels of open defecation and stunting within this population. We conducted an ecological regression analysis to assess the association between the prevalence of open defecation and stunting after adjustment for potential confounding factors. Data from the 2011 HUNGaMA survey was used for the outcome of interest, stunting; data from the 2011 Indian Census for the same districts was used for the exposure of interest, open defecation. After adjustment for various potential confounding factors – including socio-economic status, maternal education and calorie availability – a 10 percent increase in open defecation was associated with a 0.7 percentage point increase in both stunting and severe stunting. Differences in open defecation can statistically account for 35 to 55 percent of the average difference in stunting between districts identified as low-performing and high-performing in the HUNGaMA data. In addition, using a Monte Carlo simulation, we explored the effect on statistical power of the common practice of dichotomizing continuous height data into binary stunting indicators. Our simulation showed that dichotomization of height sacrifices statistical power, suggesting that our estimate of the association between open defecation and stunting may be a lower bound. Whilst our analysis is ecological and therefore vulnerable to residual confounding, these findings use the most recently collected large-scale data from India to add to a growing body of suggestive evidence for an effect of poor sanitation on human growth. New intervention studies, currently underway, may shed more light on this important issue.

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Section: Introductionmentioning

confidence: 99%

Open Defecation and Childhood Stunting in India: An Ecological Analysis of New Data from 112 Districts

Ghosh²,

2013

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“…5 CLTS has been found to increase the rate of toilet construction and decrease the prevalence of open defecation (Cameron et al, 2013;Gertler et al, 2015;Pattanayak et al, 2010;Patil et al, 2014;Hammer and Spears, 2013).…”

Section: Background On Cltsmentioning

confidence: 99%

Initial Conditions Matter: Social Capital and Participatory Development

2015

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. The Institute for the Study of Labor (IZA) in Bonn is a local and virtual international research center and a place of communication between science, politics and business. IZA is an independent nonprofit organization supported by Deutsche Post Foundation. The center is associated with the University of Bonn and offers a stimulating research environment through its international network, workshops and conferences, data service, project support, research visits and doctoral program. IZA engages in (i) original and internationally competitive research in all fields of labor economics, (ii) development of policy concepts, and (iii) dissemination of research results and concepts to the interested public. Terms of use: Documents inIZA Discussion Papers often represent preliminary work and are circulated to encourage discussion. Citation of such a paper should account for its provisional character. A revised version may be available directly from the author. Billions of dollars have been spent on participatory development programs in the developing world. These programs give community members an active decision-making role. Given the emphasis on community involvement, one might expect that the effectiveness of this approach would depend on communities' pre-existing social capital stocks. Using data from a large randomised field experiment of Community-Led Total Sanitation in Indonesia, we find that villages with high initial social capital built toilets and reduced open defecation, resulting in substantial health benefits. In villages with low initial stocks of social capital, the approach was counterproductive -fewer toilets were built than in control communities and social capital suffered. JEL Classification:O12, O22, I15

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“…A meta-analysis [43] of five cluster-randomized trials showed no effect of interventions to improve water access and handwashing on underweight and only borderline statistically significant impacts on linear growth (or HAZ). However, results from a few randomized studies [44, 45], including an analysis of cluster randomized interventions in India, Indonesia, Mali and Tanzania [46], and another in Ethiopia [38], found positive improved sanitation impacts on mean HAZ. The analysis by Gertler et al [46] notes the importance of community context, concluding that impact on HAZ on improvements in individual and household sanitation behavior is limited as long as the community context does not also improve.…”

Section: Introductionmentioning

confidence: 99%

Children with access to improved sanitation but not improved water are at lower risk of stunting compared to children without access: a cohort study in Ethiopia, India, Peru, and Vietnam

et al. 2017

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BackgroundThis study’s purpose was to understand associations between water, sanitation, and child growth.MethodsWe estimated stunting (height-for-age Z score <−2 SD) and thinness (BMI-Z <−2 SD) risk ratios using data from 7,715 Ethiopian, Indian, Peruvian, and Vietnamese children from the Young Lives study. ResultsIn unadjusted models, household access to improved water and toilets was often associated with reduced stunting risk. After adjusting for child, household, parent, and community variables, access to improved water was usually not associated with stunting nor thinness except in Ethiopia where access to improved water was associated with reduced stunting and thinness at 1y and 5y. In contrast, in both unadjusted and adjusted models, stunting at 1y was less common among children with good toilet access than among those without access and this difference persisted when children were 5y and 8y. For example, in adjusted estimates, Vietnamese 5y olds with access to improved toilets had relative stunting risk at 8y 0.62-0.68 that of 5y olds with no access to improved toilets. Water and toilets were rarely associated with thinness.ConclusionsResults from our study indicate that access to improved sanitation is more frequently associated with reduced stunting risk than access to improved water. However, additional studies are needed before drawing definitive conclusions about the impact of toilets relative to water. This study is the first to our knowledge to demonstrate the robust and persistent importance of access to improved toilets in infancy, not only during the first year but continuing into childhood. Additional longitudinal investigations are needed to determine concurrent and long-term associations of WASH with stunting and thinness.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4033-1) contains supplementary material, which is available to authorized users.

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Village Sanitation and Children's Human Capital: Evidence from a Randomized Experiment by the Maharashtra Government

Cited by 58 publications

References 35 publications

Open Defecation and Childhood Stunting in India: An Ecological Analysis of New Data from 112 Districts

Open Defecation and Childhood Stunting in India: An Ecological Analysis of New Data from 112 Districts

Initial Conditions Matter: Social Capital and Participatory Development

Children with access to improved sanitation but not improved water are at lower risk of stunting compared to children without access: a cohort study in Ethiopia, India, Peru, and Vietnam

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