Child Undernutrition Following the Introduction of a Large-Scale Toilet Construction Campaign in India

Singh, Parvati; Shah, Manisha; Bruckner, Tim A.

doi:10.2139/ssrn.3471993

SSRN Journal

2019

DOI: 10.2139/ssrn.3471993

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Child Undernutrition Following the Introduction of a Large-Scale Toilet Construction Campaign in India

Parvati Singh

Manisha Shah²,

Tim A. Bruckner

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2020

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“…Whereas India has implemented other sanitation policies in the decades preceding SBM, none of the prior programs combined public awareness campaigns with toilet construction on the scale of SBM (25). Recent work suggests that increased toilet availability following the SBM program may have reduced child undernutrition(26) and diarrheal outbreaks(27) in India. However, we know of no work that examines whether these improvements extend to reduced VPD prevalence among u5Indian children.…”

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Vaccine Preventable Diseases in Children Following a Nationwide Sanitation Campaign

Singh

Forthal

Shah

et al. 2020

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Background: India consistently reports the most diphtheria, pertussis, tetanus and measles cases worldwide. Persistent exposure to fecal pathogens due to open defecation may cause environmental enteropathy that in may lead to undernutrition and vaccine failure in under 5-year old (u5) children. The Swachh Bharat Mission (SBM) program in India, launched in 2014, aimed to construct toilets for every household nationwide and reduce open defecation. Objective: We examine whether increased household toilet availability in Indian districts corresponds with a reduction in 4 Vaccine Preventable Diseases (VPDs): diphtheria, pertussis, tetanus and measles.Methods: We retrieved data on district level change in the prevalence (per 1000 u5 children) of 4 VPDs, from 2013 (pre-SBM) to 2016 (post-SBM). We obtained data on our exposure, the change in the percentage of households with toilets (per district), from three large national surveys conducted in 2013 and 2016. We used linear regression analysis which controlled for change over time in socioeconomic factors, health system-related covariates and pre-SBM prevalence of VPDs.Results: A one percentage point increase in households with toilets corresponds with 0.33 fewer measles cases per 1000 u5 children in that district (coefficient: -0.33, 95% CI: -0.0641, -0.014; p < 0.05). We observe no relation with diphtheria, pertussis, or tetanus. Conclusion: Rapid improvements in ambient sanitation through increased toilet availability (and reduction in open defecation) may correspond with reduction in the prevalence of measles in u5 children.

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confidence: 99%

Vaccine Preventable Diseases in Children Following a Nationwide Sanitation Campaign

Singh

Forthal

Shah

et al. 2020

Preprint

Self Cite

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Child Undernutrition Following the Introduction of a Large-Scale Toilet Construction Campaign in India

Cited by 1 publication

References 58 publications

Vaccine Preventable Diseases in Children Following a Nationwide Sanitation Campaign

Vaccine Preventable Diseases in Children Following a Nationwide Sanitation Campaign

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