Child undernutrition, tropical enteropathy, toilets, and handwashing

Humphrey, Jean H.

doi:10.1016/s0140-6736(09)60950-8

Cited by 690 publications

(665 citation statements)

References 20 publications

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“…Enteropathy is hypothesized to cause growth faltering through poor nutrient absorption and low-level immune system stimulation (29). Nutritionists have hypothesized that toilet provision and handwashing with soap could reduce enteropathy and improve growth (37). Our findings indicate that the environmental improvements observed in this study have been insufficient to measurably improve growth (Fig.…”

Section: Discussionmentioning

confidence: 72%

Causal inference methods to study nonrandomized, preexisting development interventions

Arnold

Khush

Padmavathi

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

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Empirical measurement of interventions to address significant global health and development problems is necessary to ensure that resources are applied appropriately. Such intervention programs are often deployed at the group or community level. The gold standard design to measure the effectiveness of communitylevel interventions is the community-randomized trial, but the conditions of these trials often make it difficult to assess their external validity and sustainability. The sheer number of community interventions, relative to randomized studies, speaks to a need for rigorous observational methods to measure their impact. In this article, we use the potential outcomes model for causal inference to motivate a matched cohort design to study the impact and sustainability of nonrandomized, preexisting interventions. We illustrate the method using a sanitation mobilization, water supply, and hygiene intervention in rural India. In a matched sample of 25 villages, we enrolled 1,284 children <5 y old and measured outcomes over 12 mo. Although we found a 33 percentage point difference in new toilet construction [95% confidence interval (CI) = 28%, 39%], we found no impacts on height-for-age Z scores (adjusted difference = 0.01, 95% CI = −0.15, 0.19) or diarrhea (adjusted longitudinal prevalence difference = 0.003, 95% CI = −0.001, 0.008) among children <5 y old. This study demonstrates that matched cohort designs can estimate impacts from nonrandomized, preexisting interventions that are used widely in development efforts. Interpreting the impacts as causal, however, requires stronger assumptions than prospective, randomized studies.impact evaluation | study design | propensity score matching | communityled total sanitation | open defecation

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Section: Discussionmentioning

confidence: 72%

Causal inference methods to study nonrandomized, preexisting development interventions

Arnold

Khush

Padmavathi

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

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“…1.Literature in the medical and epidemiological fields link poor sanitation to poor nutritional outcomes and child height (Pickering, Djebbari, Lopez, Coulibaly, & Alzua, 2015) through diarrhoea (Checkley et al, 2004), intestinal parasites (Esrey, Potash, Roberts, & Shiff, 1991), and environmental enteropathy (Humphrey, 2009). A meta-analysis conducted by Gertler et al (2015) uses experimentally-induced variation in open defecation to identify a causal effect of open defecation on child height.…”

Section: Notesmentioning

confidence: 99%

Sanitation and Religion in South Asia: What Accounts for Differences across Countries?

Vyas

Spears

2018

The Journal of Development Studies

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Exposure to open defecation has serious consequences for child mortality, health, and human capital development. South Asia has the highest rates of open defecation worldwide, and although the incidence declines as household income rises, differences across South Asian countries are not explained by differences in per capita income. The rate of open defecation in sub-national regions of Bangladesh, India and Nepal is highly correlated with the fraction of the population that identifies as Hindu, in part because certain rituals of purity and pollution discourage having latrines in close proximity to one’s home. Almost all open defecation occurs in rural areas, and this paper estimates how much the rate could be reduced if rural households in regions that have a higher fraction of Hindus, where open defecation is still common, altered their behaviour to reflect that of non-Hindu households in regions that are predominantly non-Hindu, where the rate of open defecation is much lower. Using nonparametric reweighting methods, this paper projects that rural open defecation in Bangladesh, India, and Nepal could be reduced to rates of between 6 and 8 per cent, compared to the prevailing level of 65 per cent.

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“…Recent research in economics, epidemiology, and public health has suggested that open defecation-the practice of defecating in the open without using a toilet or latrine-is an important cause of infant mortality and child stunting in both rural and urban areas of developing countries (Cameron et al 2013;Fink et al 2011;Humphrey 2009;Spears 2013).…”

Section: Introductionmentioning

confidence: 99%

Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries

Hathi¹,

Haque

Pant³

et al. 2014

Policy Research Working Papers

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A long literature in demography has debated the importance of place for health, especially children's health. In this study, we assess whether the importance of dense settlement for infant mortality and child height is moderated by exposure to local sanitation behavior. Is open defecation (i.e., without a toilet or latrine) worse for infant mortality and child height where population density is greater? Is poor sanitation is an important mechanism by which population density influences child health outcomes? We present two complementary analyses using newly assembled data sets, which represent two points in a trade-off between external and internal validity. First, we concentrate on external validity by studying infant mortality and child height in a large, international child-level data set of 172 Demographic and Health Surveys, matched to census population density data for 1,800 subnational regions. Second, we concentrate on internal validity by studying child height in Bangladeshi districts, using a new data set constructed with GIS techniques that allows us to control for fixed effects at a high level of geographic resolution. We find a statistically robust and quantitatively comparable interaction between sanitation and population density with both approaches: open defecation externalities are more important for child health outcomes where people live more closely together.

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Child undernutrition, tropical enteropathy, toilets, and handwashing

Cited by 690 publications

References 20 publications

Causal inference methods to study nonrandomized, preexisting development interventions

Causal inference methods to study nonrandomized, preexisting development interventions

Sanitation and Religion in South Asia: What Accounts for Differences across Countries?

Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries

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