Water, Sanitation, and Child Health: Evidence From Subnational Panel Data in 59 Countries

Abstract

Water, sanitation, and hygiene (WASH) investments are widely seen as essential for improving health in early childhood. However, the experimental literature on WASH interventions identifies inconsistent impacts on child health outcomes, with relatively robust impacts on diarrhea and other symptoms of infection but weak and varying impacts on child nutrition. In contrast, observational research exploiting cross-sectional variation in water and sanitation access is much more sanguine, finding strong associations with diarrhea prevalence, mortality, and stunting. In practice, both literatures suffer from significant methodological limitations. Experimental WASH evaluations are often subject to poor compliance, rural bias, and short duration of exposure, while cross-sectional observational evidence may be highly vulnerable to omitted variables bias. To overcome some of the limitations of both literatures, we construct a panel of 442 subnational regions in 59 countries with multiple Demographic Health Surveys. Using this large subnational panel, we implement difference-in-difference regressions that allow us to examine whether longer-term changes in water and sanitation at the subnational level predict improvements in child morbidity, mortality, and nutrition. We find results that are partially consistent with both literatures. Improved water access is statistically insignificantly associated with most outcomes, although water piped into the home predicts reductions in child stunting. Improvements in sanitation predict large reductions in diarrhea prevalence and child mortality but are not associated with changes in stunting or wasting. We estimate that sanitation improvements can account for just under 10 % of the decline in child mortality from 1990 to 2015. Electronic supplementary material The online version of this article (10.1007/s13524-019-00760-y) contains supplementary material, which is available to authorized users.

Inappropriate Household Water, Sanitation and Hygiene practices are associated with Wasting for children under 5 years in Rural Tanzania: Evidence from the 2015/2016 Survey

“…Time spent by a household to fetch drinking water was retained in the model ofter controling of potential confounders which is consistent with the findings of a previous case-control study done among Ethiopian children [21]. In contrast, recent data from multiple countries showed that water access was not associated with incidence of wasting or stunting [14].…”

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“…This is why SDG 6.2 aims for the universal provision of adequate sanitation and an end to open defecation. Between 1990 and 2015, sanitation improvements have accounted for just under 10 percent of the decline in child mortality (Headey and Palloni 2019). Even though there has been progress, achieving this ambitious goal remains a fundamental challenge in many parts of the developing world.…”

Evaluation of the nutrition-sensitive features of the fourth phase of Ethiopia's Productive Safety Net Programme

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