Abstract
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.
Highlights
The post-2015 Sustainable Development Goal (SDG) for sanitation calls for universal access to adequate and equitable sanitation and an end to open defecation by 2030.1 In 2015, an estimated one billion people continued to practice open defecation of which approximately 165 million resided in rural sub-Saharan Africa.[2]
We explore the association between sanitation and household stored water quality as a potential pathway that sanitation can affect child health
Latrine presence and spatial location were identified for both census and study households; child health outcomes, reported open defecation, and water quality were measured in study households only
Summary
The post-2015 Sustainable Development Goal (SDG) for sanitation calls for universal access to adequate and equitable sanitation and an end to open defecation by 2030.1 In 2015, an estimated one billion people continued to practice open defecation of which approximately 165 million resided in rural sub-Saharan Africa.[2]. First-order linear regressions indicated statistically significant relationships between higher community latrine coverage and improved height-for-age (p-value = 0.024) and reduced prevalence of a child being underweight (p-value = 0.024) and a marginally statistically significant relationship with stunting (p-value = 0.057) (Tables S3 and S4). For weight-for-age z-scores and underweight prevalence, second-order regression models including an interaction between community-level sanitation and household sanitation identified a statistically significant relationship with community latrine coverage; there was not a statistically significant association with weight-for-height z-scores or wasting (Tables S3 and S4). Radii of less than 200 m were not useful in the study area due to low household density These alternative models did not yield statistically different results; the 1 km radius did generate qualitatively different associations between weight-forage and community latrine coverage and between weight-forheight and community latrine coverage. This difference was less apparent for binary outcomes of underweight and wasting (Tables S11 and S12)
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