Amy J. Pickering|Habiba Djebbari|Carmen López|Massa Coulibaly|María Laura Alzúa
Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a cluster-randomised controlled trial
Palo Alto Institute|Stanford University|School for Advanced Studies in the Social Sciences|Aix-Marseille University|French National Centre for Scientific Research|Universidad Nacional de La Plata|Consejo Nacional de Investigaciones Científicas y Técnicas|Mali-Folkecenter|Universidad Nacional de La Plata|Consejo Nacional de Investigaciones Científicas y Técnicas
communityled total sanitation clts uses participatory approaches mobilise communities build toilets stop open defecation aim undertake first randomised trial clts assess effect child health koulikoro maliwe clusterrandomised trial assess clts programme implemented government mali study population included households rural villages clusters koulikoro district mali every household least one child aged younger 10 years villages randomly assigned 11 computergenerated sequence study investigator receive clts programme health outcomes included diarrhoea primary outcome height age weight age stunting underweight outcomes measured 15 years intervention delivery 2 years enrolment among children younger 5 years participants masked intervention assignment trial registered clinicaltrialsgov number nct01900912we recruited participants april 12 june 23 2011 assigned 60 villages 2365 households receive clts intervention 61 villages 2167 households control group differences observed terms diarrhoeal prevalence among children clts control villages 706 22 3140 clts children vs 693 24 2872 control children prevalence ratio pr 093 95 ci 076114 access private latrines almost twice high intervention villages 1373 65 2120 vs 661 35 1911 households reported open defecation reduced female 198 9 2086 vs 608 33 1869 households male 195 10 2004 vs 602 33 1813 households adults children clts villages taller 018 increase heightforage z score 95 ci 003032 2415 children less likely stunted 35 vs 41 pr 086 95 ci 07410 children control villages 22 children underweight clts compared 26 control villages pr 088 95 ci 071108 difference mean weightforage z score 009 95 ci 004 022 groups clts villages younger children enrolment 2 years showed greater improvements height weight older childrenin villages received behavioural sanitation intervention monetary subsidies diarrhoeal prevalence remained similar control villages however access toilets substantially increased child growth improved particularly children 2 years clts might prevented growth faltering pathways reducing diarrhoeabill melinda gates foundation