Dean Spears|Anupam Ghosh|Oliver Cumming
Open Defecation and Childhood Stunting in India: An Ecological Analysis of New Data from 112 Districts
Centre for Development Economics|London School of Hygiene & Tropical Medicine
poor sanitation remains major public health concern linked several important health outcomes emerging evidence indicates link childhood stunting india half population defecates open prevalence stunting remains high recently published data levels stunting 112 districts india provide opportunity explore relationship levels open defecation stunting within population conducted ecological regression analysis assess association prevalence open defecation stunting adjustment potential confounding factors data 2011 hungama survey used outcome interest stunting data 2011 indian census districts used exposure interest open defecation adjustment various potential confounding factors including socioeconomic status maternal education calorie availability 10 percent increase open defecation associated 07 percentage point increase stunting severe stunting differences open defecation statistically account 35 55 percent average difference stunting districts identified lowperforming highperforming hungama data addition using monte carlo simulation explored effect statistical power common practice dichotomizing continuous height data binary stunting indicators simulation showed dichotomization height sacrifices statistical power suggesting estimate association open defecation stunting may lower bound whilst analysis ecological therefore vulnerable residual confounding findings use recently collected largescale data india add growing body suggestive evidence effect poor sanitation human growth new intervention studies currently underway may shed light important issue