Sumeet Patil|Benjamin F. Arnold|Alicia L. Salvatore|Bertha Briceño|Subha Ganguly|John M. Colford|Paul Gertler
The Effect of India's Total Sanitation Campaign on Defecation Behaviors and Child Health in Rural Madhya Pradesh: A Cluster Randomized Controlled Trial
University of California, Berkeley|University of California, Berkeley|Stanford University|World Bank|National Institute of Cholera and Enteric Diseases|University of California, Berkeley|University of California, Berkeley
poor sanitation thought major cause enteric infections among young children however previously published randomized trials measure health impacts largescale sanitation programs indias total sanitation campaign tsc one program seeks end practice open defecation changing social norms behaviors providing technical support financial subsidies objective study measure effect tsc implemented capacity building support world banks water sanitation program madhya pradesh availability individual household latrines ihls defecation behaviors child health diarrhea highly credible gastrointestinal illness hcgi parasitic infections anemia growthwe conducted clusterrandomized controlled trial 80 rural villages field staff collected baseline measures sanitation conditions behaviors child health mayjuly 2009 revisited households 21 months later februaryapril 2011 program delivered study enrolled random sample 5209 children 5 years old 3039 households least one child 24 months beginning study random subsample 1150 children 24 months enrollment tested soil transmitted helminth protozoan infections stool randomization successfully balanced intervention control groups estimated differences groups intention treat analysis intervention increased percentage households village improved sanitation facilities defined whounicef joint monitoring programme average 19 95 ci difference 1226 group means 22 control versus 41 intervention decreased open defecation among adults average 10 95 ci difference 415 group means 73 intervention versus 84 control however intervention improve child health measured terms multiple health outcomes diarrhea hcgi helminth infections anemia growth limitations study included relatively short followup period following implementation evidence contamination ten 40 control villages bias possible selfreported outcomes diarrhea hcgi open defecation behaviorsthe intervention led modest increases availability ihls even modest reductions open defecation improvements insufficient improve child health outcomes diarrhea hcgi parasite infection anemia growth results underscore difficulty achieving adequately large improvements sanitation levels deliver expected health benefits within largescale rural sanitation programsclinicaltrialsgov nct01465204 please see later article editors summary