Did India’s toilet campaign improve child health?
A village-randomized sanitation program raised latrine access and cut open defecation modestly but did not improve child diarrhea, parasites, anemia, or growth.
Source
The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial
What they did
Investigators cluster-randomized 80 villages in rural Madhya Pradesh to India’s Total Sanitation Campaign support versus control, surveying thousands of children under five at baseline and about 21 months later for sanitation behaviours and health outcomes.
What they found
Intervention villages gained about 19 percentage points in improved sanitation facilities and a smaller (~10%) reduction in open defecation, but child health endpoints did not improve.
The limits
What it doesn't show
Short follow-up and some control-group contamination mean the trial cannot prove sanitation never helps—only that this scaled TSC package did not move health markers enough here.
Key terms
- Open defecation
- Defecating in fields or other open environments rather than a toilet that contains feces.
- Cluster RCT
- Randomized trial that assigns groups (here villages) rather than individuals to intervention or control.
- Total Sanitation Campaign
- India’s large-scale rural program promoting household toilets and ending open defecation.
- JMP improved sanitation
- WHO/UNICEF Joint Monitoring Programme definition of facilities that hygienically separate excreta from human contact.
- Child health endpoints
- Outcomes such as diarrhea, parasite infection, anemia, and growth used to judge health impact.
Flashcards
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Quiz yourself
What design did the Madhya Pradesh TSC evaluation use?
Common questions
What was randomized?
Villages, with equal allocation to TSC-supported intervention or control.
Did toilet access rise?
Yes—improved sanitation facility availability increased by about 19 percentage points.
Did children get healthier?
No significant improvements in diarrhea, parasites, anemia, or growth were detected.
Why might behaviour change be incomplete?
Open defecation fell only modestly, so environmental fecal exposure may have remained high.
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