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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.
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What public-health problem motivated the trial?
Open defecation is linked to diarrhea and enteric parasite infection in children under five.
Source: The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial · DOI · quote verified
What program was evaluated in Madhya Pradesh?
India’s Total Sanitation Campaign (TSC) as implemented with Water and Sanitation Program support.
Source: The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial · DOI · quote verified
How was the study designed?
A village-level cluster randomized controlled trial with equal allocation to two arms.
Source: The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial · DOI · quote verified
How large was the baseline child sample?
3,390 children under five from 1,954 households across 80 villages.
Source: The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial · DOI · quote verified
What happened to improved sanitation facility availability?
It increased by about 19 percentage points in intervention areas.
Source: The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial · DOI · quote verified
How much did open defecation change?
It decreased more modestly, about 10%.
Source: The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial · DOI · quote verified
Did child health outcomes improve?
No—the sanitation gains were insufficient to improve diarrhea, parasite infections, 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 · DOI · quote verified
What follow-up interval was used?
About 21 months, with 15% household attrition balanced across arms.
Source: The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial · DOI · quote verified
What broader lesson do the authors draw?
Scaled rural sanitation programs must achieve large enough behaviour and coverage changes to deliver expected health benefits.
Source: The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial · DOI · quote verified
Which child outcomes were pre-specified health endpoints?
Diarrhea, parasite infections, anemia, and 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 · DOI · quote verified
Why randomize villages rather than households?
Sanitation effects operate through community environments, so village-level assignment matches the intervention unit.
Source: The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial · DOI · quote verified