An individual-level meta-analysis assessing the impact of community-level sanitation access on child stunting, anemia, and diarrhea : evidence from DHS and MICS surveys

 A lack of access to a sanitation facility, i.e. a toilet and/or latrine, leads to numerous health challenges such as parasitic worms and environmental enteropathy. Parasitic worms are transmitted through human feces and cause multiple health complications in children including anemia and child growth stunting. Environmental enteropathy occurs with repeated and long-term inflammation of the small intestine which then reduces nutrient uptake and can cause child growth stunting, anemia and diarrhea. One-sixth of the world population has no access to any type of sanitation facility, and are therefore at higher risk of these challenges. Scientific literature on the impacts of sanitation typically examines household access to sanitation rather than community-level access to sanitation. We used national survey data to assess the impact that community-level access to sanitation has on child health, both for children with access to a sanitation facility and children without access to a sanitation facility. We found that a lack of sanitation access in the community is a significant risk factor for anemia and child growth stunting, but not for incidence of diarrhea. This risk decreases if a child has access to a sanitation facility, but even among those children with a sanitation facility poor sanitation access in the community is still a risk factor for anemia, child growth stunting and diarrhea. In addition to improving household access to adequate sanitation, community-level sanitation access needs to be addressed to improve child health. These results will add impetus to the Sustainable Development Goal to ensure sanitation access for all by 2030. [author summary]