Household vs. Neighborhood Latrine Use: Child Health Effects in Urban Bangladesh

Alison M. Buttenheim, Princeton University

Inadequate sanitation is a persistent threat to child health, particularly in urban slums in developing countries. This study evaluates a sanitation improvement initiative in fourteen slum communities in Bangladesh. I estimate the effects of changing from unhygienic to hygienic latrines on child weight-for-height, a key measure of short-term nutritional status. I also test whether these effects are moderated by hand washing behaviors and by household food security. Fixed-effects methods address selection bias in the placement and adoption of improved latrines. Results suggest that the prevalence of improved latrines at the neighborhood level better predicts child weight-for-height than does household-specific latrine use. This neighborhood effect is driven entirely by latrine usage among households with young children; use of improved latrines by neighboring households with no young children makes no difference to child health. These findings have important implications for the targeting and implementation of sanitation projects in similar settings.