The sanitation environment in urban slums: implications for child health

I examine the effect of improved sanitation on child health in urban Bangladesh to assess the relative importance of household versus neighborhood characteristics and of adult latrine usage versus safe disposal of children’s feces. Using fixed-effects regression, I calculate the change in weight-for-height in 153 children as a function of changes in latrine usage in the surrounding community. The use of longitudinal data allows children to act as their own controls, a stumbling point of many other sanitation evaluation studies using cross-sectional or case–control methods. Results provide strong evidence that children’s toileting matters more than adult toileting behavior in creating a safe, hygienic environment and reducing diarrheal disease. I conclude that investments in sanitation improvements offer important externalities, and that sanitation programs must encourage the safe disposal of children’s feces in order to produce maximum health gains.