Growing Taller Among Toilets

Evidence from changes in sanitation and child height in Cambodia in 2005 and 2010

Phrym Kov, Susanna Smets, Dean Spears, Sangita Vyas

rice and WSP

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The ContextOpen defecation is widespread in Cambodia, but

significantly reduced from 2005 to 2010

Child height increased by 0.13 standard deviations – the entire India-Africa height gap

Question: How did the improvement in sanitation affect the height of children age 0-5 over the same period?

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Summary Statistics

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Medical/Epidemiological Literature

ChildStuntin

g

Fecal-oral contamination and diarrhea(Chekley et al 2008)

Environmental enteropathy

(Humphrey 2009, Lin et al 2013, Kosek et al

2013)

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Economic LiteratureHammer and Spears (2013) – randomized

sanitation motivation caused an increase in child height in Maharashtra

Spears (2013) - differences in child height between India and Africa explained by differences in sanitation

Cameron et al (2013) - Total Sanitation project in Indonesia increased the height of children living in households that did not have latrines at baseline

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Two is the Magic Number

Data from Cambodia DHS 2010.

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Good Toilets Make Good Neighbors

Data from Cambodia DHS 2010.

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Spurious Correlations?Fixed effects analysis: control for persistent

regional-level differences by looking at change over time within regionsWere regions where open defecation decreased by

more the regions where child height increased by more, on average?

Include control variables

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Change Within Regions

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Fixed Effects Estimation

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Controls Eilpt: Household socio-economic characteristics

household electrification; indicators for owning a radio, TV, and refrigerator; 10 indicators for floor material (an important indicator of disease exposure); 19 indicators for household size; indicators for level of literacy of the child's mother; indicators for cooking fuel type; and province-level measures of average consumption and population density.

Dilpt: Child demography 13 indicators for birth order and 11 indicators for birth month.

Hilpt: Health and healthcare an indicator for the child having a health and vaccination card; an

indicator for having had an institutional delivery; and indicators for being breastfed immediately and within the first day.

Age-in-month dummies for girls and boys

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Regression Results

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Regression Results

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Change Over Years

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Not Shown Here..Blinder-Oaxaca decomposition

Non-parametric reweighting decomposition

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Take-awaysLatrines spillover (effect)

Improvement in sanitation access likely played a big role in increasing average child height

The change in sanitation accounts for almost the entire change in height