by Sumeet R. Patil, Benjamin F. Arnold, Alicia L. Salvatore et al.
PLoS Med 11(8): e1001709 (August 26, 2014)
Poor sanitation is thought to be a major cause of enteric infections among young children. However, there are no previously published randomized trials to measure the health impacts of large-scale sanitation programs. India’s Total Sanitation Campaign (TSC) is one such program that seeks to end the practice of open defecation by changing social norms and behaviours, and providing technical support and financial subsidies. The intervention led to modest increases in availability of individual household latrines and even more modest reductions in open defecation. These improvements were insufficient to improve child health outcomes (diarrhea, highly credible gastrointestinal illness, parasite infection, anemia, growth). The results underscore the difficulty of achieving adequately large improvements in sanitation levels to deliver expected health benefits within large-scale rural sanitation programs.