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Community-level sanitation coverage is more strongly associated with child growth and household drinking water quality than access to a private toilet in rural Mali Michael Harris, Maria Laura Alzua, Nicolas Osbert, and Amy J Pickering Environ. Sci. Technol., Just Accepted Manuscript • Publication Date (Web): 17 May 2017 Downloaded from http://pubs.acs.org on May 18, 2017

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Environmental Science & Technology

Community-level sanitation coverage is more strongly associated with child growth and household drinking water quality than access to a private toilet in rural Mali

Authors Michael Harris1, Maria Laura Alzua2, Nicolas Osbert3,4, Amy Pickering5,6* 1 Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, CA, 94305, USA 2 CEDLAS-CONICET-Universidad Nacional de La Plata, La Plata, 1900, Argentina 1

3 UNICEF, New Delhi, 110 003, India

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4 UNICEF, Bamako, Mali 5 Civil and Environmental Engineering, Stanford University, Stanford, CA, 94305, USA 6 Civil and Environmental Engineering, Tufts University, Medford, MA, 02155, USA

*[email protected]

ACS Paragon Plus Environment

Environmental Science & Technology

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Abstract

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Sanitation access can provide positive externalities; for example, safe disposal of feces by one household

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prevents disease transmission to households nearby. However, little empirical evidence exists to

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characterize the potential health benefits from sanitation externalities. This study investigated the effect of

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community sanitation coverage versus individual household sanitation access on child health and drinking

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water quality. Using a census of 121 villages in rural Mali, we analyzed the association of community

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latrine coverage (defined by a 200-meter radius surrounding a household) and individual household

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latrine ownership with child growth and household stored water quality. Child height-for-age had a

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significant and positive linear relationship with community latrine coverage, while child weight-for-age

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and household water quality had non-linear relationships that leveled off above 60% coverage (p