Impacts of Sanitation on Child and Maternal Health

描述（由申请人提供）：发育迟缓-意味着身体高度对于儿童的年龄来说太短-和贫血-由血红蛋白水平低表示-是两个重要的营养结果。由于这两种结果，生活在南亚的儿童和妇女的营养状况是世界上最差的。南亚的这种极端营养不良一直是研究文献中的一个长期难题，部分原因是南亚的儿童平均比撒哈拉以南非洲的儿童矮，而撒哈拉以南非洲的儿童平均更穷。身高和贫血都很重要，因为它们反映了孩子更广泛的身体和认知发展。研究工作，以解释这些南亚营养不足和政策努力，设计方案，以改善结果通常集中在提供更多或更好的食物。然而，事实上，这些营养不足可能主要是由异常的疾病负担造成的。南亚的卫生条件非常差，特别是印度。在印度，超过一半的家庭在露天排便，而不使用厕所或厕所， 世界上这样做的人都生活在印度。这使儿童接触粪便中的细菌，阻碍他们的生长，消耗他们的能量，并可能阻止关键营养素的吸收。我们将对南亚的大型健康相关调查数据集应用计量经济学技术来检验这一假设。首先，我们的目标是估计露天排便是否对儿童生长发育迟缓有因果关系，以及影响有多大。我们将通过观察两波关于印度村庄的调查数据来得出这一估计，这两波调查数据相隔七年。卫生条件改善较多的村庄，在这一时期结束时出生的儿童的身高是否也比在这一时期开始时出生的儿童的身高平均增长更大？由于我们将使用的数据包含详细的社会经济数据，我们将能够验证结果不是由财富变化驱动的。其次，我们将评估露天排便是否会降低妇女和儿童的血红蛋白水平。我们将使用类似的统计方法来研究尼泊尔各地区卫生和贫血状况随时间的变化。此外，我们还将研究各国卫生和血红蛋白水平的平均值，以评估露天排便的差异是否可以解释各国贫血的平均差异。这项研究不仅有助于解决有关营养不良的重要、长期研究难题，而且结果将表明改善卫生条件（而不仅仅是提供食物）是否应该成为改善营养结果的计划和政策的关键部分。

DESCRIPTION (provided by applicant): Stunting - meaning physical height that is too short for a child's age - and anemia - indicated by low levels of hemoglobin - are two important nutritional outcomes. For both of these outcomes, children and women living in South Asia have among the worst nutritional status in the world. This extreme malnutrition is South Asia has been a longstanding puzzle in the research literature, in part because children in South Asia are shorter, on average, than children in Sub-Saharan Africa, who are poorer, on average. Height and anemia are both important because they reflect a child's broader physical and cognitive development. Research efforts to explain these South Asian nutritional deficits and policy efforts to design programs to improve outcomes have typically focused in providing more or better food. However, it may be the case that these nutritional deficits in fact importantly result from a exceptional burden of disease. Sanitation is very bad in South Asia, specifically in India. More than half of all families in India defecate in the open without using a toilet or latrine, and most people in the world who do so live in India. This exposes children to germs from feces that stunt their growth, sap their energy, and may prevent absorption of key nutrients. We will apply econometric techniques to large health-related survey datasets from South Asia in order to test this hypothesis. First, we aim to estimate whether there is a causal effect of open defecation on reduced child growth, and how big any effect is. We will produce this estimate by looking at two waves of survey data about Indian villages, measured seven years apart. Did villages where sanitation improved by more also experience a larger average increase in the height of children born at the end of the period, relative to the height of children born at the beginning of the period? Because the data we will use contains detailed socioeconomic data, we will be able to verify that results are not driven by changes in wealth. Second, we will estimate whether open defecation reduces hemoglobin levels in women and children. We will use a similar statistical approach to study change over time in sanitation and anemia in regions of Nepal. Additionally we will study country-level averages in sanitation and hemoglobin levels to assess whether differences in open defecation can account for some part of average differences across countries in anemia. Not only will this study contribute to resolving important, longstanding research puzzles about malnutrition, the results will indicate whether improving sanitation - and not only providing food - should be a key part of programs and policies to improve nutritional outcomes.