Impacts of Sanitation on Child and Maternal Health

描述(由申请人提供)：发育迟缓和贫血是两种重要的营养后果。发育迟缓意味着身高对于孩子的年龄来说太矮了，而贫血则表现为低水平的血红蛋白。对于这两种结果，生活在南亚的儿童和妇女的营养状况位居世界最差之列。南亚的极端营养不良一直是研究文献中的一个长期谜题，部分原因是南亚的儿童平均比撒哈拉以南非洲的儿童矮，后者平均更穷。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。解释南亚营养不足的研究努力，以及设计改善结果的计划的政策努力，通常都集中在提供更多或更好的食物上。然而，可能的情况是，这些营养不足实际上是由异常的疾病负担造成的。南亚的卫生状况很差，尤其是在印度。在印度，超过一半的家庭在不使用厕所或厕所的情况下在露天排便，大多数 世界上这样做的人生活在印度。这会使儿童接触到粪便中的细菌，阻碍他们的生长，消耗他们的能量，并可能阻止关键营养的吸收。我们将把计量经济学技术应用于南亚与健康相关的大型调查数据集，以检验这一假设。首先，我们的目标是评估露天排便对儿童生长发育减退是否存在因果影响，以及影响有多大。我们将通过查看两波关于印度村庄的调查数据来得出这一估计，这些数据相隔七年进行测量。卫生条件改善更多的村庄是否也经历了在该时期结束时出生的儿童的身高相对于在该时期开始时出生的儿童的身高的较大平均增长？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地区卫生设施和贫血随时间的变化。此外，我们将研究国家一级卫生和血红蛋白水平的平均水平，以评估露天排便的差异是否可以解释各国在贫血方面的平均差异。这项研究不仅将有助于解决有关营养不良的重要、长期的研究难题，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.