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Sanitation, the disease environment and anemia among young children « Sanitation « Downloads

Date postedSeptember 16, 2013
Downloaded544 times
CategoriesSanitation, Working Papers, Topic, Health


Globally, almost half of children have hemoglobin levels below the threshold for anemia; rates of anemia are highest in South Asia and sub-Saharan Africa. Anemia impairs cognitive ability, and so also has implications for educational attainment and adult productivity. This paper uses three complementary empirical strategies to provide the first population-based evidence for the hypothesis that open defecation, a behavior with important externalities, contributes to a disease environment which causes hemoglobin deficiency. First, it finds a strong cross-country gradient between children’s hemoglobin and open defecation. Second, it uses individual data from India and Nepal to show a robust relationship between hemoglobin and community open defecation. Third, it uses fixed effects analysis to show that improvement in open defecation in Nepal between 2006 and 2011 predicts improvement in hemoglobin. This study suggests that research and policy on anemia should focus more on sanitation, particularly in regions with high open defecation rates.

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