Final report: Impact evaluation of community-led total sanitation (CLTS) in rural Mali, 2015.
Authors: Maria Laura Alzua, Amy Janel Pickering, et al.
There is evidence that the CLTS program has a positive and significant impact on growth outcomes among children less than five years of age. When accounting for baseline height measurements, children under five years old in CLTS villages were taller (+0.16 height for-age Z-score, CI: 0.0, 0.32) and 13% less likely to be stunted (RR: 0.87, CI: 0.75, 1.0). Improvements in child weight (+0.09 weight-for-age Z-score, CI: -0.04, 0.21) and a reduction in the proportion of children underweight (RR: 0.85, CI: 0.70, 1.03) were also observed but were not statistically significant. However, the program significantly reduced the risk of severe stunting by 26% and the risk of being severely underweight by 35%.
This study provides evidence that a pure behavioral intervention with no monetary subsidies substantially increased access to sanitation facilities in rural Mali. Latrines were also cleaner and better stocked with handwashing supplies in treatment villages, indicating improved hygiene behavior. Our findings suggest CLTS improved child growth, reduced the prevalence of stunting among children, and reduced child mortality due to diarrhea. However, the program did not have a significant impact on self-reported diarrheal illness, thus the program may have impacted child growth and mortality through pathways other than preventing diarrhea, such as reducing the subclinical condition of environmental enteropathy via decreased exposure to environmental fecal contamination.
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