Research article Special Issues

Access to sanitary toilets and health outcomes: A panel data analysis using two-way fixed effects model

  • Received: 16 August 2021 Accepted: 08 October 2021 Published: 14 October 2021
  • Based on the data regarding the renovation of the toilets of 30 provinces (municipalities) in rural China from 2005 to 2017, this study utilized a two-way fixed effect model to empirically test the impact of access to sanitary toilets on health, which include intestinal infectious diseases (consisting of hepatitis A, dysentery, and typhoid) and child mortality (consisting of perinatal mortality, infant mortality, and the mortality rate of children under 5). This study attempted to assess the health outcomes of the "toilet revolution" in rural China. The results showed that: (1) Access to sanitary toilets effectively reduced the incidence of hepatitis A and dysentery. For every 1% increase in the rate of access to sanitary toilets, the incidence of hepatitis A was reduced by 5.6%, and the incidence of dysentery was reduced by 36.5%. (2) Access to sanitary toilets does not significantly reduce child mortality. (3) There are obviously regional differences in the impact of access to sanitary toilets on the health outcomes. The renovation of sanitary toilets has shown the most significant effect on reducing the incidence of intestinal infectious diseases in the central region as well as the effect on reducing child mortality in the western region. It is implied that the health outcomes of China's "toilet revolution" may provide supporting evidence and experience for other developing countries and regions in implementing toilet renovation projects.

    Citation: Wanli Zhou, Yingwen Gu, Xiulin Wang. Access to sanitary toilets and health outcomes: A panel data analysis using two-way fixed effects model[J]. Mathematical Biosciences and Engineering, 2021, 18(6): 8815-8830. doi: 10.3934/mbe.2021435

    Related Papers:

  • Based on the data regarding the renovation of the toilets of 30 provinces (municipalities) in rural China from 2005 to 2017, this study utilized a two-way fixed effect model to empirically test the impact of access to sanitary toilets on health, which include intestinal infectious diseases (consisting of hepatitis A, dysentery, and typhoid) and child mortality (consisting of perinatal mortality, infant mortality, and the mortality rate of children under 5). This study attempted to assess the health outcomes of the "toilet revolution" in rural China. The results showed that: (1) Access to sanitary toilets effectively reduced the incidence of hepatitis A and dysentery. For every 1% increase in the rate of access to sanitary toilets, the incidence of hepatitis A was reduced by 5.6%, and the incidence of dysentery was reduced by 36.5%. (2) Access to sanitary toilets does not significantly reduce child mortality. (3) There are obviously regional differences in the impact of access to sanitary toilets on the health outcomes. The renovation of sanitary toilets has shown the most significant effect on reducing the incidence of intestinal infectious diseases in the central region as well as the effect on reducing child mortality in the western region. It is implied that the health outcomes of China's "toilet revolution" may provide supporting evidence and experience for other developing countries and regions in implementing toilet renovation projects.



    加载中


    [1] D. Coffey, A. Gupta, P. Hathi, D. Khurana, D. Spears, N. Srivastav, et al., Revealed preference for open defecation—Evidence from a new survey in rural North India, Econ. Polit. Wkly., 38 (2014), 43-55.
    [2] M. Odagiri, A. Schriewer, E. Daniels-Miles, S. Wuertz, W. A. Smith, T. Clasen, et al., Human fecal and pathogen exposure pathways in rural Indian villages and the effect of increased latrine coverage, Water Res., 100 (2016), 232-244.
    [3] K. Santosh, V. Sebastian, Does improved sanitation reduce diarrhea in children in rural India? Health Econ., 22 (2013), 410-427.
    [4] V. Shyama, T. F. Ramani, D. Arijita, On Diarrhoea in adolescents and school toilets: Insights from an Indian village school study, J. Dev. Stud., 53 (2017), 1899-1914. doi: 10.1080/00220388.2016.1277017
    [5] U. F. Ekpo, S. N. Odoemene, C. F. Mafiana, S. O. Sam-Wobo, Helminthiasis and hygiene conditions of schools in Ikenne, Ogun State, Nigeria, PLoS Negl. Trop Dis., 2 (2008), 1-6.
    [6] D. T. Trang, K. Mølbak, P. D. Cam, A. Dalsgaard, Helminth infections among people using wastewater and human excreta in peri-urban agriculture and aquaculture in Hanoi, Vietnam, Trop Med. Int. Health., 12 (2007), 82-90.
    [7] L. Andrés, B. Briceño, C. Chase, J. A. Echenique, Sanitation and externalities: Evidence from early childhood health in rural India, J. Water Sanit Hyg Dev., 7 (2017), 272-289. doi: 10.2166/washdev.2017.143
    [8] E. Duflo, M. Greenstone, R. P. Guiteras, T. Clasen, Toilets can work: Short and medium run health impacts of addressing complementarities and externalities in water and sanitation, Becker Friedman Institute for Research in Economics Working Paper No. 2654864, 2015. Available from: https://ssrn.com/abstract=2654864 or http://dx.doi.org/10.2139/ssrn.2654864.
    [9] D. Spears, how much international variation in child height can sanitation explain? World Bank Policy Research Working Paper. NO. 6351, 2013. Available from: https://documents1.worldbank.org/curated/en/449651468191643600/pdf/wps6351.pdf.
    [10] M. I. Smith, T. Yatsunenko, M. J. Manary, I. Trehan, R. Mkakosya, J. Cheng, et al., Gut microbiomes of Malawian twin pairs discordant for kwashiorkor, Science, 339 (2013), 548-554.
    [11] W. Checkley, G. Buckley, R. H. Gilman, A. M. Assis, R. L. Guerrant, S. S. Morris, et al., Multi-country analysis of the effects of diarrhoea on childhood stunting, Int. J. Epidemiol., 37 (2008), 816-830.
    [12] J. H. Humphrey, Child undernutrition, tropical enteropathy, toilets, and handwashing, Lancet, 374 (2009), 1032-1035.
    [13] J. A. Fuller, E. Villamor, W. Cevallos, J. Trostle, J. N. Eisenberg, I get height with a little help from my friends: Herd protection from sanitation on child growth in rural Ecuador, Int. J. Epidemiol., 45 (2016), 460-469. doi: 10.1093/ije/dyv368
    [14] A. Tarozzi, Growth reference charts and the nutritional status of Indian children, Econ. Hum. Biol., 6 (2008), 455-468. doi: 10.1016/j.ehb.2008.07.004
    [15] S. Jayachandran, R. Pande, Why are Indian children shorter than African. National Bureau of Economic Research: Cambridge, MA, USA, 2013. Available from: http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.404.4791.
    [16] B. Augsburg, P. A. Rodríguez-Lesmes, Sanitation and child health in India, IFS Working Paper W15/32, 2015. Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.707.2958&rep=rep1&type=pdf.
    [17] C. Walker, I. K. Friberg, N. Binkin, M. Young, N. Walker, O. Fontaine, et al., Scaling up Diarrhea prevention and treatment interventions: A lives saved tool analysis, PLoS Med., 8 (2011), 1-10.
    [18] C. Bozzoli, A. Deaton, C. Quintana-Domeque, Adult height and childhood disease, Demography, 46 (2009), 647-669.
    [19] J. Currie, D. Almond, Human capital development before age five, Handb. Labor Econ., 4b (2011), 1315-1486.
    [20] World Health Organization. Diarrhoeal Disease. Report of WHO, 2017. Available from: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease.
    [21] J. Hammer, D. Spears, Village sanitation and child health: Effects and external validity in a randomized field experiment in rural India, J Health Econ., 48 (2016), 135-148. doi: 10.1016/j.jhealeco.2016.03.003
    [22] M. Geruso, D. Spears, Neighborhood Sanitation and Infant Mortality, Am. Econ. J., 10 (2018), 125-162.
    [23] K. Ezeh-Osita, E. Agho-Kingsley, M. J. Dibley, J. Hall, A. N. Page, The impact of water and sanitation on childhood mortality in Nigeria: Evidence from demographic and health surveys, 2003-2013, Int. J. Environ. Res. Public Health., 11 (2014), 9256-9272.
    [24] A. Das, B. Das, Does sanitation affect health outcomes? Evidence from India, MPRA Paper. NO.63760, 2015. Available from: https://ideas.repec.org/p/pra/mprapa/63760.html.
    [25] H. Li, W. Yu, Effects of the Government's Health Expenditure on the Health of Rural Residents in China, Soc. Sci. China (Chinese), 34 (2013), 41-60.
    [26] Z. Wen, Y. Yang, The Economic Benefit and Social Benefit of Improvident of Latrines in Countryside in Hunan Province, Chinese Prim. Health Care (Chinese), 19 (2005), 76-78.
    [27] K. Y. Chay, M. Greenstone, The impact of air pollution on infant mortality: Evidence from geographic variation in pollution shocks induced by a recession, Q. J. Econ., 118 (2003), 1121-1167. doi: 10.1162/00335530360698513
    [28] J. H. You, P. M. Wei, D. G. Dong, Analysis on epidemiological characteristics of type A and B intestinal infectious diseases in Xinghua City from 1990 to 2019, Chinese J. Disease Control Prevent. (Chinese), 24 (2020), 1348-1351.
    [29] C. P. Zhang, D. K. Sun, D. Z. Chen, S. M. Li, Q. Li, Performance evaluation of rural latrine renovation in Jinhu County from 2010 to 2014, Int. J. Med. Parasit. Diseases (Chinese), 42 (2015), 323-327.
    [30] W. Song, M. Dong, L. S. Xu, Analysis on control effect of major intestinal infectious diseases after toilet improvement in rural areas, Tai'an city, 2013-2017, Prevent. Med. Trib. (Chinese), 24 (2018), 933-935.
    [31] S. Wang, R. Zhang, Y. Tao, Burden of diarrheal in typical rural areas with water supply and latrines improvement, J. Environ. Health (Chinese), 31 (2014), 159-162.
    [32] M. C. Freeman, J. V. Garn, G. D. Sclar, S. Boisson, K. Medlicott, K. T. Alexander, et al., The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis, Int. J. Hyg Environ. Health, 220 (2017), 928-949.
    [33] Q. L. Ni, Analysis of the Government's responsibilities in the "Toilet Revolution"—enlightenment of "Toilet Improvement" in Nantong City, Jiangsu Province, Econom. Res. Guide (Chinese), 18 (2020), 39-40.
    [34] R. Parimita, S. Wolf-Peter, B. Sophie, C. Thomas, W. J. Marion, Socio-cultural and behavioral factors constraining latrine adoption in rural coastal Odisha: An exploratory qualitative study, BMC Public Health, 15 (2015), 1-19. doi: 10.1186/s12889-015-1889-9
    [35] Y. H. Wang, X. P. Zeng, Y. Wang, Efficacy analysis of latrines improvement implementation on control of enteric infectious diseases, Jiangsu J. Prevent. Med. (Chinese), 25 (2014), 20-22.
    [36] H. J. Hu, F. C. Fan, W. Yao, Y. F. Fu, Latrine improvement situation and influencing factors in rural areas of China, J. Environ. Health (Chinese), 36 (2019), 1029-1032.
  • Reader Comments
  • © 2021 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索

Metrics

Article views(3147) PDF downloads(167) Cited by(6)

Article outline

Figures and Tables

Figures(2)  /  Tables(5)

Other Articles By Authors

/

DownLoad:  Full-Size Img  PowerPoint
Return
Return

Catalog