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What Works in Fighting Diarrheal Diseases in Developing Countries? A Critical Review

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  • Michael Kremer

Abstract

The Millennium Development Goals call for reducing by half the proportion of people without sustainable access to safe drinking water. This goal was adopted in large part because clean water was seen as critical to fighting diarrheal disease, which kills 2 million children annually. There is compelling evidence that provision of piped water and sanitation can substantially reduce child mortality. However, in dispersed rural settlements, providing complete piped water and sanitation infrastructure to households is expensive. Many poor countries have therefore focused instead on providing community-level water infrastructure, such as wells. Various traditional child health interventions have been shown to be effective in fighting diarrhea. Among environmental interventions, handwashing and point-of-use water treatment both reduce diarrhea, although more needs to be learned about ways to encourage households to take up these behavior changes. In contrast, there is little evidence that providing community-level rural water infrastructure substantially reduces diarrheal disease or that this infrastructure can be effectively maintained. Investments in communal water infrastructure short of piped water may serve other needs and may reduce diarrhea in particular circumstances, but the case for prioritizing communal infrastructure provision needs to be made rather than assumed.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 12987.

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Date of creation: Mar 2007
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Publication status: published as Kremer, Michael and Alix Peterson Zwane. “What Works in Fighting Diarrheal Diseases in Developing Countries? A Critical Review.” World Bank Research Observer 22:1 (Spring 2007): 1-24.
Handle: RePEc:nbr:nberwo:12987

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Cited by:
  1. William Easterly, 2008. "Can the West Save Africa?," NBER Working Papers 14363, National Bureau of Economic Research, Inc.
  2. Bhattamishra, Ruchira & Barrett, Christopher B., 2010. "Community-Based Risk Management Arrangements: A Review," World Development, Elsevier, vol. 38(7), pages 923-932, July.
  3. Leonardo Becchetti & Giuseppina Gianfreda, 2008. "When consumption heals producers: the effect of fair trade on marginalised producers’ health and productivity," Working Papers 86, ECINEQ, Society for the Study of Economic Inequality.
  4. Patrick J. McEwan, 2012. "Cost-effectiveness analysis of education and health interventions in developing countries," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 4(2), pages 189-213, June.
  5. Harttgen, Kenneth & Günther, Isabel, 2011. "Deadly Cities? A Note on Spatial Inequalities in Mortality in Sub-Saharan Africa," Proceedings of the German Development Economics Conference, Berlin 2011 39, Verein für Socialpolitik, Research Committee Development Economics.
  6. Youssouf Kiendrebeogo, 2012. "Access to Improved Water Sources and Rural Productivity: Analytical Framework and Cross-country Evidence," African Development Review, African Development Bank, vol. 24(2), pages 153-166.
  7. Sheila M. Olmstead, 2010. "The Economics of Water Quality," Review of Environmental Economics and Policy, Association of Environmental and Resource Economists, vol. 4(1), pages 44-62, Winter.
  8. Zhang, Jing, 2012. "The impact of water quality on health: Evidence from the drinking water infrastructure program in rural China," Journal of Health Economics, Elsevier, vol. 31(1), pages 122-134.
  9. Spears, Dean, 2014. "Decision costs and price sensitivity: Field experimental evidence from India," Journal of Economic Behavior & Organization, Elsevier, vol. 97(C), pages 169-184.
  10. Hammer, Jeffrey & Spears, Dean, 2013. "Village sanitation and children's human capital : evidence from a randomized experiment by the Maharashtra government," Policy Research Working Paper Series 6580, The World Bank.
  11. Jeffrey Hammer & Dean Spears, 2013. "Village sanitation externalities and children's human capital: Evidence from a randomized experiment by the Maharashtra government," Working Papers 1443, Princeton University, Woodrow Wilson School of Public and International Affairs, Center for Health and Wellbeing..
  12. Tobias Lechtenfeld, 2012. "Why does piped water not reduce diarrhea for children? Evidence from urban Yemen," Courant Research Centre: Poverty, Equity and Growth - Discussion Papers 119, Courant Research Centre PEG.

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