The impact of access to improved sanitation facilities on child health in Pakistan

Poor sanitation is a major public health issue linked to various significant health outcomes. Several studies have associated poor sanitation with malnutrition and childhood diarrhoea. Improved sanitation, however, is determined by household decisions, which may induce endogeneity. Such endogeneity of household sanitation choices has been insufficiently explored in most of the previous literature. Using the Pakistan Demographic and Health Survey (PDHS), we examine the impact of improved sanitation on children’s height-for-age, weight-for-age, and weight-for-height z scores, as well as diarrhoea. We address potential endogeneity using an instrumental variable approach. Our findings highlight the significance of better domestic sanitation in improving child health in Pakistan: improved sanitation was found to positively and significantly affect children’s growth, mainly height-for-age and weight-for-age in those below five years old. In contrast, no significant impact was identified on weight-for-height and diarrhoea prevalence. The sub-sample analysis showed that particularly girls, children older than two years, children with uneducated mothers, and those from households with poor economic status are positively and significantly affected by access to improved sanitation facilities. Our results were robust throughout different model specifications. We suggest that policies concerning the provision of and enhanced access to improved sanitation are effective in reducing child malnutrition.