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What prevents child diarrhoea? The impacts of water supply, toilets, and hand-washing in rural India


  • Victoria Yue-May Fan
  • Ajay Mahal


The authors apply three matching methods to estimate the impacts of water supply, toilet, and hand-washing interventions on child diarrhoea in rural India. Although propensity-score matching generally retains sample size, it can be associated with imbalance in the variables used to estimate propensity scores between treated and control groups. In contrast, exact matching is balanced over observables between treated and control units, but can result in considerable loss of observations. The authors also apply a novel ‘coarsened exact matching’ method that can potentially address the problem of sample attrition when matching. Their main finding using each of these three methods is that hand-washing, after defecating or before eating, significantly reduces prevalence and duration of a measure of overall diarrhea as well as acute watery diarrhoea among children under age five but not acute dysentery. In contrast, there may also be an effect of piped water on acute dysentery but not acute watery diarrhoea. Effects of improved water supply or improved toilets on different diarrhoeal outcomes are not observed consistently across matching methods.

Suggested Citation

  • Victoria Yue-May Fan & Ajay Mahal, 2011. "What prevents child diarrhoea? The impacts of water supply, toilets, and hand-washing in rural India," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 3(3), pages 340-370, September.
  • Handle: RePEc:taf:jdevef:v:3:y:2011:i:3:p:340-370
    DOI: 10.1080/19439342.2011.596941

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    References listed on IDEAS

    1. Gauri Khanna, 2008. "The Impact on Child Health from Access to Water and Sanitation and Other Socioeconomic Factors," IHEID Working Papers 02-2008, Economics Section, The Graduate Institute of International Studies, revised Jan 2008.
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    Cited by:

    1. Stephan Klasen & Tobias Lechtenfeld & Kristina Meier & Johannes Rieckmann, 2012. "Benefits trickling away: the health impact of extending access to piped water and sanitation in urban Yemen," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 4(4), pages 537-565, December.
    2. Santosh, Kumar & Sebastian, Vollmer, 2011. "Does improved sanitation reduce diarrhea in children in rural India?," MPRA Paper 31804, University Library of Munich, Germany.
    3. Joseph J. Capuno & Carlos Antonio R. Tan, Jr. & Xylee Javier, 2016. "WASH for child health: Some evidence in support of public intervention in the Philippines," UP School of Economics Discussion Papers 201611, University of the Philippines School of Economics.
    4. Kotsila, Panagiota & Saravanan, V. Subramanian, 2017. "Biopolitics Gone to Shit? State Narratives versus Everyday Realities of Water and Sanitation in the Mekong Delta," World Development, Elsevier, vol. 93(C), pages 374-388.
    5. Sowmya Dhanaraj, 2015. "Determinants of Child Health: An Empirical Analysis," Working Papers 2015-136, Madras School of Economics,Chennai,India.

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