Lack of community-level improved sanitation causes stunting in rural villages of Lao PDR and Vietnam

Increasing evidence indicates that inadequate sanitation is among the underlying causes of stunting. Stunted children are not only shorter than average: their cognitive development and chances to become productive adults are also affected. Poor sanitation, especially open defecation, still prevails in rural communities of Lao PDR, while unimproved sanitation showed no improvement in rural Vietnam during the past decade (although open defecation has declined rapidly). The poorest living in remove villages of Lao PDR and rural mountainous regions of Vietnam suffer the most from unimproved sanitation and stunting. Our analysis shows that community-level unimproved sanitation causes stunting in rural Vietnam and Lao PDR, regardless of whether a child household uses improved toilets. Thus, policies, programmatic interventions and incentives would best focus on community-wide (rather than household) outcomes and behavioural change. Targeted support for the poor might be a complementary element to ensure their inclusion.