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Child malnutrition is a major challenge facing low-income countries, with important implications for longer-term health, future economic growth and development. An emerging literature suggests that nutritional investments on their own are insufficient in reducing the high levels of child malnutrition. It is conjectured that nutritional investments should be complemented with improvements to the disease environment within which a child grows up. A poor disease environment increases exposure to faecal matter, which may increase susceptibility to diarrhoea, and also lead to gut inflammation (environmental enteropathy), which reduces an individual's ability to absorb nutrients. Improvements in water, sanitation and hygiene (WASH) have received increasing attention in policy circles as possible key complements.
In this paper we provide, to the best of our knowledge, the first causal evidence on the relative importance of and interaction between nutrition and WASH in determining child health among children aged 6-24 months. We estimate flexible production functions for child physical growth that allow for interactions between WASH and nutrition investments. We allow investments to be endogenous and account for the endogeneity in our estimation. We use rich data from the Cebu Longitudinal Health and Nutritional Survey of Filipino infants born between 1983 -1984. Our study sample faced similar nutritional and WASH conditions as those faced by poor households in low-income settings today.
We find evidence of complementarity between nutrition and WASH among children aged 6-24 months. The effects of nutrition and WASH investments vary by gender, with WASH investments being more productive for females.
