To summarize, the results to this point show that the number of toilets built in treatment communities since the program’s implementation was higher (3 percentage points) than in control communities. This is a 31 percent increase in the rate of toilet construction in treatment communities relative to control communities. There is evidence of declines in occasional open defecation by households that have access to a sanitation facility. Significantly fewer households in treatment communities reported that one or more household members defecate in the open (4.4 percentage points fewer). Knowledge of the health benefits of improved sanitation seems to be high across East Java, even in control communities. And the program is associated with increased acknowledgement that unclean food and water leads to diarrhea. However, defecating in rivers is still an accepted practice. The main obstacle to constructing facilities as reported by households seems to be the cost.

- _8.7 Prevalence of Diarrhea, Acute Lower Respiratory Infection (ALRI), Helminth Infections, and Acute Respiratory Infection (ARI)_

Now we turn our attention to health outcomes. Table 8b presents the summary statistics for the health variables. Diarrhea was defined using the WHO definition (three or more stools per day and the stools were loose or watery, or blood and/or mucus is visible in the stool (Baqui et al., 1991) based on symptoms reported by the child’s caregiver. There was a decline in diarrhea prevalence between the baseline and endline surveys.<sup>15</sup> Diarrhea prevalence was balanced in the baseline. In the endline, diarrhea prevalence in the treatment group was lower than that in the control group, regardless of the recall period used. Using a recall period of seven days, 2.4 percent of children under the age of five in the treatment group reported having had diarrhea in comparison to about 3.8 percent in the control group. The same pattern is observed if we use the shorter recall period of two days. These differences are statistically significant.<sup>16</sup> Soil transmitted helminthes ( _Ascaris lumbricoides, Trichuris trichuria,_ hookworm) are estimated to infect about one-third of the world’s population, and a significant share of infection is born by preschool-aged children (Albonico et al., 2008). Helminth infections can lead to iron-deficiency anemia, protein-energy malnutrition, abdominal pain, and listlessness (Adams et al., 1994). To examine this, stool specimens were collected and analyzed at endline from a random subsample of 2,330 children in the 80 villages. Each child in the parasitological sample was given a plastic container (a stool specimen container, with a spoon attached to the lid) and asked to provide a stool sample. The container had 15 ml of preservative (formalin) in it, unless the child was reported to have diarrhea, in which case there was 30 ml of formalin in it. Caregivers were told

> 15 This decrease at least in part reflects the aging of the children as these are figures for children who were present during both the baseline and endline surveys. Diarrhea prevalence is higher in children under the age of two. It may also be due to the different timing of the two surveys. The endline survey was conducted in the rainy season, whereas the baseline was conducted at the end of the dry season.

> 16 Shorter recall periods may be a more accurate measure of diarrhea prevalence because they involve less recall error.

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