The impact of early-stage sanitation improvements on the long-term health of children in rural areas of China: An analysis based on data from the CHNS database from 1991 to 2015

Objective: To understand the impact of early-stage sanitation improvements in rural areas of China on children’s long-term health outcomes, thereby providing a basis for future health policies aimed at rural children. Methods: Data from the China Health and Nutrition Survey (CHNS) from 1991 to 2015 was utilized to analyze the usage of sanitation facilities by 2,929 children aged 7–18 years in rural areas during their ages 3–6. A two-level mixed-effects model was used to examine the health effects of sanitation improvements on children. Additionally, a multi-layer mediation model was employed to explore the role of household sanitation conditions as a mediating factor between sanitation improvements and children’s long-term health outcomes in rural areas.