This article provides a brief overview of the method and findings from a cluster-randomised trial that was conducted in 2011-2013 in Koulikoro, Mali, to assess a government implemented Community-Led Total Sanitation (CLTS) programme’s effect on child health.

The study population included households in rural villages (clusters); every household had to have at least one child aged younger than ten years. Villages were randomly assigned (1:1) with a computer-generated sequence by a study investigator to receive CLTS or no programme. Health outcomes included diarrhoea (primary outcome), height for age, weight for age, stunting, and underweight. Outcomes were measured one and a half years after intervention delivery (two years after enrolment) among children younger than five years.

Overall the findings showed that in villages that received a behavioural sanitation intervention with no monetary subsidies, diarrhoeal prevalence remained similar to control villages. However, access to toilets substantially increased and child growth improved, particularly in children under two years. This shows that CLTS might have prevented growth faltering through pathways other than reducing diarrhoea.