A Toilet or a Mobile Phone?: Exploring Interactions and Choices That Influence the Health of Mothers in Kenya Using Structural Equation Modeling

In 2013 the UN opined, “Of the world’s seven billion people, six billion have mobile phones.  However, only 4.5 billion have access to toilets or latrines…” (Eliasson, 2013).  This statement clearly reflects a bias that implies toilets are better than mobile phones for meeting basic needs.  While it is well document that access to toilets results in improved health through improved hygiene, it remains to be determined if investments in toilets provide a greater return for protecting health as compared to investments in alternative technologies such as mobile phones.  The research gap that this study aims to address is to compare the relative contributions of toilets or mobile phones for protecting the health of mothers.  The approach taken in this study is to construct and evaluate a structural equation model (SEM) that explicitly tests the hypothesis, toilets are more important than mobile phones for protecting the health of mothers.  A secondary data set collected in 2008 from household surveys in Kenya was retrieved from the demographic healthy survey program funded by the United States Agency for International Development (USAID).  The SEM was constructed to evaluate maternal health as the primary objective with socioeconomic status, household education, the presence of a toilet, and the presence of a mobile phone as critical inputs.  Output measures included maternal body mass index (BMI) and child BMI.  This project highlights that interventions such as toilets or mobile phones are best evaluated when considering the complex interactions that are part of a dynamic health system with rapid advances occurring in technology.