Understanding household water insecurity after an industrial crisis

Household food and water insecurity has been previously associated with adverse health consequences in children. However, these relationships are understudied in middle‐income Latin American populations such as in Ecuador, where a high prevalence of food and water insecurity has been reported. Using cross‐sectional data from 2018 Ecuadorian National Health and Nutrition Survey, we examined the association of household food insecurity (HFI), household water insecurity (HWI), and concurrent HFI‐HWI with diarrhoea, respiratory illness (RI), and stunting in 20,510 children aged ≤59 months. HFI was measured using the Food Insecurity Experience Scale. HWI was defined when households responded negatively to one or more of four drinking water indicators. Maternal caregivers reported on child diarrhoea and RI episodes during the previous 2 weeks. Measured length or height was used to assess stunting. We constructed log‐binomial regression models to estimate the associations of HFI, HWI, and concurrent HFI‐HWI with child outcomes. Moderate‐severe HFI was associated with a higher prevalence of diarrhoea (PR = 1.39; 95% CI: 1.18, 1.63) and RI (PR = 1.34; 95% CI: 1.22, 1.47), HWI with a higher prevalence of RI (PR = 1.13; 95% CI: 1.04, 1.22), and concurrent HFI‐HWI with a higher prevalence of diarrhoea (PR = 1.30; 95% CI: 1.05, 1.62) and RI (PR = 1.45; 95% CI: 1.29, 1.62). Stunting was not associated with HFI, HWI nor concurrent HFI‐HWI. These findings suggest that HFI and HWI can independently and jointly act to negatively affect children's health. Policies and interventions aimed at alleviating both food and water insecurity are needed to bring sustained health improvements in Ecuadorian children.

This study compared the prevalence of concentrated urine (urine specific gravity ≥1.021), an indicator of hypohydration, across Tsimane' hunter-forager-horticulturalists living in hot-humid lowland Bolivia and Daasanach agropastoralists living in hot-arid Northern Kenya. It tested the hypotheses that household water and food insecurity would be associated with higher odds of hypohydration. This study collected spot urine samples and corresponding weather data along with data on household water and food insecurity, demographics, and health characteristics among 266 Tsimane' households (N = 224 men, 235 women, 219 children) and 136 Daasanach households (N = 107 men, 120 women, 102 children). The prevalence of hypohydration among Tsimane' men (50.0%) and women (54.0%) was substantially higher (P < .001) than for Daasanach men (15.9%) and women (17.5%); the prevalence of hypohydration among Tsimane' (37.0%) and Daasanach (31.4%) children was not significantly different (P = .33). Multiple logistic regression models suggested positive but not statistically significant trends between household water insecurity and odds of hypohydration within populations, yet some significant joint effects of water and food insecurity were observed. Heat index (2°C) was associated with a 23% (95% confidence interval [CI]: 1.09-1.40, P = .001), 34% (95% CI: 1.18-1.53, P < .0005), and 23% (95% CI: 1.04-1.44, P = .01) higher odds of hypohydration among Tsimane' men, women, and children, respectively, and a 48% (95% CI: 1.02-2.15, P = .04) increase in the odds among Daasanach women. Lactation status was also associated with hypohydration among Tsimane' women (odds ratio = 3.35, 95% CI: 1.62-6.95, P = .001). These results suggest that heat stress and reproductive status may have a greater impact on hydration status than water insecurity across diverse ecological contexts.

Drinking water access and water and food insecurity have been linked to mental well-being, but few studies have comprehensively assessed potential pathways linking these associations. Understanding these mediation pathways is particularly important among pregnant women, as prenatal stress and poor mental well-being have been shown to negatively impact fetal development. In this study, we address this gap by analyzing the relationships between drinking water source and water and food insecurity with mental well-being amongst pregnant women living in low-income, urban neighborhoods of Beira, Mozambique. Data for this cross-sectional analysis were collected among third-trimester, pregnant women (n=740) from February 2021 through October 2022 as part of a matched cohort study. Validated, cross-cultural measures of mental well-being and household water and food insecurity were administered in the survey. Drinking water source was determined by presence of a household drinking water source on-premises. We used logistic regression to characterize the associations between drinking water source, water and food insecurity, and mental well-being and causal mediation analysis to determine mediation by food and water insecurity along these pathways. We found evidence that water insecurity (OR 1.44; 95%CI 1.02, 2.02) and food insecurity (OR 2.27; 95%CI 1.57, 3.34) were individually associated with adverse mental well-being. Drinking water source was not associated with mental well-being (OR 1.00; 95%CI 0.71, 1.39), water insecurity (OR 0.86; 95%CI 0.60, 1.24), or food insecurity (OR 1.02; 95%CI 0.71, 1.47). Food insecurity may also mediate the relationship between water insecurity and mental well-being (ACME 0.05; 95%CI 0.02, 0.07; ADE 0.04; 95%CI -0.04, 0.13). Our findings support growing literature that water and food insecurity are important to mental well-being, a key aspect of overall health. Further research is needed to confirm causality along these pathways and determine specific mechanisms through which these interactions take place.

Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0-27) and WI (using a modified scale developed for this region, range: 0-51) in the prior month (n=716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0-100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P<0.001) and 2.92 times greater odds of probable depression (P<0.001). Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. This trial was registered at clinicaltrials.gov as NCT02815579.

The COVID-19 pandemic has increased the risk of global public health and has the potential to cause severe food and water insecurity due to economic recession during lockdown for people living in low-middle income countries like Bangladesh where capital resources are scarce. There is growing evidence that household food and water insecurity has been associated with poor psychological outcomes. The objective of this study was to determine the association between household food and water insecurity with mental health and whether these differed among urban-rural households. A cross-sectional online survey was conducted with 545 participants immediately after the COVID-19 lockdown period in Bangladesh (August 1-September 30, 2020). Household food and water security were determined using a 9-item Household Food Insecurity Access Scale (HFIAS) (score range 0-27) and a 12-item Household Water Insecurity Experiences (HWISE) scale (score range 0-36), respectively. The Perceived Stress Scale (PSS) was used to evaluate mental health. Multivariable logistic regression examined the association between household food and water insecurity with perceived stress, adjusting socioeconomic characteristics. An urban-rural stratified analysis was also performed. About 72.84% (397) respondents reported high stress and more than 70% of households suffered from food and water insecurity during the lockdown period. After adjusting covariates, logistic regression model results show that food insecurity was associated with a 1.07-point increase in high perceived stress (OR=1.07, 95% CI=1.01-1.11, p<0.01) while water insecurity was associated with 1.03 times greater odds of high perceived stress (OR=1.03, 95% CI=0.93-1.23, p<0.05). In stratified analysis, only food insecurity was associated with high perceived stress in the urban household (OR=1.08, 95% CI=1.00-1.11, p<0.05). However, none of the household insecurity was associated with perceived stress in rural households. Interventions that promote equal access to resources for low-income individuals will likely to be more effective to alleviate economic burden of pandemic.

Billions of people globally are at risk for severe water scarcity periodically throughout the year. Moreover, intensifying climate change and increasingly unpredictable weather patterns will increase the severity and scope of those affected by household water insecurity, with negative consequences on household health and wellbeing. Faced with water insecurity, households shift to alternative water sources, which may be more expensive or of lower quality and contribute to both financial and health burdens. The extent to which household water insecurity varies throughout the year, however, remains understudied. Using a panel dataset of 2014 households across 40 villages in Matlab, Bangladesh, we test for seasonal variation in household water insecurity and its determinants using a modified HWISE scale. We find that while water insecurity in Matlab was low both pre- and post-monsoon, household water experiences vary throughout the year. Households report significantly lower water insecurity post-monsoon, compared to pre-monsoon, suggesting an annual measure of household water insecurity is insufficient to fully characterize intra-annual household water experiences. Comparing determinants of household water insecurity, we find that geography, household water use behaviors, and household characteristics are significantly related to experiences of household water insecurity but vary in their extent depending on the season. Our results demonstrate that physical location, seasonality, water quality, and household-level factors contribute to the dynamic nature of intra-annual household water insecurity. Knowing when and to what extent such determinants influence household water experiences throughout the year is essential for guiding and adapting engineering and policy design to reduce the costs and consequences of household water insecurity.

Despite the central importance of water for human wellbeing and development, researchers and practitioners have few tools to quantitatively measure, assess, and compare the scope and scale of household and individual water insecurity across cultural and climatic variations. There are multiple definitions of water insecurity, and the analytical tools for measuring household‐level water insecurity are in their infancy. This paper provides an overview and systematic evaluation of current household and individual water in security metrics for human development. We seek to advance micro‐level metrics—attending to the considerations of dimensionality, temporality, unit of analysis, and comparability—because they will provide the research community with necessary tools to untangle the complex determinants and outcomes of water insecurity. Moreover, such metrics will support the translation of research outcomes into meaningful and useful products and results for stakeholders, communities, and decision‐makers.WIREs Water2017, 4:e1214. doi: 10.1002/wat2.1214This article is categorized under:Human Water &gt; Methods

Compounding systems of marginalization differentiate and shape water-related risks. Yet, quantitative water security scholarship rarely assesses such risks through intersectionality, a paradigm that conceptualizes and examines racial, gendered, class, and other oppressions as interdependent. Using an intersectionality approach, we analyze the relationships between household head gender and self-reported socio-economic status, and water affordability (proportion of monthly income spent on water) and water insecurity (a composite measure of 11 self-reported experiences) for over 4000 households across 18 low- and middle-income countries in Central and South America, Africa, and Asia. Interaction terms and composite categorical variables were included in regression models, adjusting for putative confounders. Among households with a high socio-economic status, the proportion of monthly income spent on water differed by household head gender. In contrast, greater household water insecurity was associated with lower socio-economic status and did not meaningfully vary by the gender of the household head. We contextualize and interpret these experiences through larger systems of power and privilege. Overall, our results provide evidence of broad intersectional patterns from diverse sites, while indicating that their nature and magnitude depend on local contexts. Through a critical reflection on the study's value and limitations, including the operationalization of social contexts across different sites, we propose methodological approaches to advance multi-sited and quantitative intersectional research on water affordability and water insecurity. These approaches include developing scale-appropriate models, analyzing complementarities and differences between site-specific and multi-sited data, collecting data on gendered power relations, and measuring the impacts of household water insecurity.

Household water insecurity may influence common mental disorders directly and indirectly through multiple pathways: Evidence from Haiti

Household Water Insecurity Is Positively Associated With Household Food Insecurity in Low- and Middle-Income Countries

Food and water security are essential components for Panama’s advancement toward the Sustainable Development Goals. This study aimed to quantify the prevalence of household food insecurity and water insecurity, and to explore the association between them using standardized measurement tools. A cross-sectional survey was conducted between January and June 2024 using an online questionnaire administered via Google Forms. The survey collected sociodemographic data and applied the Food Insecurity Experience Scale (FIES) and the Household Water Insecurity Experiences (HWISE) scale to assess water and food insecurity, respectively. A total of 222 adult household heads were included (66.2% female), with a median age of 31.4 years. The prevalence of moderate and severe food insecurity was 29.7% (95% CI: 24.8–34.6%) and 6.1% severe food insecurity (95% CI: 3.7–8.4%), while water insecurity affected 27% of households (10.4% high; 16.7% moderate). Multiple linear regression showed that moderate to severe food insecurity was significantly associated with water insecurity (β = 0.19; 95% CI: 0.08–0.31) and lower income levels. Specifically, food insecurity was associated with households reporting no income (β = 0.25; 95% CI: 0.05–0.44) and those with monthly income between 501 and 1000 USD (β = 0.11; 95% CI: 0.01–0.22), compared to households with income above 1000 USD. The results suggest that food insecurity is significantly associated with water insecurity, supporting the need for integrated approaches in public policy to address basic resource access in vulnerable populations.

There is growing interest in the phenomenon of water insecurity, yet a relative paucity of tools to assess the occurrence and severity of water insecurity at the household level. We sought to assess the validity and reliability of a household water insecurity scale in a rural Ethiopian context. Secondary data on water insecurity from up to 1934 rural Ethiopian households that had participated in a water and sanitation intervention was analysed. Exploratory factor analysis and Cronbach’s alpha were used to assess dimensionality of the water insecurity responses and parametric and non-parametric tests used to test for differences in household water insecurity scores across household types and objective measures of household water access. Factor analysis revealed one dominant factor and the Cronbach’s alpha of the water insecurity scale was 0.94. Households with access to improved water sources, that lived close to water collection points, that did not farm, and that felt they had “enough” water all scored as significantly more water secure on the household water insecurity scale (P < 0.05). The household water insecurity scale also predicted the occurrence of diarrhea among children in the household (aOR 1.2, 95 % CI 1.08, 1.33) whereas no other measure of water access did. Finally, household water insecurity scores improved by 55 % after a water and sanitation intervention.

This study examined access to water, food, and nutrition programs among marginalized communities in Southern Punjab, Pakistan, and their effects on nutrition. Both qualitative and quantitative data were used in this study. We held two focus group discussions (one with 10 males and one with 10 females) and conducted in-depth interviews with 15 key stakeholders, including 20 mothers and 10 healthcare providers. A survey of 235 households was carried out to evaluate water and food insecurity, with the data analyzed using Wilcoxon's rank-sum test, t-test, and Pearson's chi-square test. The results revealed that 90% of households experienced moderate-to-severe water insecurity, and 73% faced moderate-to-severe food insecurity. Household water and food insecurity were positively correlated with each other (correlation coefficient = 0.205; p = 0.004). Greater household water (p = 0.028) and food insecurity (p < 0.001) were both associated with higher perceived stress. Furthermore, lower socioeconomic status was strongly related to higher levels of water (p < 0.001) and food insecurity (p < 0.001). Qualitative findings highlight the impact of colonial and post-colonial policies, which have resulted in water injustice, supply issues, and corruption in water administration. Women face significant challenges in fetching water, including stigma, harassment, and gender vulnerabilities, leading to conflicts and injuries. Water scarcity and poor quality adversely affect sanitation, hygiene, and breastfeeding practices among lactating mothers. Structural adjustment policies have exacerbated inflation and reduced purchasing power. Respondents reported a widespread lack of dietary diversity and food quality. Nutrition programs face obstacles such as the exclusion of people with low social and cultural capital, underfunding, weak monitoring, health sector corruption, and the influence of formula milk companies allied with the medical community and bureaucracy. This study concludes that addressing the macro-political and economic causes of undernutrition should be prioritized to improve nutrition security in Pakistan.

Water insecurity may exacerbate food insecurity even in water-rich environments: Evidence from the Bolivian Amazon

Water plays a critical role in the production of food and preparation of nutritious meals, yet few studies have examined the relationship between water and food insecurity. The primary objective of this study, therefore, was to examine how experiences of household water insecurity (HWI) relate to experiences of household food insecurity (HFI) among a pastoralist population living in an arid, water-stressed region of northern Kenya. We implemented the twelve-item Household Water Insecurity Experiences (HWISE, range 0-36) Scale and the nine-item Household Food Insecurity Access Scale (HFIAS, range 0-27) in a cross-sectional survey to measure HWI and HFI, respectively. Data on socio-demographic characteristics and intake of meat and dairy in the prior week were collected as covariates of interest. Northern Kenya, June-July 2019. Daasanach pastoralist households (n 136) from seven communities. In the prior 4 weeks, 93·4 % and 98·5 % of households had experienced moderate-to-severe HWI and HFI, respectively. Multiple linear regression analyses indicated a strong association between HWI and HFI. Each point higher HWISE score was associated with a 0·44-point (95 % CI: 0·22, 0·66, P = 0·003) higher HFIAS score adjusting for socio-economic status and other covariates. These findings demonstrate high prevalence and co-occurrence of HWI and HFI among Daasanach pastoralists in northern Kenya. This study highlights the need to address HWI and HFI simultaneously when developing policies and interventions to improve the nutritional well-being of populations whose subsistence is closely tied to water availability and access.