Water Insecurity Is Prevalent and Associated With Constrained Food Choices in Low- and Middle-Income Countries

Abstract

Abstract Objectives Water insecurity may coincide with and exacerbate food insecurity and poor nutrition and health. The Household Water Insecurity Experiences (HWISE) Scale permits quantification and comparison of water access and use across low- and middle-income countries (LMICs). With Gallup and UNESCO, we collected the first nationally representative data on water insecurity in half the world's population. We investigated the national prevalence of water insecurity and predictors of altered food choice resulting from problems (in quantity, quality, or stability) with water. Methods The 2020–2021 Gallup World Poll administered the 12-item HWISE module to individuals ≥ 15 y in 31 countries in Africa, Asia, and South America. Responses to each item were “never,” “1–2 months,” “some, not all months,” and “almost every month” (scored 0–3, total range 0–36) in the prior 12 months. One HWISE item asked the frequency with which respondents changed what was eaten due to water problems. Ordered logistic regression models controlling for country fixed effects examined the odds of reporting a higher frequency of water-induced changes in food choices in relation to 10-y-increment age groups, sex, rural/urban residence, marital status, education, number of children and adult household members, 27 income brackets, difficulty affording shelter, and social support. Results In the seven countries for which data were available at the time of submission (China, Congo Brazzaville, Ghana, Ivory Coast, Mauritius, Uganda, and Zambia, n = 8,916), the national prevalence of water insecurity (HWISE score > 12) ranged from 2.4 ± 0.4% in China to 42.7 ± 2.1% in Zambia. Higher odds of water-induced changes in food choices were found for each additional child (OR: 1.05; 95% CI: 1.02, 1.08) and with difficulty affording shelter (OR: 1.90; 95% CI: 1.69, 2.14). Lower odds of water-induced changes in food choices were found for each higher income bracket (OR: 0.97; 95% CI: 0.96, 0.98) and amongst those with social support (OR: 0.76; 95% CI: 0.67, 0.87) and those > 65 years of age relative to other age groups (ORs ranging from 0.50–0.60; all P < 0.02). Conclusions Water insecurity is a concern in many LMICs and may constrain food choices for people experiencing other social and economic hardships. Funding Sources Carnegie Corporation and United State Agency for International Development Cooperative Agreement.