Household Water Insecurity Will Complicate the Ongoing COVID-19 Response: Evidence from 29 Sites in 23 Low- and Middle-Income Countries

IntroductionWater fetching for household needs can cause injury, but documentation of the burden of harm globally has been limited. We described the frequency, characteristics and correlates of water-fetching injuries in 24 sites in 21 low-income and middle-income countries in Asia, Africa and Latin America and the Caribbean.MethodsIn a survey of 6291 randomly selected households, respondents reported whether and how they had experienced water-fetching injuries. Responses were coded for injury type, mechanism, bodily location and physical context. We then identified correlates of injury using a multilevel, mixed-effects logistic regression model.ResultsThirteen per cent of respondents reported at least one water-fetching injury. Of 879 injuries, fractures and dislocations were the most commonly specified type (29.2%), and falls were the most commonly specified mechanism (76.4%). Where specified, 61.1% of injuries occurred to the lower limbs, and dangerous terrain (69.4%) was the most frequently reported context. Significant correlates included being female (aOR=1.50, 95% CI 1.15 to 1.96); rural (aOR=4.80, 95% CI 2.83 to 8.15) or periurban residence (aOR=2.75, 95% CI 1.64 to 4.60); higher household water insecurity scores (aOR=1.09, 95% CI 1.07 to 1.10) and reliance on surface water (aOR=1.97, 95% CI 1.21 to 3.22) or off-premise water sources that required queueing (aOR=1.72, 95% CI 1.19 to 2.49).ConclusionThese data suggest that water-fetching injuries are an underappreciated and largely unmeasured public health challenge. We offer guidelines for comprehensive data collection on injuries to better capture the true burden of inadequate water access. Such data can guide the design of interventions to reduce injury risk and promote equitable water access solutions.

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Handwashing and water security in the context of a pandemic

10.5194/egusphere-egu21-10438 ◽

2021 ◽

Author(s):

David M. Hannah ◽

Iseult Lynch ◽

Feng Mao ◽

Joshua D. Miller ◽

Sera L. Young ◽

...

Keyword(s):

Hand Hygiene ◽

Behavioural Change ◽

Water Security ◽

Water Insecurity ◽

Middle Income ◽

Security Issues ◽

Middle Income Countries ◽

Sanitation And Hygiene ◽

Household Water ◽

Sustainable Development Goal 6

<p>The COVID-19 pandemic is a wake-up call for water security issues. It makes us acutely aware how crucial access, and ability, for adequate hand hygiene are for reducing transmission risks of communicable diseases. An estimated 40% of households globally lack access to basic handwashing facilities. A recent cross-cultural study of household water insecurity experiences (HWISE) found that nearly one in four of 6,637 randomly sampled households across 23 sites in 20 low- and middle-income countries. Similar water, sanitation and hygiene problems impact on poorer families in high-income nations too.</p><p>We explore the challenge of hand hygiene in a changing water world and reflect on the importance of making rapid progress towards &#8220;ensure availability and sustainable management of water and sanitation for all&#8221; (UN Sustainable Development Goal 6). We contest that urgent action on water security is essential to better prepare societies for the future, including global health crises. Drawing on the latest evidence, we provide recommendations on how to increase handwashing, and improve human health and wellbeing more broadly, by reducing water insecurity. Across our world, policymakers must focus on: investment in water infrastructure, water independent alternatives, and behavioural change and knowledge promotion. Moreover, we must prioritise holistic, evidence-based solutions that address 3 facets of water (in)security: availability, quality & accessibility.</p>

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The Household Water InSecurity Experiences (HWISE) Scale: development and validation of a household water insecurity measure for low-income and middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2019-001750 ◽

2019 ◽

Vol 4 (5) ◽

pp. e001750 ◽

Cited By ~ 32

Author(s):

Sera L Young ◽

Godfred O Boateng ◽

Zeina Jamaluddine ◽

Joshua D Miller ◽

Edward A Frongillo ◽

...

Keyword(s):

Low Income ◽

Discriminant Validity ◽

Population Level ◽

Well Being ◽

Random Coefficient Models ◽

Water Insecurity ◽

Cross Sectional ◽

Middle Income ◽

Middle Income Countries ◽

Household Water

ObjectiveProgress towards equitable and sufficient water has primarily been measured by population-level data on water availability. However, higher-resolution measures of water accessibility, adequacy, reliability and safety (ie, water insecurity) are needed to understand how problems with water impact health and well-being. Therefore, we developed the Household Water InSecurity Experiences (HWISE) Scale to measure household water insecurity in an equivalent way across disparate cultural and ecological settings.MethodsCross-sectional surveys were implemented in 8127 households across 28 sites in 23 low-income and middle-income countries. Data collected included 34 items on water insecurity in the prior month; socio-demographics; water acquisition, use and storage; household food insecurity and perceived stress. We retained water insecurity items that were salient and applicable across all sites. We used classical test and item response theories to assess dimensionality, reliability and equivalence. Construct validity was assessed for both individual and pooled sites using random coefficient models.FindingsTwelve items about experiences of household water insecurity were retained. Items showed unidimensionality in factor analyses and were reliable (Cronbach’s alpha 0.84 to 0.93). The average non-invariance rate was 0.03% (threshold <25%), indicating equivalence of measurement and meaning across sites. Predictive, convergent and discriminant validity were also established.ConclusionsThe HWISE Scale measures universal experiences of household water insecurity across low-income and middle-income countries. Its development ushers in the ability to quantify the prevalence, causes and consequences of household water insecurity, and can contribute an evidence base for clinical, public health and policy recommendations regarding water.

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

Current Developments in Nutrition ◽

10.1093/cdn/nzab045_007 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 625-625

Author(s):

Hilary Bethancourt ◽

Edward Frongillo ◽

Sera Young

Keyword(s):

Social Support ◽

Age Groups ◽

Food Choices ◽

State Agency ◽

Water Insecurity ◽

Middle Income ◽

Middle Income Countries ◽

Induced Changes ◽

National Prevalence ◽

Low And Middle Income

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.

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