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Chakraborty R, Armijos RX, Beidelman ET, Rosenberg M, Margaret Weigel M. Household food and water insecurity and its association with diarrhoea, respiratory illness, and stunting in Ecuadorian children under 5 years. MATERNAL & CHILD NUTRITION 2024:e13683. [PMID: 38873704 DOI: 10.1111/mcn.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/22/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
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.
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Affiliation(s)
- Rishika Chakraborty
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Rodrigo X Armijos
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Center for Latin American & Caribbean Studies, Indiana University, Bloomington, Indiana, USA
- Center for Global Health Equity, Indiana University, Indianapolis, Indiana, USA
| | - Erika T Beidelman
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
| | - M Margaret Weigel
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Center for Latin American & Caribbean Studies, Indiana University, Bloomington, Indiana, USA
- Center for Global Health Equity, Indiana University, Indianapolis, Indiana, USA
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Workman CL, Miller JD, Shah SH, Maes K, Tesfaye Y, Mapunda KM. Frequency and perceived difficulty of household water experiences in Morogoro, Tanzania: Evidence of the psychosocial burden of water insecurity. SSM - MENTAL HEALTH 2024; 5:100295. [PMID: 39099889 PMCID: PMC11293490 DOI: 10.1016/j.ssmmh.2023.100295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024] Open
Affiliation(s)
- Cassandra L. Workman
- Department of Anthropology, University of North Carolina Greensboro, United States
| | - Joshua D. Miller
- Department of Nutrition, University of North Carolina Chapel Hill, United States
| | - Sameer H. Shah
- School of Environmental and Forest Sciences, University of Washington, United States
| | - Kenneth Maes
- Anthropology Program, School of Language, Culture & Society, Oregon State University, United States
| | - Yihenew Tesfaye
- Department of Social Anthropology, Bahir Dar University, Ethiopia
| | - Kenneth M. Mapunda
- Department of Agricultural Extension and Community Development, Sokoine University of Agriculture, Tanzania
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Thomson P, Pearson AL, Kumpel E, Guzmán DB, Workman CL, Fuente D, Wutich A, Stoler J. Water Supply Interruptions Are Associated with More Frequent Stressful Behaviors and Emotions but Mitigated by Predictability: A Multisite Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:7010-7019. [PMID: 38598435 DOI: 10.1021/acs.est.3c08443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Water supply interruptions contribute to household water insecurity. Unpredictable interruptions may particularly exacerbate water insecurity, as uncertainty limits households' ability to optimize water collection and storage or to modify other coping behaviors. This study used regression models of survey data from 2873 households across 10 sites in 9 middle-income countries to assess whether water supply interruptions and the predictability of interruptions were related to composite indicators of stressful behaviors and emotional distress. More frequent water service interruptions were associated with more frequent emotional distress (β = 0.49, SE = 0.05, P < 0.001) and stressful behaviors (β = 0.39, SE = 0.06, P < 0.001). Among households that experienced interruptions, predictability mitigated these respective relationships by approximately 25 and 50%. Where the provision of continuous water supplies is challenged by climate change, population growth, and poor management, water service providers may be able to mitigate some psychosocial consequences of intermittency through scheduled intermittency and communication about water supply interruptions. Service providers unable to supply continuous water should optimize intermittent water delivery to reduce negative impacts on users, and global monitoring regimes should account for intermittency and predictability in post-2030 water service metrics to better reflect household water insecurity experiences.
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Affiliation(s)
- Patrick Thomson
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, U.K
- School of Geography and the Environment, University of Oxford, Oxford OX1 3QY, U.K
| | - Amber L Pearson
- CS Mott Department of Public Health, Michigan State University, Flint, Michigan 48503, United States
| | - Emily Kumpel
- Department of Civil and Environmental Engineering, University of Massachusetts Amherst, Amherst, Massachusetts 01003, United States
| | - Danice B Guzmán
- Pulte Institute of Global Development, University of Notre Dame, Notre Dame, Indiana 46556, United States
| | - Cassandra L Workman
- Department of Anthropology, University of North Carolina Greensboro, Greensboro, North Carolina 27412, United States
| | - David Fuente
- School of the Earth, Ocean and Environment, University of South Carolina, Columbia, South Carolina 29208, United States
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona 85281, United States
| | - Justin Stoler
- Department of Geography and Sustainable Development, University of Miami, Coral Gables, Florida 33146, United States
- Department of Public Health Sciences, University of Miami, Miami, Florida 33136, United States
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Logie CH, Newman PA, Admassu Z, MacKenzie F, Chakrapani V, Tepjan S, Shunmugam M, Akkakanjanasupar P. Associations between water insecurity and mental health outcomes among lesbian, gay, bisexual, transgender and queer persons in Bangkok, Thailand and Mumbai, India: Cross-sectional survey findings. Glob Ment Health (Camb) 2024; 11:e31. [PMID: 38572259 PMCID: PMC10988155 DOI: 10.1017/gmh.2024.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/29/2023] [Accepted: 02/20/2024] [Indexed: 04/05/2024] Open
Abstract
Background Water insecurity disproportionally affects socially marginalized populations and may harm mental health. Lesbian, gay, bisexual, transgender and queer (LGBTQ) persons are at the nexus of social marginalization and mental health disparities; however, they are understudied in water insecurity research. Yet LGBTQ persons likely have distinct water needs. We explored associations between water insecurity and mental health outcomes among LGBTQ adults in Mumbai, India and Bangkok, Thailand. Methods This cross-sectional survey with a sample of LGBTQ adults in Mumbai and Bangkok assessed associations between water insecurity and mental health outcomes, including anxiety symptoms, depression symptoms, loneliness, alcohol misuse, COVID-19 stress and resilience. We conducted multivariable logistic and linear regression analyses to examine associations between water insecurity and mental health outcomes. Results Water insecurity prevalence was 28.9% in Mumbai and 18.6% in Bangkok samples. In adjusted analyses, in both sites, water insecurity was associated with higher likelihood of depression symptoms, anxiety symptoms, COVID-19 stress, alcohol misuse and loneliness. In Mumbai, water insecurity was also associated with reduced resilience. Conclusion Water insecurity was common among LGBTQ participants in Bangkok and Mumbai and associated with poorer well-being. Findings signal the importance of assessing water security as a stressor harmful to LGBTQ mental health.
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Affiliation(s)
- Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
| | - Peter A. Newman
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Zerihun Admassu
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Frannie MacKenzie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | | | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | - Pakorn Akkakanjanasupar
- Department of Educational Policy, Management, and Leadership, Faculty of Education, Chulalongkorn University, Bangkok, Thailand
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Burns PA, Mutunga C. Addressing the Impact of Climate Change on Sexual and Reproductive Health Among Adolescent Girls and Young Women in Low- and Middle-Income Countries. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:GHSP-D-23-00374. [PMID: 38365281 PMCID: PMC10906547 DOI: 10.9745/ghsp-d-23-00374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/23/2024] [Indexed: 02/18/2024]
Abstract
There is an urgent need to better understand the role of climate change on sexual and reproductive health outcomes, particularly among adolescent girls and young women in low- and middle-income countries. Stakeholders at all levels should apply a rights-based, gendered approach to climate action and adaptation.
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Affiliation(s)
- Paul A Burns
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA.
- U.S. Agency for International Development, Bureau for Global Health, Office of Population and Reproductive Health, Division of Research, Technology and Utilization, Washington, DC
- American Association for the Advancement of Science, Washington, DC
| | - Clive Mutunga
- BUILD (Building Capacity for Integrated Family Planning & Reproductive Health and Population, Environment and Development Action), The African Institute for Development for Policy, Lilongwe, Malawi
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Avelar Portillo LJ, Calderón-Villarreal A, Abramovitz D, Harvey-Vera A, Cassels S, Vera CF, Munoz S, Tornez A, Rangel G, Strathdee SA, Kayser GL. WaSH insecurity and anxiety among people who inject drugs in the Tijuana-San Diego border region. BMC Public Health 2024; 24:19. [PMID: 38166866 PMCID: PMC10763368 DOI: 10.1186/s12889-023-17341-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Water, sanitation, and hygiene (WaSH) insecurity increases the risk of water-related diseases. However, limited research has been conducted on psychosocial distress as it relates to WaSH insecurity, especially among people who inject drugs (PWID). We examined the relationship between WaSH insecurity and related anxiety among PWID living in different housing conditions along the US-Mexico border region. METHODS From 2020-2021, a cross-sectional study was conducted among 585 people who injected drugs within the last month in Tijuana (N = 202), San Diego (N = 182), and in both Tijuana and San Diego (N = 201). Participants underwent interviewer-administered surveys related to WaSH access, substance use, and generalized anxiety disorder (GAD-7). Quasi-Poisson regressions were used to assess associations between WaSH insecurity and anxiety in the prior 6-months. RESULTS Participants were 75% male, 42% were unhoused and 91% experienced WaSH insecurity in the prior 6-months. After adjusting for housing status, gender, and age, lack of access to basic drinking water (Adj RR: 1.28; 95% CI: 1.02-1.58), sanitation (Adj RR:1.28; 95% CI: 1.07-1.55), and a daily bath/shower (Adj RR: 1.38; 95% CI: 1.15-1.66) were associated with mild-severe anxiety. The number of WaSH insecurities was independently associated with a 20% increased risk of experiencing anxiety per every additional insecurity experienced (Adj RR: 1.20; CI: 1.12-1.27). We also found a significant interaction between gender and housing status (p = 0.003), indicating that among people experiencing sheltered/unsheltered homelessness, women had a higher risk of mild-severe anxiety compared to men (Adj RR: 1.55; 95% CI: 1.27-1.89). At the same time, among women, those who are unhoused have 37% increased risk of anxiety than those who live in stable housing conditions (Adj RR: 1.37; 95% CI: 1.01-1.89). CONCLUSION The lack of specific WaSH services, particularly lack of drinking water, toilets, and daily showers were associated with higher levels of anxiety among PWID in the Tijuana-San Diego border region. Women experiencing homelessness were especially vulnerable. WaSH interventions that provide safe, 24-h access may help to reduce anxiety and health risks associated with WaSH insecurity.
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Affiliation(s)
- Lourdes Johanna Avelar Portillo
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA.
- Benioff Homelessness and Housing Initiative, School of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Alhelí Calderón-Villarreal
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Daniela Abramovitz
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Alicia Harvey-Vera
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
- Facultad de Medicina, Campus Tijuana, Universidad de Xochicalco, Tijuana, Baja California, México
- United States-Mexico Border Health Commission, Tijuana, Baja California, Mexico
| | - Susan Cassels
- Department of Geography, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Carlos F Vera
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Sheryl Munoz
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Arturo Tornez
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Gudelia Rangel
- United States-Mexico Border Health Commission, Tijuana, Baja California, Mexico
- Departamento de Estudios de Población, Colegio de La Frontera Norte, Tijuana, México
| | - Steffanie A Strathdee
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Georgia L Kayser
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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Toivettula A, Varis O, Vahala R, Juvakoski A. Making waves: Mental health impacts of inadequate drinking water services - From sidenote to research focus. WATER RESEARCH 2023; 243:120335. [PMID: 37516073 DOI: 10.1016/j.watres.2023.120335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/30/2023] [Accepted: 07/09/2023] [Indexed: 07/31/2023]
Abstract
The paramount significance of the harmful impacts of poor drinking water services on physical health have been recognized for decades. Besides, over the past twenty years, an additional body of literature on their negative mental health impacts has emerged. With this brief review, we summarise the findings of the scholarship to advance addressing overall health (physical, mental, and social) in the water sector. We furthermore review the key policy documents of this field with a focus on mental health aspects and give recommendations for practitioners and decision-makers on addressing mental health in water service delivery. We reviewed the existing published works (42) assessing psychological impacts of deficient drinking water services in low-income settings. We then identified and compared the different mechanisms causing negative mental health outcomes described in them. For these purposes, we used a water insecurity experience -model and the vulnerability-stress model of clinical psychology. Next, we probed key international and national guiding documents of the water sector to analyse how mental health issues resulting from poor services are addressed today. We found that according to the literature, poor quality and quantity of water was predictably one of the most important psychosocial stressors to users. Surprisingly, however, various kinds of water-service-related inequalities (e.g. between genders, communities or socio-economic groups) showed up as equally significant stressors. Our analysis with the vulnerability-stress model furthermore indicates that insufficient drinking water services may predispose to common mental disorders particularly through external stress. Existing field guidelines have evolved to highlight the values of non-discrimination and participation, whilst mental health aspects remain ignored. This should not be the case. Therefore, practices for addressing mental health effectively in documentation and water service development should be further researched. But already in the light of the existing literature, we urge stakeholders to focus more on the negative mental health impacts of unequal service provision for users and nearby people left without improved services.
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Affiliation(s)
- A Toivettula
- Department of Built Environment, School of Engineering, Aalto University, PO Box 15200, FI-00076 Aalto, Finland.
| | - O Varis
- Department of Built Environment, School of Engineering, Aalto University, PO Box 15200, FI-00076 Aalto, Finland
| | - R Vahala
- Department of Built Environment, School of Engineering, Aalto University, PO Box 15200, FI-00076 Aalto, Finland
| | - A Juvakoski
- Department of Built Environment, School of Engineering, Aalto University, PO Box 15200, FI-00076 Aalto, Finland.
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Gizamba JM, Wilson JP, Mendenhall E, Ferguson L. A review of place-related contextual factors in syndemics research. Health Place 2023; 83:103084. [PMID: 37437495 DOI: 10.1016/j.healthplace.2023.103084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
This review investigates the extent to which a place-based approach has been used to conceptualize context, as well as the place-related contextual factors explored in studies that explicitly invoked a syndemic framework. The literature search focused on 29 peer-reviewed empirical syndemic studies. Only 11 studies used a place-based approach to define and measure contextual factors and the spatial context was denoted using administrative boundaries such as census tracts, counties, and countries. A narrow range of place-related contextual factors were explored and most of them were related to social and economic factors that were used to define a place. Methodological gaps like a paucity of multilevel studies and studies using a place-based approach to measure context were identified. Future syndemics research should leverage multidimensional geospatial approaches to decipher the role of place-related contextual factors in syndemic dynamics.
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Affiliation(s)
| | - John P Wilson
- Spatial Science Institute, University of Southern California, Los Angeles, USA
| | - Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, USA
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Sultana A, Wilson J, Martin-Hill D, Lickers A. Water Insecurity and Maternal Health Among Haudenosaunee Women in Canada. Med Anthropol 2023; 42:535-550. [PMID: 37459600 DOI: 10.1080/01459740.2023.2235629] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Water is central to Haudenosaunee knowledge, philosophy, and culture. The health of Haudenosaunee mothers is tied to that of water. Today, the lack of access to reliable drinking water for Six Nations is a significant health concern. Technical measurement of water advisories in Canada fails to understand the interwoven relationship that Haudenosaunee women have with water. Highlighting the voices of 55 Haudenosaunee women, we provide expanded definitions of water insecurity and maternal health to include more-than-human beings. This comprehensive understanding of water insecurity and health shapes SN mothers' experiences with water in a settler colonial state, affecting their holistic wellbeing.
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Affiliation(s)
- Afroza Sultana
- Department of Anthropology, McMaster University, Hamilton, ON, Canada
| | - Julie Wilson
- Six Nations Birthing Center, Ohsweken, ON, Canada
| | - Dawn Martin-Hill
- Department of Anthropology, Indigenous Studies Program, McMaster University Hamilton, ON, Canada
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Kimutai JJ, Lund C, Moturi WN, Shewangizaw S, Feyasa M, Hanlon C. Evidence on the links between water insecurity, inadequate sanitation and mental health: A systematic review and meta-analysis. PLoS One 2023; 18:e0286146. [PMID: 37228056 DOI: 10.1371/journal.pone.0286146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Water insecurity and inadequate sanitation have adverse impacts on the mental health of individuals. OBJECTIVE To review and synthesize evidence on the relationship between water insecurity, inadequate sanitation, and mental health globally. DATA SOURCES Relevant studies were identified by searching PubMed, PsycINFO, and EMBASE databases from inception up to March 2023. STUDY ELIGIBILITY CRITERIA Only quantitative studies were included. The exposure was water insecurity and or inadequate sanitation. The outcome was common mental disorders (CMD: depression or anxiety), mental distress, mental health or well-being. There was no restriction on geographical location. PARTICIPANTS General population or people attending health facilities or other services. EXPOSURE Water insecurity and/ or inadequate sanitation. RISK OF BIAS The effective Public Health Practice Project (EPHPP) assessment tool was used to assess quality of selected studies. SYNTHESIS OF RESULTS A meta-analysis was conducted using a random effects statistical model. RESULTS Twenty-five studies were included, with 23,103 participants from 16 countries in three continents: Africa (Kenya, Ethiopia, Ghana, Uganda, South Africa, Malawi, Mozambique, and Lesotho), Asia (Nepal, Bangladesh, India, and Iran) and the Americas (Brazil, Haiti, Bolivia and Vietnam). There was a statistically significant association between water insecurity and CMD symptoms. Nine studies reported a continuous outcome (5,248 participants): overall standardized mean difference (SMD = 1.38; 95% CI = 0.88, 1.87). Five studies reported a binary outcome (5,776 participants): odds ratio 5.03; 95% CI = 2.26, 11.18. There was a statistically significant association between inadequate sanitation and CMD symptoms (7415 participants), overall SMD = 5.36; 95% CI = 2.51, 8.20. LIMITATIONS Most of the included studies were cross-sectional which were unable to examine temporal relationships. CONCLUSIONS Water insecurity and inadequate sanitation contribute to poorer mental health globally. IMPLICATIONS OF KEY FINDINGS Interventions to provide basic water, sanitation and psychosocial support, could substantially contribute to reducing the burden of CMD alongside other health and social benefits. TRIAL REGISTRATION PROSPERO registration number: CRD42022322528.
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Affiliation(s)
- Joan J Kimutai
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Wilkister N Moturi
- Department of Environmental Science, Faculty of Environment and Resource Development, Egerton University, Njoro, Kenya
| | - Seble Shewangizaw
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Merga Feyasa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Charles I, Salinger A, Sweeney R, Batagol B, Barker SF, Nasir S, Taruc RR, Francis N, Clasen T, Sinharoy SS. Joint Food and Water Insecurity Had a Multiplicative Effect on Women's Depression in Urban Informal Settlements in Makassar, Indonesia during the COVID-19 Pandemic. J Nutr 2023; 153:1244-1252. [PMID: 36959077 PMCID: PMC10028453 DOI: 10.1016/j.tjnut.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Women living in urban informal settlements may be particularly vulnerable to the detrimental effects of the COVID-19 pandemic because of increased economic and psychosocial stressors in resource-limited environments. OBJECTIVES The objective of this study was to assess the associations between food and water insecurity during the pandemic and depression among women living in the urban informal settlements in Makassar, Indonesia. METHODS We implemented surveys at 3 time points among women enrolled in the Revitalizing Informal Settlements and their Environments trial. Depression was measured using the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) between November and December 2019 and again between February and March 2021. Food insecurity was measured using questions from the Innovation for Poverty Action's Research for Effective COVID-19 Reponses survey and water insecurity was measured using the Household Water Insecurity Experiences Short Form. Both were measured between August and September 2020. We built 3 multivariate quantile linear regression models to assess the effects of water insecurity, food insecurity, and joint food and water insecurity during the COVID-19 pandemic on CESD-10 score. RESULTS In models with the full sample (n = 323), food insecurity (β: 1.48; 95% CI: 0.79, 2.17), water insecurity (β: 0.13; 95% CI: -0.01, 0.26), and joint food and water insecurity (β: 2.40; 95% CI: 1.43, 3.38) were positively associated with CESD-10 score. In subgroup analyses of respondents for whom we had prepandemic CESD-10 scores (n = 221), joint food and water insecurity (β: 1.96; 95% CI: 0.78, 3.15) maintained the strongest relationship with CESD-10 score. A limitation of this study is that inconsistency in respondents from households across the survey waves reduced the sample size used for this study. CONCLUSIONS Our results find a larger association between depression and joint resource insecurity than with water or food insecurity alone, underlining the importance of addressing food and water insecurity together, particularly as they relate to women's mental health and well-being.
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Affiliation(s)
- Isabel Charles
- Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA, USA.
| | - Allison Salinger
- Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA, USA
| | - Rohan Sweeney
- Center for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Becky Batagol
- Monash Sustainable Development Institute and Faculty of Law, Monash University, Melbourne, Australia
| | - S Fiona Barker
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Sudirman Nasir
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia; Universitas Hasanuddin, Centre of Excellence for Interdisciplinary and Sustainability Sciences, Makassar, Indonesia
| | - Ruzka R Taruc
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Naomi Francis
- Monash Sustainable Development Institute and Faculty of Law, Monash University, Melbourne, Australia
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sheela S Sinharoy
- Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA, USA
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Rosinger AY, Bethancourt HJ, Young SL. Tap Water Avoidance Is Associated with Lower Food Security in the United States: Evidence from NHANES 2005-2018. J Acad Nutr Diet 2023; 123:29-40.e3. [PMID: 35872245 PMCID: PMC10119945 DOI: 10.1016/j.jand.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/03/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Food insecurity has profound nutritional and public health consequences. Water insecurity may exacerbate food insecurity, yet little is known about the association between water and food insecurity in the United States or other high-income countries. OBJECTIVE This study aimed to estimate how tap water avoidance, a proxy of water insecurity, covaries with food insecurity; examine how the probability of food insecurity changed by tap water avoidance between 2005 and 2018; and test how the association between tap water avoidance and food insecurity differed across income and housing statuses. DESIGN This was a secondary analysis of the cross-sectional 2005-2018 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING Participants were 31,390 US adults 20 years and older. MAIN OUTCOME MEASURES The main outcome was food insecurity, using the US Food Security Survey Module. STATISTICAL ANALYSES Adjusted logistic regression models estimated how tap water avoidance was associated with the odds of food insecurity. Predicted probabilities of food insecurity over time and by income and housing status were plotted using marginal standardization. RESULTS Adults who avoided tap water had 21% higher odds (95% CI 1.09 to 1.34) of food insecurity compared with those who drank tap water. The probability of any food insecurity doubled between 2005-2006 and 2017-2018 and was consistently higher for tap water avoiders. Food insecurity decreased across both tap water drinkers and avoiders as income increased, but was higher among tap water avoiders at all income levels. Likewise, food insecurity was higher among renters than among homeowners but was higher among tap water avoiders in both housing groups. CONCLUSIONS Tap water avoidance is positively associated with food insecurity in the United States, and both insecurities have increased over time. Efforts to mitigate food insecurity should simultaneously address water insecurity issues, including tap water availability and quality, as these may be a modifiable contributors to food insecurity.
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Affiliation(s)
- Asher Y Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA; Department of Anthropology, Pennsylvania State University, University Park, PA.
| | - Hilary J Bethancourt
- Department of Anthropology, Northwestern University, Evanston, IL; Institute for Policy Research, Northwestern University, Evanston IL
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL; Institute for Policy Research, Northwestern University, Evanston IL
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Koyratty N, Ntozini R, Mbuya MNN, Jones AD, Schuster RC, Kordas K, Li CS, Tavengwa NV, Majo FD, Humphrey J, Smith LE. Growth and growth trajectory among infants in early life: contributions of food insecurity and water insecurity in rural Zimbabwe. BMJ Nutr Prev Health 2022; 5:332-343. [PMID: 36619329 PMCID: PMC9813639 DOI: 10.1136/bmjnph-2022-000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Stunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied. Methods We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1-M18). Results A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=-0.09; 95% -0.19 to -0.13). From M6 to M18, poor food access was associated with lower LAZ (β=-0.11; 95% -0.20 to -0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time. Conclusion FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory.
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Affiliation(s)
- Nadia Koyratty
- Department of Poverty, Health and Nutrition, International Food Policy Research Institute, Washington DC, Washington DC, USA
| | - Robert Ntozini
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Mduduzi NN Mbuya
- Knowledge Leadership, Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Andrew D Jones
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Roseanne C Schuster
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA
| | - Chin-Shang Li
- School of Nursing, University at Buffalo, Buffalo, NY, USA
| | - Naume V Tavengwa
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D Majo
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura E Smith
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, USA
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Aluko OO, Oloruntoba EO, Ana GREE, Afolabi OT, Okon AJ. The dynamics of household water security and treatment practices: a population-based, cross-sectional study in Osun State, Southwest Nigeria. ENVIRONMENTAL MONITORING AND ASSESSMENT 2022; 195:138. [PMID: 36416983 DOI: 10.1007/s10661-022-10682-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
A minimum of basic water supply service is pertinent to improving living standards and water-dependent quality of life indices. In Nigeria, 14% have access to safely managed drinking water services, though approximately 30% of water pumps and schemes are likely to fail within 12 months of construction. This study aims to determine household water security and its predictors in Osun State, Nigeria. The cross-sectional study recruited 548 households through a five-stage sampling technique and used a semi-structured questionnaire for data collection. Results were presented by descriptive and inferential statistics, while binary logistic regression identified water-security predictors at Pά 0.05. Hand-dug wells (27.7%) and motorized boreholes (21.2%) were the predominant household drinking water sources. A total of 43.7% of households were water-secured while 35.2% of water sources were within residential settlements. A total of 25.1% of households experienced water scarcity, and 27.2% of households treat drinking water mainly by chlorination (56.7%) and boiling (14.7%). A total of 21.2%, 64.2%, and 9% of households, respectively, have safely managed basic and limited water supply services. Drinking water sources were associated with house ownership (p = 0.001) and residence period (p = 0.025) while water treatment was associated with gender (p = 0.010) and wealth (p = 0.0001). Age (p = 0.002) and wealth (p = 0.0001) are predictors of household water security. Two-fifths of households were water-secured, highlighting the dearth of potable water supply services and the need to incorporate strategic predictors of household water security in the existing national and state-level water resources regulations.
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Affiliation(s)
- Olufemi O Aluko
- Department of Environmental Health Sciences, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria.
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Elizabeth O Oloruntoba
- Department of Environmental Health Sciences, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Godson R E E Ana
- Department of Environmental Health Sciences, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Olusegun T Afolabi
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Workman CL, Stoler J, Harris A, Ercumen A, Kearns J, Mapunda KM. Food, water, and sanitation insecurities: Complex linkages and implications for achieving WASH security. Glob Public Health 2022; 17:3060-3075. [PMID: 34506263 DOI: 10.1080/17441692.2021.1971735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Food, water and sanitation insecurities are complex, multi-dimensional phenomena that entail more than availability and access; food, water, and sanitation resources must be safe and culturally appropriate. Researchers and implementers concerned with these insecurities have demonstrated that there are notable interactions between them resulting in significant psychological and biological outcomes. Recent randomised controlled trials (RCTs) in Bangladesh, Kenya (WASH Benefits) and Zimbabwe (SHINE) demonstrated no effect from water, sanitation and hygiene (WASH) interventions on linear growth, and mixed evidence on enteropathogen burden and risk of diarrhoea in young children. These data suggest a need for a more comprehensive understanding of WASH security. The risks posed by multiple resource insecurities shift depending on the individual, their movement throughout their day, their economically and socially prescribed roles, and ecological features such as seasonality and precipitation. By more fully integrating food, water and sanitation security in interventions and subsequent impact evaluations, we can achieve WASH security-one that addresses myriad transmission pathways and co-occurring diseases-that ultimately would improve health outcomes throughout the world. In this critical review, we outline the complexity of combined resource insecurities as a step towards transformative WASH.
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Affiliation(s)
| | | | - Angela Harris
- North Carolina State University, Raleigh, North Carolina
| | - Ayse Ercumen
- North Carolina State University, Raleigh, North Carolina
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Bethancourt HJ, Swanson ZS, Nzunza R, Young SL, Lomeiku L, Douglass MJ, Braun DR, Ndiema EK, Pontzer H, Rosinger AY. The co-occurrence of water insecurity and food insecurity among Daasanach pastoralists in northern Kenya. Public Health Nutr 2022; 26:1-11. [PMID: 35941080 PMCID: PMC9989708 DOI: 10.1017/s1368980022001689] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/23/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE 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. DESIGN 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. SETTING Northern Kenya, June-July 2019. PARTICIPANTS Daasanach pastoralist households (n 136) from seven communities. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Hilary J Bethancourt
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Research Policy, Northwestern University, Evanston, IL, USA
| | - Zane S Swanson
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
| | | | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Research Policy, Northwestern University, Evanston, IL, USA
| | - Luke Lomeiku
- Department of Education and Outreach Programs, National Museums of Kenya, Nairobi, Kenya
| | - Matthew J Douglass
- College of Agricultural Sciences and Natural Resources and Agricultural Research Division, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - David R Braun
- Center for the Advanced Study of Human Paleobiology, Department of Anthropology, The George Washington University, Washington, DC, USA
- Department of Human Evolution, Max Planck Institute of Evolutionary Anthropology, Leipzig, Germany
| | - Emmanuel K Ndiema
- Department of Earth Sciences, National Museums of Kenya, Nairobi, Kenya
| | - Herman Pontzer
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
- Global Health Institute, Duke University, Durham, NC, USA
| | - Asher Yoel Rosinger
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA16802, USA
- Department of Anthropology, The Pennsylvania State University, University Park, PA, USA
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Jayaweera RT, Goin D, Twine R, Neilands TB, Wagner RG, Lippman SA, Kahn K, Pettifor A, Ahern J. Associations between WASH-related violence and depressive symptoms in adolescent girls and young women in South Africa (HPTN 068): a cross-sectional analysis. BMJ Open 2022; 12:e061032. [PMID: 35790334 PMCID: PMC9258484 DOI: 10.1136/bmjopen-2022-061032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE There is a lack of research on experiences of WASH-related violence. This study aims to quantify the association between experience or worry of violence when using the toilet or collecting water and depressive symptoms among a cohort of young women in South Africa. METHODS Data are from visit 3 of the HPTN 068 cohort of adolescent girls in rural Mpumalanga Province, South Africa. Participants (n=1798) included in this analysis were aged 13-21 at baseline. Lifetime experience of violence or fear of violence when using the toilet and collecting water was collected by self-report; depressive symptoms in the past week were measured using the Center for Epidemiological Studies Depression Scale (CES-D). We used G-computation to calculate the prevalence difference (PD) and prevalence ratio of depression (CES-D score >15) associated with each domain of violence, controlling for baseline covariates. FINDINGS A total of 15.1% of respondents reported experiencing violence when using the toilet; 17.1% reported experiencing violence when collecting water and 26.7% reported depression. In adjusted models, those who reported experiencing violence when using the toilet had an 18.1% higher prevalence of depression (95% CI: 11.6% to 24.4%) than those who did not experience violence when using the toilet. Adjusted prevalence of depression was also higher among those who reported violence when collecting water (PD 11.9%, 95% CI: 6.7% to 17.2%), and who worried about violence when using the toilet (PD 12.8%, 95% CI: 7.9% to 19.8%), as compared with those who did not report these experiences. Worrying about violence when collecting water was not associated with depression after adjusting for covariates. CONCLUSION Experience of WASH-related violence is common among young women in rural South Africa, and experience or worry of experiencing violence is associated with higher prevalence of depressive symptoms. TRIAL REGISTRATION NUMBER NCT01233531; Post-results.
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Affiliation(s)
- Ruvani T Jayaweera
- Ibis Reproductive Health, Oakland, California, USA
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Dana Goin
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Torsten B Neilands
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheri A Lippman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA
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Cabral NLDA, Pequeno NPF, Roncalli AG, Marchioni DML, Lima SCVC, Lyra CDO. A methodological proposal for assessing food insecurity from a multidimensional perspective. CIENCIA & SAUDE COLETIVA 2022; 27:2855-2866. [PMID: 35730852 DOI: 10.1590/1413-81232022277.11752021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to develop a methodological proposal for the assessment of food and nutritional insecurity (FNiS) in adults and older adults (Vigi-FNiS). The proposal was developed using data from the BRAZUCA Natal survey, a cross-sectional study with 411 people living in Natal in the state of Rio Grande do Norte, Brazil. The association between sociodemographic, health and nutrition variables and food insecurity (FI) was tested using Poisson multiple regression. Overall prevalence of FI was 42.1% (37.4%-46.9%) and was higher in women (47.5%), adults (48.2%) and black people (52.7%). The following variables were included in the Vigi-FNiS: people aged <18 years living in the household (A) (AdjPR=1.3; 1.1-1.6); family income (B) in quintiles (Q1: AdjPR=5, 4; 2.5-11.7; Q2: AdjPR=4.8; 2.2-10.5; Q3: AdjPR=3.8; 1.8-8.5; Q4 AdjPR=2.2; 1.0-5.1); inadequate treatment of drinking water (C) (AdjPR=1.3; 1.1-1.5); presence of chronic non-communicable diseases (D) (AdjPR=1.3; 1.1-1.7); not eating fruit for breakfast (E) (AdjPR=1.7; 1.3-2.5);eating meals on the couch or in bed (F) (AdjPR=1.3; 1.1-1.6); and skipping either lunch or dinner or dinner (G) (AdjPR=1.4; 1.2-1.7). A cutoff point for FNiS of 2.3 was adopted (Kappa=0.47; sensitivity=0.82; specificity=0.67; PPV=0.64; NPV=0.83).
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Affiliation(s)
- Natália Louise de Araújo Cabral
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN). R. General Cordeiro de Faria s/n, Petrópolis. 59012-570 Natal RN Brasil.
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Vuong TN, Dang CV, Toze S, Jagals P, Gallegos D, Gatton ML. Household water and food insecurity negatively impacts self-reported physical and mental health in the Vietnamese Mekong Delta. PLoS One 2022; 17:e0267344. [PMID: 35511953 PMCID: PMC9071150 DOI: 10.1371/journal.pone.0267344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/06/2022] [Indexed: 12/17/2022] Open
Abstract
Introduction Household food insecurity and inadequate water, sanitation, and hygiene (WASH) contribute to ill health. However, the interactions between household food insecurity, WASH and health have been rarely assessed concurrently. This study investigated compounded impacts of household food insecurity and WASH on self-reported physical and mental health of adults in the Vietnamese Mekong Delta. Materials and methods This cross-sectional survey interviewed 552 households in one northern and one southern province of the Vietnamese Mekong Delta. The survey incorporated previously validated tools such as the Short Form 12-item Health Survey, Household Food Insecurity Assessment Scale, and the Access and Behavioural Outcome Indicators for Water, Sanitation, and Hygiene. Physical and mental health were quantified using the physical health composite score (PCS) and mental health composite score (MCS), respectively. These measures were the dependent variables of interest for this study. Results Statistical analysis revealed that household food insecurity and using <50 litres of water per person per day (pppd) were independently associated with lower PCS (p<0.05), after adjusting for socio-economic confounders. Household food insecurity and lack of food availability, using <50 litres of water pppd, and the use of untreated drinking water were associated with lower MCS (p<0.05), with water usage being an effect modifier of the relationship between household food insecurity and MCS. The results indicate that being food insecure and having limited potable quality water had a compounding effect on MCS, compared to being individually either food insecure or having limited water. Conclusion This study is one of only a few that have established a link between potable water availability, food insecurity and poorer physical and mental health. The results also indicate a need to validate national data with fine-scale investigations in less populous regions to evaluate national initiatives with local populations that may be at higher risk. Adopting joint dual-action policies for interventions that simultaneously address water and food insecurity should result in larger improvements in health, particularly mental health, compared to targeting either food or water insecurity in isolation.
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Affiliation(s)
- Thuy Ngoc Vuong
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Public Health in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Chinh Van Dang
- Institute of Public Health in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Simon Toze
- Urban Water Futures, Brisbane, QLD, Australia
| | - Paul Jagals
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Woolworths Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- * E-mail:
| | - Michelle L. Gatton
- School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Experiences of inequalities in access to safe water and psycho-emotional distress in Ghana. Soc Sci Med 2022; 301:114970. [PMID: 35430464 DOI: 10.1016/j.socscimed.2022.114970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 11/21/2022]
Abstract
Research suggests that experiences of water insecurity may negatively impact the psycho-emotional wellbeing of water-insecure households. This paper examines how perceived inequalities in water access mediate the relationship between water insecurity and psycho-emotional distress. Data were collected among 1192 men and women in Ghana who are active water collectors within their households. We employed a binary logistics regression to identify the determinants of psycho-emotional distress. Sobel test was used to test the indirect effect of water insecurity and psycho-emotional distress through perceived inequalities. The results show that wealth (OR = 6.6, CI = 2.784-14.076), number of people in a household (OR = 1.07, CI = 1.002-1.145) and perceived inequalities (OR = 4.6, CI = 2.737-7.907) are significant predictors of psycho-emotional distress. Sobel test indicated that the point estimate (PE) of the indirect effect between water insecurity and psycho-emotional distress through perceived inequality is -0.136 (p = 0.000), meaning households were less likely to experience psycho-emotional distress if they felt that safe water facilities were equally distributed. The findings suggest that the distribution of water resources in cities with water challenges, no matter how scarce those resources are, has a profound effect on psycho-emotional distress. In resources constrained cities, there is a need for holistic water-related interventions that make inclusivity and fairness their primary focus.
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Boateng GO, Workman CL, Miller JD, Onono M, Neilands TB, Young SL. The syndemic effects of food insecurity, water insecurity, and HIV on depressive symptomatology among Kenyan women. Soc Sci Med 2022; 295:113043. [PMID: 32482382 PMCID: PMC8869838 DOI: 10.1016/j.socscimed.2020.113043] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/28/2020] [Accepted: 05/09/2020] [Indexed: 02/06/2023]
Abstract
Depression is a leading cause of disability worldwide and a major contributor to the overall global burden of disease, especially for women of childbearing age. Social science scholarship has demonstrated significant relationships between mental health, food insecurity (FI), water insecurity (WI), and HIV. Little is known, however, about the temporal relationships between food and water insecurity or the mechanisms through which these multiple stressors may operate or interact to impact depression. We therefore used syndemic theory to explore the complex relationships between FI, WI, and HIV on depressive symptomatology among Kenyan women of mixed HIV status (n=183, NCT02979418). We sought to 1) understand the temporal relationships between time-variant risk factors for depression, i.e. FI and WI, and 2) assess how these factors potentially interacted with HIV to impact depressive symptomatology. We first assessed the bidirectional relationship between WI and FI using a cross-lagged three-wave, two-variable panel model. Next, we modeled depressive symptomatology at 21 months as a linear function of the potentially syndemic interaction between FI, WI, and HIV status, adjusting for household wealth. WI had a predominant predictive effect on FI (Bayesian posterior predictive p-value=0.13); there was no reverse causality for the influence of FI on WI. The interaction effect of FI, WI, and HIV was significantly associated with greater depressive symptomatology (β=0.06) at 21 months postpartum. These data suggest that water insecurity may be an important determinant of food insecurity. Further, the co-occurrence of FI, WI, and HIV increases the likelihood of maternal depressive symptomatology, i.e. there is a syndemic relationship. These findings suggest that the role of household WI in other adverse health outcomes beyond mental well-being should be examined, and that interventions to improve mental health will be more effective if they also consider concurrent resource insecurities, regardless of HIV status.
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Affiliation(s)
- Godfred O Boateng
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, 76019, USA; Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
| | - Cassandra L Workman
- Department of Anthropology, University of North Carolina at Greensboro, Greensboro, NC, 27412, USA
| | - Joshua D Miller
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
| | | | - Torsten B Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Sera L Young
- Department of Anthropology & Global Health, Faculty Fellow, Institute for Policy Research, Northwestern University, Evanston, IL, 60208, USA.
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22
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Nagata JM, Miller JD, Cohen CR, Frongillo EA, Weke E, Burger R, Wekesa P, Sheira LA, Mocello AR, Otieno P, Butler LM, Bukusi EA, Weiser SD, Young SL. Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya. AIDS Behav 2022; 26:549-555. [PMID: 34373987 PMCID: PMC8813828 DOI: 10.1007/s10461-021-03410-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 12/21/2022]
Abstract
Reliable access to safe and acceptable water in sufficient quantities (i.e., water security) is important for medication adherence and limiting pathogen exposure, yet prior studies have only considered the role of food security as a social determinant of HIV-related health. Therefore, the objective of this analysis was to assess the relationships between household water insecurity and HIV-related outcomes among adults living with HIV in western Kenya (N = 716). We conducted a cross-sectional analysis of baseline data from Shamba Maisha (NCT02815579), a cluster randomized controlled trial of a multisectoral agricultural and asset loan intervention. Baseline data were collected from June 2016 to December 2017. We assessed associations between water insecurity and HIV-related outcomes, adjusting for clinical and behavioral confounders, including food insecurity. Each five-unit higher household water insecurity score (range: 0-51) was associated with 1.21 higher odds of having a viral load ≥ 1000 copies/mL (95% CI 1.07, 1.36) and 1.26 higher odds of AIDS-defining illness (95% CI 1.11, 1.42). Household water insecurity was not associated with CD4 cell count (B: 0.27; 95% CI -3.59, 13.05). HIV treatment and support programs should consider assessing and addressing water insecurity in addition to food insecurity to optimize HIV outcomes.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, 550 16th Street, Box 0110, San Francisco, CA, 94158, USA.
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA.
| | - Joshua D Miller
- Department of Nutrition, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rachel Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lila A Sheira
- Department of Medicine, University of California, San Francisco, CA, USA
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Phelgona Otieno
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lisa M Butler
- Institute for Collaboration On Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Elizabeth A Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
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23
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Cabral NLDA, Pequeno NPF, Roncalli AG, Marchioni DML, Lima SCVC, Lyra CDO. A methodological proposal for assessing food insecurity from a multidimensional perspective. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022277.11752021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract The aim of this study was to develop a methodological proposal for the assessment of food and nutritional insecurity (FNiS) in adults and older adults (Vigi-FNiS). The proposal was developed using data from the BRAZUCA Natal survey, a cross-sectional study with 411 people living in Natal in the state of Rio Grande do Norte, Brazil. The association between sociodemographic, health and nutrition variables and food insecurity (FI) was tested using Poisson multiple regression. Overall prevalence of FI was 42.1% (37.4%-46.9%) and was higher in women (47.5%), adults (48.2%) and black people (52.7%). The following variables were included in the Vigi-FNiS: people aged <18 years living in the household (A) (AdjPR=1.3; 1.1-1.6); family income (B) in quintiles (Q1: AdjPR=5, 4; 2.5-11.7; Q2: AdjPR=4.8; 2.2-10.5; Q3: AdjPR=3.8; 1.8-8.5; Q4 AdjPR=2.2; 1.0-5.1); inadequate treatment of drinking water (C) (AdjPR=1.3; 1.1-1.5); presence of chronic non-communicable diseases (D) (AdjPR=1.3; 1.1-1.7); not eating fruit for breakfast (E) (AdjPR=1.7; 1.3-2.5);eating meals on the couch or in bed (F) (AdjPR=1.3; 1.1-1.6); and skipping either lunch or dinner or dinner (G) (AdjPR=1.4; 1.2-1.7). A cutoff point for FNiS of 2.3 was adopted (Kappa=0.47; sensitivity=0.82; specificity=0.67; PPV=0.64; NPV=0.83).
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24
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Dharod JM, Nounkeu CD, Paynter L, Labban JD, Sastre LR. Examination of the Cameroon DHS data to investigate how water access and sanitation services are related to diarrhea and nutrition among infants and toddlers in rural households. JOURNAL OF WATER AND HEALTH 2021; 19:1030-1038. [PMID: 34874909 DOI: 10.2166/wh.2021.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Undernutrition among children is a significant issue in rural areas in Cameroon, with diarrhea being one of the major contributing risk factors. To gain a better understanding of the risk factors of diarrhea, the main objective of this epidemiological study was to examine associations between water access and sanitation service with diarrhea, diet diversity, and anemia among infants and toddlers in rural households in Cameroon. The study involved household- and individual-level data of 2,129 rural-dwelling infants and toddlers from the Demographic and Health Survey database. About one-third of infants and toddlers were experiencing diarrhea, with higher odds among those who lived in households with limited water service (p = 0.028). The odds of having diarrhea were 50% higher among infants and toddlers when households did not have sanitation facilities (p = 0.007). The lack of improved water and sanitation was also associated with a low intake of various food groups among older infants and toddlers. The prevalence of anemia was high, but no significant differences were seen by water and sanitation services. The achievement of SDG #6 will help address undernutrition and achieve other SDGs, including improving health and wellbeing.
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Affiliation(s)
- Jigna M Dharod
- Department of Nutrition, University of North Carolina, Greensboro, NC, USA E-mail:
| | | | - Lauren Paynter
- Department of Nutrition, University of North Carolina, Greensboro, NC, USA E-mail:
| | - Jeffrey D Labban
- Office of Research, School of Health and Human Sciences, University of North Carolina, Greensboro, NC, USA
| | - Lauren R Sastre
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC 27834, USA
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25
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Rosinger AY, Bethancourt HJ, Young SL, Schultz AF. The embodiment of water insecurity: Injuries and chronic stress in lowland Bolivia. Soc Sci Med 2021; 291:114490. [PMID: 34662760 PMCID: PMC8671240 DOI: 10.1016/j.socscimed.2021.114490] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/25/2021] [Accepted: 10/13/2021] [Indexed: 12/14/2022]
Abstract
Water is critical to health and wellbeing. Studies have theorized that problems with water can become embodied, yet few studies have quantified this. Therefore, we first sought to understand the lowland Bolivian water environment of Tsimane' forager-horticulturalists. We assessed the water environment holistically, using objective measures of water quality and water services (Joint Monitoring Programme's drinking water services ladder) and subjective measures, including perceived water safety and water insecurity experiences [Household Water Insecurity Experiences Scale (HWISE)]. We tested how water service levels, perceived water safety, and water fetching frequency were associated with HWISE scores using Tobit regression models among 270 households. We then tested if and how water becomes embodied via self-reported water-related injury and a chronic stress biomarker, hair cortisol concentration (HCC). Results demonstrated that, compared with households using surface water, households with basic water services had HWISE scores 1.59-pts lower (SE = 0.29; P < 0.001). Ingestion of water perceived to be "bad" and more daily water-fetching trips were associated with higher HWISE scores. Twenty percent of households reported prior water-related injuries, with women most commonly injured. In logistic regressions, each point higher HWISE score was associated with 28% (95%CI:1.16-1.41; P < 0.001) higher odds of injury. Basic water services compared to surface water was associated with 48% lower odds (OR = 0.52; 95%CI:0.33-0.82; P = 0.005) of injury. Finally, using linear regressions among 332 adults, HWISE scores were not associated with HCC. Past water-related injury was associated with higher HCC (Beta = 0.31; SE = 0.09; P = 0.029) among women, but not men. Relying on unimproved water services compared to surface was associated with 46.2% higher HCC for women (Beta=0.38; SE=0.14; P=0.048) and 55.3% higher HCC for men (Beta=0.44; SE=0.15; P=0.044), respectively. Overall, our findings demonstrate that water insecurity can become embodied through water-related injuries and elevated HCC. Improving water service levels through an equity lens may help ameliorate water insecurity and its accompanying negative health effects.
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Affiliation(s)
- Asher Y Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, 16802, USA; Department of Anthropology, Pennsylvania State University, State College, PA, 16802, USA.
| | - Hilary J Bethancourt
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, 16802, USA; Department of Anthropology, Northwestern University, Evanston, IL, USA; Anthropology Institute for Policy Research, Northwestern University, IL, USA
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA; Anthropology Institute for Policy Research, Northwestern University, IL, USA
| | - Alan F Schultz
- Centro Boliviano de Investigación y Desarrollo Socio Integral, San Borja, Bolivia
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26
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Ahmed F, Shahid M, Cao Y, Qureshi MG, Zia S, Fatima S, Guo J. A Qualitative Exploration in Causes of Water Insecurity Experiences, and Gender and Nutritional Consequences in South-Punjab, Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312534. [PMID: 34886260 PMCID: PMC8657084 DOI: 10.3390/ijerph182312534] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
Although water insecurity has been discussed in general, its impacts on mothers’ physical and mental health, and infants’ and young children’s feeding (IYCF), has largely been ignored. This study explores household water insecurity experiences and their association with optimal health and nutrition of women and children in the Rajanpur district of Punjab Province. Using focus group discussions (FGDs) and key informants (KIIs) interviews from an area with high maternal-child malnutrition prevalence, a qualitative study was conducted to describe local experiences of water acquirement and arrangement, and of the consequences of water insecurity. The findings highlight that rural Western marginalized populations of the Rajanpur district rely on brackish, canal, or flood surface water as the water supply is absent, which intensifies mothers’ work burden and stress, and often makes them victims of violence, stigma, and sickness. Water fetching impacts women in unforeseen ways, impacting the psychosocial and physical health of mothers engaged in maternal breastfeeding. Water insecurity, originally rooted in regional disparities, compounds with gender inequities, which leads to maternal stress and child sickness. Justice in water resources is imperative and urgent in the deprived South of Punjab province for improving public health nutrition.
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Affiliation(s)
- Farooq Ahmed
- Department of Anthropology, Quaid-I-Azam University, Islamabad 44000, Pakistan;
- Department of Anthropology, University of Washington, Seattle, WA 98105, USA
| | - Muhammad Shahid
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing 100029, China;
| | - Yang Cao
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing 100029, China;
- Correspondence: ; Tel.: +86-173-1948-0430
| | | | - Sidra Zia
- Independent Researcher, Islamabad 44000, Pakistan;
| | - Saireen Fatima
- Fazaia Medical College, Air University, Islamabad 44000, Pakistan;
| | - Jing Guo
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100091, China;
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27
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Singer M, Bulled N, Ostrach B, Lerman Ginzburg S. Syndemics: A Cross-Disciplinary Approach to Complex Epidemic Events Like COVID-19. ANNUAL REVIEW OF ANTHROPOLOGY 2021. [DOI: 10.1146/annurev-anthro-100919-121009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this review, we trace the origins and dissemination of syndemics, a concept developed within critical medical anthropology that rapidly diffused to other fields. The goal is to provide a review of the literature, with a focus on key debates. After a brief discussion of the nature and significance of syndemic theory and its applications, we trace the history and development of the syndemic framework within anthropology and the contributions of anthropologists who use it. We also look beyond anthropology to the adoption and use of syndemics in other health-related disciplines, including biomedicine, nursing, public health, and psychology, and discuss controversies in syndemics, particularly the perception that existing syndemics research focuses on methodologies at the individual level rather than at the population level and fails to provide evidence of synergistic interactions. Finally, we discuss emerging syndemics research on COVID-19 and provide an overview of the application of syndemics research.
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Affiliation(s)
- Merrill Singer
- Department of Anthropology, University of Connecticut, Storrs, Connecticut 06269-1248, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut 06269-1248, USA
| | - Nicola Bulled
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut 06269-1248, USA
| | - Bayla Ostrach
- Family Medicine Department, Boston University School of Medicine, Boston, Massachusetts 02118, USA
| | - Shir Lerman Ginzburg
- Department of Public Health Sciences, The University of Connecticut Health Center, Manchester, Connecticut 06042, USA
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28
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Marlow M, Christie H, Skeen S, Rabie S, Louw JG, Swartz L, Mofokeng S, Makhetha M, Tomlinson M. Alcohol use during pregnancy in rural Lesotho: "There is nothing else except alcohol". Soc Sci Med 2021; 291:114482. [PMID: 34700117 DOI: 10.1016/j.socscimed.2021.114482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/19/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Reducing alcohol use during pregnancy is a pressing public health priority in Sub-Saharan Africa, but insight into the factors that influence prenatal drinking practices is lacking. This study investigated perceptions of, and motivations for, alcohol consumption during pregnancy and associated practices in a rural district of Lesotho. METHODS A combination of purposive and snowball sampling methods were used to identify pregnant women and mothers with young children from the general community, as well as from alcohol-serving venues. Between September 2016 and March 2017, a trained data collector conducted in-depth interviews with 40 women on reasons why pregnant women drink, what they know about the risk of drinking alcohol during pregnancy, and perceptions of women who drink during pregnancy. RESULTS Sixty-five percent of women (n = 26) reported that they consumed alcohol during pregnancy. Findings were clustered into four themes: 1) alcohol use in daily and cultural life; 2) alcohol as relief from stress and hunger; 3) alcohol's effect on the baby; and 4) access to information about alcohol consumption. Our data suggest that alcohol use was a prominent feature of daily life and a key part of traditional events and ceremonies. Other than potentially harming the baby through falling on their stomachs while inebriated, women did not mention other risks associated with prenatal alcohol use. Rather, there were prominent beliefs that drinking alcohol - home-brewed alcohol in particular - had cleansing or protective benefits for the baby. Experiences of food insecurity were prominent, and women reported that alcohol helped curb their hunger and allowed them to save food to give to their children. CONCLUSIONS Within this context of chronic poverty and food insecurity, alcohol use during pregnancy will continue to represent a valid, though tragic choice if the structural conditions and current social arrangements that facilitate prenatal alcohol use remain unchanged.
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Affiliation(s)
- Marguerite Marlow
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Office 4009, 4th Floor, Education Building, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
| | - Hope Christie
- Department of Clinical Psychology, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom.
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Office 4009, 4th Floor, Education Building, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
| | - Stephan Rabie
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa.
| | - Jacobus G Louw
- Foundation for Alcohol Related Research, 42 Bloemhof Rd, Bloemhof, Cape Town, 7530, South Africa; Department of Psychology, Stellenbosch University, Stellenbosch, RW Wilcocks Building, 2nd Floor, Ryneveld Street, Stellenbosch, 7600, South Africa.
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, RW Wilcocks Building, 2nd Floor, Ryneveld Street, Stellenbosch, 7600, South Africa.
| | - Shoeshoe Mofokeng
- Department of Social Work, Sociology and Anthropology, National University of Lesotho, P.O Roma 180, Maseru, Lesotho, Lesotho.
| | - Moroesi Makhetha
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Office 4009, 4th Floor, Education Building, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Office 4009, 4th Floor, Education Building, Francie van Zijl Drive, Tygerberg, 7505, South Africa; School of Nursing and Midwifery, Queens University, Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, United Kingdom.
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29
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Young SL, Frongillo EA, Jamaluddine Z, Melgar-Quiñonez H, Pérez-Escamilla R, Ringler C, Rosinger AY. Perspective: The Importance of Water Security for Ensuring Food Security, Good Nutrition, and Well-being. Adv Nutr 2021; 12:1058-1073. [PMID: 33601407 PMCID: PMC8321834 DOI: 10.1093/advances/nmab003] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/21/2022] Open
Abstract
Water security is a powerful concept that is still in its early days in the field of nutrition. Given the prevalence and severity of water issues and the many interconnections between water and nutrition, we argue that water security deserves attention commensurate with its importance to human nutrition and health. To this end, we first give a brief introduction to water insecurity and discuss its conceptualization in terms of availability, access, use, and stability. We then lay out the empirical grounding for its assessment. Parallels to the food-security literature are drawn throughout, both because the concepts are analogous and food security is familiar to the nutrition community. Specifically, we review the evolution of scales to measure water and food security and compare select characteristics. We then review the burgeoning evidence for the causes and consequences of water insecurity and conclude with 4 recommendations: 1) collect more water-insecurity data (i.e., on prevalence, causes, consequences, and intervention impacts); 2) collect better data on water insecurity (i.e., measure it concurrently with food security and other nutritional indicators, measure intrahousehold variation, and establish baseline indicators of both water and nutrition before interventions are implemented); 3) consider food and water issues jointly in policy and practice (e.g., establish linkages and possibilities for joint interventions, recognize the environmental footprint of nutritional guidelines, strengthen the nutrition sensitivity of water-management practices, and use experience-based scales for improving governance and regulation across food and water systems); and 4) make findings easily available so that they can be used by the media, community organizations, and other scientists for advocacy and in governance (e.g., tracking progress towards development goals and holding implementers accountable). As recognition of the importance of water security grows, we hope that so too will the prioritization of water in nutrition research, funding, and policy.
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Affiliation(s)
- Sera L Young
- Department of Anthropology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Zeina Jamaluddine
- London School of Tropical Medicine and Hygiene, London, England
- American University of Beirut, Lebanon, Beirut
| | | | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Claudia Ringler
- Environment and Production Technology Division, International Food Policy Research Institute, Washington, DC, USA
| | - Asher Y Rosinger
- Department of Biobehavioral Health and Department of Anthropology, Pennsylvania State University, State College, PA, USA
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30
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Tomberge VMJ, Bischof JS, Meierhofer R, Shrestha A, Inauen J. The Physical Burden of Water Carrying and Women's Psychosocial Well-Being: Evidence from Rural Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7908. [PMID: 34360203 PMCID: PMC8345449 DOI: 10.3390/ijerph18157908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
Many women in low-income countries carry heavy loads of drinking water for their families in difficult terrain. This can adversely affect their health and well-being. The present study is the first to investigate the physical burden of water carrying and women's psychosocial well-being, and how this relationship is moderated by environmental and health conditions. Trained local interviewers conducted interviews with 1001 women across five rural communities in Nepal. In addition, objective measurement was used to assess the weight carried and distance from the water source. The physical burden of water carrying was calculated from weight, distance, and frequency of trips. Its association with psychosocial well-being was modeled using generalized estimating equations. Two additional models included the terrain and uterine prolapse as moderators. The physical burden of water carrying is directly related to higher emotional distress and reduced daily functioning. This correlation was exacerbated for women carrying in hilly versus flat terrain, and for those who had uterine prolapse. Our results underline the importance of adequate water access for women's psychosocial well-being, especially for vulnerable populations such as women with impaired health (e.g., uterine prolapse) or those living in hilly terrain. The results further highlight the interconnectedness of the Sustainable Development Goal (SDG) 6: water access, SDG 3: health and well-being, and SDG 5: gender equality.
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Affiliation(s)
- Vica Marie Jelena Tomberge
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland; (J.S.B.); (J.I.)
| | - Janine Stefanie Bischof
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland; (J.S.B.); (J.I.)
| | - Regula Meierhofer
- Department of Sanitation, Water and Solid Waste for Development (Sandec), Eawag, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600 Duebendorf, Switzerland;
| | - Akina Shrestha
- School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel 1008, Nepal;
| | - Jennifer Inauen
- Department of Health Psychology & Behavioral Medicine, Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland; (J.S.B.); (J.I.)
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31
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Choudhary N, Schuster RC, Brewis A, Wutich A. Household Water Insecurity Affects Child Nutrition Through Alternative Pathways to WASH: Evidence From India. Food Nutr Bull 2021; 42:170-187. [PMID: 34282660 DOI: 10.1177/0379572121998122] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Household water security matters greatly for child nutrition outcomes in the global South. Water's role in sanitation/hygiene, via diarrheal disease, is cited as a primary mechanism here. Yet, the relationship between Water along with Sanitation and Hygiene (WASH) and child stunting remains inconclusive. Water-related mechanisms outside of the traditional scope of WASH might assist with explaining this. OBJECTIVE We aim to test the mediating role of reduced dietary diversity as an additional potential mechanism in linking worse household water access to increased risk of early childhood stunting, separating its effects from sanitation and diarrhea among children (as a proxy for hygiene) and taking into account regional water availability. METHOD We use nationally representative India Demographic and Health Survey (2015-16) data for 58 038 children aged 6 to 23 months, applying generalized structural equation modelling to estimate water's direct and indirect effects (as mediated through dietary diversity and access to sanitation) on a child's likelihood of being stunted. RESULTS Suboptimal water access is significantly associated with elevated likelihood of child stunting. More than 30% of the effect is indirect. In the context of low water access and availability, children's dietary diversity alone mediates more than 20% of its total effect on child stunting. CONCLUSION Beyond the WASH mechanisms, household water access affects child stunting indirectly, mediated through its impacts on children's dietary diversity. These mediating effects are also moderated by regional water availability. Water interventions in low-water regions should help reduce children's risk of nutrition-related stunting in households with lowest water access.
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32
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Nounkeu CD, Gruber KJ, Kamgno J, Teta I, Dharod JM. Development of water insecurity scale for rural households in Cameroon- Central Africa. Glob Health Action 2021; 14:1927328. [PMID: 34165038 PMCID: PMC8231399 DOI: 10.1080/16549716.2021.1927328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Water represents the core of food-energy nexus and is vital for human survival. In developing countries, contaminated water and lack of basic water services undermine efforts to improve nutritional status and related health issues. In the rural areas of Central Africa, a majority of the population lacks access to improved water sources and has to devote considerable efforts to obtain water. Objectives: Using the following definition of water insecurity, i.e. it exists when access to adequate amount of safe and clean water does not occur all the times for the entirety of household members to lead a healthy and active life, the study aimed to develop and test a household-level experiential water insecurity scale for rural households in Central Africa. Methods: The research was conducted in three phases: 1) the formative data collection; 2) the scale development; and, 3) the scale testing. In the third Phase, the scale was tested with 250 women who were water managing person of their households. Statistical analysis included items reduction, reliability, as well as criterion and construct validity assessment. The testing led to a final scale of 17 statements (WATINE-17), covering three domains of water insecurity: 1) psychosocial distress; 2) quantity; 3) quality of water. Results: The scale showed an excellent reliability (Cronbach’s alpha = 0.92) and was significantly associated with lower frequency of water intake among women (p = 0.007, concurrent validity). In assessing WATINE-17’s predictive validity, it was found that water insecurity was positively related to food insecurity (p < 0.001) and the level of water insecurity was the highest among severely food insecure households [F (3, 246) = 22.469, p < 0.001]. Conclusion: The WATINE-17 is able to capture key elements of water insecurity and can be used to monitor and evaluate SDG# 6 and water-related programs, such as WASH, in Central Africa.
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Affiliation(s)
| | - Kenneth J Gruber
- Center for Housing and Community Studies, The University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Joseph Kamgno
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Director of the Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Ismael Teta
- Hellen Keller International Cameroon, Yaoundé, Cameroon
| | - Jigna Morarji Dharod
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC, USA
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Nounkeu CD, Dharod JM. Integrated Approach in Addressing Undernutrition in Developing Countries: A Scoping Review of Integrated Water Access, Sanitation, and Hygiene (WASH) + Nutrition Interventions. Curr Dev Nutr 2021; 5:nzab087. [PMID: 34268466 PMCID: PMC8275452 DOI: 10.1093/cdn/nzab087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
A scoping review of integrated water access, sanitation, and hygiene (WASH) plus nutrition interventions was conducted mainly to describe different components of intervention and examine their effectiveness in improving nutritional outcomes among children. Of the 8 small- to large-scale interventions, 6 were conducted in sub-Saharan Africa and the remaining 2 in South Asia. All the interventions were done in rural settings; the majority involved sanitation and hygiene deliverables along with the nutrition strategies, such as distribution of nutrition supplements. In assessing effectiveness, no significant improvements were seen in growth indicators; reduction in diarrheal rate among children was also not universal across interventions. Further strengthening of WASH, especially an improvement in "W", or water access, is warranted to ensure uptake of sanitation and hygiene behaviors and prevent the fecal-oral route among children. Improved water access will also enhance the effectiveness of nutrition initiatives, such as promoting vegetable gardening and utilization of child nutrient supplements.
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Affiliation(s)
| | - Jigna M Dharod
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC, USA
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Nounkeu CD, Dharod JM. Water fetching burden: a qualitative study to examine how it differs by gender among rural households in the west region of Cameroon. Health Care Women Int 2021; 43:1023-1041. [PMID: 34191674 DOI: 10.1080/07399332.2021.1931225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Women act as gatekeepers in securing water for their households. Using this qualitative methodology, 35 participants were interviewed with the objectives to determine roles and responsibilities of different family members in fetching and managing water and examine differences in perceptions related to water access/use between men and women in households from rural areas of the Menoua Division, West Cameroon. We found that the household structure was key component in each family member's degree of involvement in water fetching and management. A significant gender gap was found among adults with fewer men than women experiencing coping strategies-related to water scarcity. Hence, women participation in designing water and food security initiatives is warranted.
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Affiliation(s)
| | - Jigna Morarji Dharod
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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Miller JD, Frongillo EA, Weke E, Burger R, Wekesa P, Sheira LA, Mocello AR, Bukusi EA, Otieno P, Cohen CR, Weiser SD, Young SL. Household Water and Food Insecurity Are Positively Associated with Poor Mental and Physical Health among Adults Living with HIV in Western Kenya. J Nutr 2021; 151:1656-1664. [PMID: 33709134 PMCID: PMC8243794 DOI: 10.1093/jn/nxab030] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/04/2021] [Accepted: 01/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND 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. OBJECTIVES We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Joshua D Miller
- Department of Anthropology, Northwestern
University, Evanston, IL, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior,
University of South Carolina, Columbia, SC, USA
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research
Institute, Nairobi, Kenya
| | - Rachel Burger
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research
Institute, Nairobi, Kenya
| | - Lila A Sheira
- Department of Medicine, University of California San
Francisco, San Francisco, CA, USA
| | - A Rain Mocello
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research
Institute, Nairobi, Kenya
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Phelgona Otieno
- Centre for Clinical Research, Kenya Medical Research
Institute, Nairobi, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive
Sciences, University of California San Francisco, San
Francisco, CA, USA
| | - Sheri D Weiser
- Department of Medicine, University of California San
Francisco, San Francisco, CA, USA
| | - Sera L Young
- Department of Anthropology, Northwestern
University, Evanston, IL, USA
- Institute for Policy Research, Northwestern
University, Evanston, IL, USA
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Workman CL, Cairns MR, de los Reyes FL, Verbyla ME. Global Water, Sanitation, and Hygiene Approaches: Anthropological Contributions and Future Directions for Engineering. ENVIRONMENTAL ENGINEERING SCIENCE 2021; 38:402-417. [PMID: 34079211 PMCID: PMC8165478 DOI: 10.1089/ees.2020.0321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/20/2021] [Indexed: 06/12/2023]
Abstract
Anthropologists contribute key insights toward a comprehensive understanding of water, sanitation, and hygiene (WASH) as a multidimensional, multiscalar, and culturally embedded phenomenon. Yet, these insights have yet to be sufficiently operationalized and implemented in WASH development and wider WASH access-related paradigms. Ensuring WASH security requires a comprehensive approach to identifying both human health risk and environmental impact of WASH-related programs and strategies. It requires an understanding of how sanitation is integrated into households and communities and how individuals within particular cultural contexts practice sanitation and hygiene. This work facilitates that goal by outlining the major contributions of anthropology and allied social sciences to WASH, as well as outlining key considerations for future work and collaboration. We identify six major themes that, if applied in future engineering approaches, will more equitably integrate stakeholders and multiple vantage points in the successful implementation of WASH projects for marginalized and diverse groups. These include a critical understanding of previous approaches, culturally aware interventions, capacity building that considers (un)intended impact, co-created technology, collaboration between fields such as anthropology and engineering, and challenge-ready initiatives that respond to historic and emergent social and environmental inequity.
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Affiliation(s)
- Cassandra L. Workman
- Department of Anthropology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Maryann R. Cairns
- Department of Anthropology, Southern Methodist University, Dallas, Texas, USA
| | - Francis L. de los Reyes
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Matthew E. Verbyla
- Department of Civil and Environmental Engineering, San Diego State University, San Diego, California, USA
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Jepson WE, Stoler J, Baek J, Morán Martínez J, Uribe Salas FJ, Carrillo G. Cross-sectional study to measure household water insecurity and its health outcomes in urban Mexico. BMJ Open 2021; 11:e040825. [PMID: 33674365 PMCID: PMC7938997 DOI: 10.1136/bmjopen-2020-040825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 01/24/2021] [Accepted: 02/10/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess the links between structural and household determinants of household water insecurity and test three water insecurity measures against self-reported diarrhoea, dengue fever and perceived stress in the middle-income and low-income urban areas of Torreón, Mexico. DESIGN Cross-sectional household survey conducted in two waves (rainy and dry seasons). PARTICIPANTS 500 households selected via multistage cluster sample in selected communities. Socioeconomic status determined the selection of participant neighbourhoods; five were identified in low socioeconomic status neighbourhoods and five in low-medium socioeconomic status neighbourhoods. We examine how the context of urban water provision is related to a new cross-culturally valid Household Water Insecurity Experiences (HWISE) Scale. PRIMARY OUTCOME MEASURES The HWISE Scale, self-reported diarrhoea, dengue fever and the Perceived Stress Scale. RESULTS Water system intermittency (adjusted OR (AOR) 3.96, 95% CI 2.40 to 6.54, p<0.001), unpredictability (AOR 2.24, 95% CI 1.34 to 3.74, p=0.002) and the dry season (AOR 3.47, 95% CI 2.18 to 5.52, p<0.001) were structural correlates of the HWISE Scale. This study also found that the HWISE Scale was associated with two health outcomes, self-reported diarrhoea (AOR 1.09, 95% CI 1.03 to 1.15, p=0.002) and perceived stress (β=0.28, SE=0.07, t=4.30, p<0.001), but not self-reported dengue fever (AOR 1.02, 95% CI 0.98 to 1.06). A 3-item hygiene subscore and a 3-item water worry subscore were also both positively associated with self-reported diarrhoea and perceived stress. CONCLUSION Short-form screeners of water insecurity may be useful for assessing certain health risks by lay survey workers in settings with limited healthcare resources, particularly in lieu of more expensive microbiological tests that require specialised training and facilities.
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Affiliation(s)
- Wendy E Jepson
- Geography, Texas A&M University, College Station, Texas, USA
| | - Justin Stoler
- Geography, University of Miami, Coral Gables, Florida, USA
| | - Juha Baek
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Javier Morán Martínez
- Universidad Autónoma de Coahuila Facultad de Medicina Unidad Torreón, Torreón, Mexico
| | | | - Genny Carrillo
- Environmental and Occupational Health, Texas A&M University, College Station, Texas, USA
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Workman CL, Brewis A, Wutich A, Young S, Stoler J, Kearns J. Understanding Biopsychosocial Health Outcomes of Syndemic Water and Food Insecurity: Applications for Global Health. Am J Trop Med Hyg 2021; 104:8-11. [PMID: 33146108 DOI: 10.4269/ajtmh.20-0513] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Household food and water insecurity often co-occur, and both can lead to malnutrition, psycho-emotional stress, and increased risk of infectious and chronic diseases. This can occur through multiple pathways including poor diet and inadequate sanitation. In this perspective, we discuss the potential advantages of a syndemic approach to understanding the consequences of food and water insecurity, that is, one that makes possible the assessment of their mutually enhancing effects on health. Syndemic theory considers the concerted, deleterious interaction of two or more diseases or other health conditions, such as psycho-emotional stress, that result from structural inequities. We therefore call for an approach that links localized morbidity of individual- or household-level experiences of concurrent food and water insecurity to larger structural and contextual forces/risk environments. Such an approach permits the investigation of food and water insecurity as suites of risk, such that certain disease outcomes serve as signals for interlinked stressors. For example, the use of a syndemic perspective could help explain the persistence of conditions like diarrhea or stunting after food or water interventions; that is, existing approaches may be too narrow in scope to protect individuals from multiple and overlapping environmental and biopsychosocial stressors.
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Affiliation(s)
| | | | | | - Sera Young
- 3Northwestern University, Evanston, Illinois
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Lai C, Pellicano GR, Méndez H, Castellanos BA, Pomoni E, Tomai M, Langher V, La Longa F, Crescimbene M. Retracted: Water Scarcity May Lead to Poor Mental Health: A Community-Focused Study in Rural El Salvador. ECOPSYCHOLOGY 2020. [DOI: 10.1089/eco.2020.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Carlo Lai
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Gaia Romana Pellicano
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Hilda Méndez
- University of El Salvador (UES), San Salvador, El Salvador
| | | | - Elpiniki Pomoni
- Institute of Geosciences and Earth Resources—National Research Council, Pisa, Italy
| | - Manuela Tomai
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Viviana Langher
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
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Nguyen KH, Operario DJ, Nyathi ME, Hill CL, Smith JA, Guerrant RL, Samie A, Dillingham RA, Bessong PO, Rogawski McQuade ET. Seasonality of drinking water sources and the impact of drinking water source on enteric infections among children in Limpopo, South Africa. Int J Hyg Environ Health 2020; 231:113640. [PMID: 33115698 DOI: 10.1016/j.ijheh.2020.113640] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Enteric infections and water-related illnesses are more frequent during times of relative water abundance, especially in regions that experience bimodal rainfall patterns. However, it is unclear how seasonal changes in water availability and drinking water source types affect enteric infections in young children. This study investigated seasonal shifts in primary drinking water source type and the effect of water source type on enteric pathogen prevalence in stool samples from 404 children below age 5 in rural communities in Limpopo Province, South Africa. From wet to dry season, 4.6% (n = 16) of households switched from a source with a higher risk of contamination to a source with lower risk, with the majority switching to municipal water during the dry season. In contrast, 2.6% (n = 9) of households switched from a source with a lower risk of contamination to a source with higher risk. 74.5% (n = 301) of the total households experienced interruptions in their water supply, regardless of source type. There were no significant differences in enteric pathogen prevalence between drinking water sources. Intermittent municipal water distribution and household water use and storage practices may have a larger impact on enteric infections than water source type. The limited differences in enteric pathogen prevalence in children by water source could also be due to other exposure pathways in addition to drinking water, for example through direct contact and food-borne transmission.
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Affiliation(s)
- Kathy H Nguyen
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, 22908, USA
| | - Darwin J Operario
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, 22908, USA
| | - Mzwakhe E Nyathi
- Department of Animal Science, University of Venda, Limpopo Province, Thohoyandou, 0950, South Africa
| | - Courtney L Hill
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, 22904, USA
| | - James A Smith
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, 22904, USA
| | - Richard L Guerrant
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, 22908, USA
| | - Amidou Samie
- Department of Microbiology, University of Venda, Limpopo Province, Thohoyandou, 0950, South Africa
| | - Rebecca A Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, 22908, USA
| | - Pascal O Bessong
- Department of Microbiology, University of Venda, Limpopo Province, Thohoyandou, 0950, South Africa
| | - Elizabeth T Rogawski McQuade
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, 22908, USA; Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, 22908, USA.
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Rosinger AY, Brewis A, Wutich A, Jepson W, Staddon C, Stoler J, Young SL. Water borrowing is consistently practiced globally and is associated with water-related system failures across diverse environments. GLOBAL ENVIRONMENTAL CHANGE : HUMAN AND POLICY DIMENSIONS 2020; 64:102148. [PMID: 33071475 PMCID: PMC7566692 DOI: 10.1016/j.gloenvcha.2020.102148] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Water problems due to scarcity, inaccessibility, or poor quality are a major barrier to household functioning, livelihood, and health globally. Household-to-household water borrowing has been posited as a strategy to alleviate unmet water needs. However, the prevalence and predictors of this practice have not been systematically examined. Therefore, we tested whether water borrowing occurs across diverse global contexts with varying water problems. Second, we tested if household water borrowing is associated with unmet water needs, perceived socio-economic status (SES), and/or water-related system failures, and if water access moderated (or changed) these relationships. Using survey data from the Household Water Insecurity Experiences (HWISE) study from 21 sites in 19 low- and middle-income countries (n = 5495 households), we found that household-to-household water borrowing was practiced in all 21 sites, with 44.7% (11.4-85.4%) of households borrowing water at least once the previous month. Multilevel mixed-effect logistic regression models demonstrate that high unmet water needs (odds ratio [OR] = 2.86], 95% confidence interval [CI] = 2.09-3.91), low perceived SES (OR = 1.09; 95% CI = 1.05-1.13), and water-related system failures (23-258%) were all significantly associated with higher odds of water borrowing. Significant interactions (all p < 0.01) between water access, unmet water needs, and water-related system failures on water borrowing indicate that water access moderates these relationships. These data are the first to demonstrate that borrowing water is commonly used by households around the world to cope with water insecurity. Due to how prevalent water borrowing is, its implications for social dynamics, resource allocation, and health and well-being are likely vast but severely under-recognized.
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Affiliation(s)
- Asher Y. Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA 16802, USA
- Department of Anthropology, Pennsylvania State University, University Park, PA 16802, USA
- Corresponding author at: 219 Biobehavioral Health Building, University Park, PA 16802, USA. (A.Y. Rosinger)
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Phoenix, Arizona State University, Tempe, AZ 85287, USA
| | - Amber Wutich
- School of Human Evolution and Social Change, Phoenix, Arizona State University, Tempe, AZ 85287, USA
| | - Wendy Jepson
- Department of Geography, Texas A&M University, College Station, TX 77843, USA
| | - Chad Staddon
- Centre for Water, Communities and Resilience, University of the West of England, Bistol BS161QY, UK
| | - Justin Stoler
- Department of Geography, University of Miami, Coral Gables, FL 33146, USA
| | - Sera L. Young
- Department of Anthropology & Institute for Policy Research, Northwestern University, Evanston, IL 60208, USA
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Wutich A, Brewis A, Tsai A. Water and mental health. WIRES WATER 2020; 7. [DOI: 10.1002/wat2.1461] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/21/2020] [Indexed: 08/30/2023]
Abstract
AbstractThere is a well‐established connection among water quality, sanitation, and physical health. The potentially important relationship between water and mental health is considerably less studied. Reviewing evidence from ethnography, geography, folklore, indigenous studies, rural medicine, drought research, and large‐n statistical studies, we argue there is now good theoretical rationale and growing evidence of water insecurity as a possible driver of mental ill‐health. Furthermore, some nascent evidence suggests that emotionally meaningful interactions with water might improve mental health outcomes. Leveraging these literatures, we address the many ways in which mental health outcomes are conceptualized and operationalized in water research, including as emotional distress, perceived stress, depressive symptoms, anxiety symptoms, somatic symptoms, and quality of life. We outline arguments supporting seven possible (and likely interlocking) mechanisms that could explain such a relationship: (a) material deprivation and related uncertainty, (b) shame of social failure, (c) worry about health threats, (d) loss of connections to people and places, (e) frustration around opportunity losses and restricted autonomy, (f) interpersonal conflict and intimate partner violence, and (g) institutional injustice or unfairness. However, we explain that as most existing studies are ethnographic, qualitative, or cross‐sectional, a causal relationship between water and mental ill‐health is yet to be confirmed empirically. More research on this topic is needed, particularly given that poorly understood connections may create barriers to achieving Sustainable Development Goals 3 (health) and 6 (water). We further suggest that tracking mental health indicators may provide unique and as‐yet underappreciated insights into the efficacy of water projects and other development interventions.This article is categorized under:
Engineering Water > Water, Health, and Sanitation
Human Water > Water as Imagined and Represented
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Affiliation(s)
- Amber Wutich
- School of Human Evolution & Social Change Arizona State University Tempe Arizona USA
| | - Alexandra Brewis
- School of Human Evolution & Social Change Arizona State University Tempe Arizona USA
| | - Alexander Tsai
- Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
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Abstract
Scholarship on water insecurity has carried over an important insight from studies of food insecurity: Insecurity often occurs in the midst of plenty, and water insecurity is therefore better characterized by inaccessibility than by scarcity. Access to clean, adequate, and reliable water is, however, more challenging to systematize than access to food. Water is fluid and protean, and only when it is safely stored can people pretend to own it. In this paper, I make a case for the centrality of infrastructure - systems of water storage and transport - to water security. Equitable access to water often depends on technologies that protect, filter, and distribute water; it also depends on social arrangements that protect the least powerful from exclusion. I analyse two water infrastructure projects in Ethiopia, one a project to protect village water supplies and the other a large hydroelectric dam. The project to protect springs used by villagers for household water supply had the unintended effect of limiting access to those who could pay fees to a water committee. The dam harnessed water to produce electricity and supply irrigated plantations, but deprived downstream communities of water for farming. Water infrastructure can have far-reaching implications for water access, both for better and for worse. It is often instrumental in securing one group's access to water at the cost of another's.
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44
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Choudhary N, Brewis A, Wutich A, Udas PB. Sub-optimal household water access is associated with greater risk of intimate partner violence against women: evidence from Nepal. JOURNAL OF WATER AND HEALTH 2020; 18:579-594. [PMID: 32833684 DOI: 10.2166/wh.2020.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Household water management is often women's responsibility, as related to the gendered nature of household roles. Ethnographic data suggest that household water insecurity could increase women's exposure to emotional and physical forms of intimate partner violence (IPV), as punishments for failures to complete socially expected household tasks that rely on water (like cooking and cleaning) and the generally elevated emotional state of household members dealing with resource scarcity. Here, we test the associations between sub-optimal household water access and women's exposure to IPV, using the nationally-representative data from Nepal Demographic and Health Survey, 2016. Drawing upon the intra-household bargaining model as the theoretical framework, we run instrumental variable probit regression, to test the association between household water access and prevalence of IPV against women. After controlling for other known covariates of IPV such as women's empowerment and education, the findings substantiate that worse household water access consistently elevates women's exposures to all forms of IPV. This suggests that improvements in household water access may have additional ramifications for reducing women's risk of IPV, beyond currently recognized socioeconomic benefits. While both household water access and IPV have known health consequences, linking them provides another pathway through which water could affect women's health.
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Affiliation(s)
| | | | - Amber Wutich
- Arizona State University, Tempe, Arizona, USA E-mail:
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Wies JR, Mays A, Collins SM, Young SL. “As Long As We Have the Mine, We'll Have Water”: Exploring Water Insecurity in Appalachia. ANNALS OF ANTHROPOLOGICAL PRACTICE 2020. [DOI: 10.1111/napa.12134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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46
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Neves-Silva P, Lopes JADO, Heller L. The right to water: Impact on the quality of life of rural workers in a settlement of the Landless Workers Movement, Brazil. PLoS One 2020; 15:e0236281. [PMID: 32687522 PMCID: PMC7371196 DOI: 10.1371/journal.pone.0236281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022] Open
Abstract
Access to water for rural populations is vital not only for personal consumption and hygiene but also for food production, income generation and cultural practices. To deepening the understanding of this issue, this research addressed the access to water in a settlement of the Landless Workers Movement. The perspective of the Human Rights to Water and Sanitation was used as a theoretical framework, assessing how inadequate access to water impacts the quality of rural populations. A qualitative research was used, through participant observation and individual interviews with 12 rural workers, living at the Ulisses Oliveira settlement. The findings reflect that water is not sufficiently available to meet the community’s social, economic and cultural needs and that such conditions can lead to a loss of identity. Therefore, access to water must be understood in the light of its political, social and cultural dimensions and the Human Rights to Water and Sanitation can be used as an instrument to public policies.
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Affiliation(s)
- Priscila Neves-Silva
- Department of Public Policies and Human Rights for Health and Sanitation, Rene Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Juliana Aurora de Oliveira Lopes
- Department of Public Policies and Human Rights for Health and Sanitation, Rene Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Léo Heller
- Department of Public Policies and Human Rights for Health and Sanitation, Rene Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
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Nounkeu CD, Dharod JM. A Qualitative Examination of Water Access and Related Coping Behaviors to Understand Its Link to Food Insecurity among Rural Households in the West Region in Cameroon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4848. [PMID: 32640517 PMCID: PMC7369772 DOI: 10.3390/ijerph17134848] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022]
Abstract
Food insecurity is a significant public health issue, since it causes malnutrition and engenders millions of deaths every year. A significant association is found between water and food insecurity. However, it remains unclear what are the pathways through which water shortage impacts food insecurity. Hence, a qualitative study was conducted in rural areas in Cameroon to (1) examine water access, its management, and its daily use and (2) investigate common behavior changes and coping strategies adults used in managing limited water availability in their households. Three rounds of focus group discussions and six key informant interviews were conducted with men and women. The results demonstrated that water access was limited, involving long walking distances and making several trips to the water sources. The household size, number of adults vs. children, and presence of storage containers affected water availability and its daily use. To manage limited water, coping behaviors included skipping drinking, changing cooking plans, and recycling water. In conclusion, limited water access increases food insecurity through several pathways. Governments, policy makers, and international organizations should recognize the interwoven link between water and food security. Joint actions and collaborative efforts are needed to improve success and reduce tradeoffs in achieving Sustainable Development Goals # 2 and # 6.
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Affiliation(s)
| | - Jigna M. Dharod
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC 27402-6170, USA;
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Boateng GO, Balogun MR, Dada FO, Armah FA. Household energy insecurity: dimensions and consequences for women, infants and children in low- and middle-income countries. Soc Sci Med 2020; 258:113068. [PMID: 32534302 DOI: 10.1016/j.socscimed.2020.113068] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/14/2020] [Accepted: 05/15/2020] [Indexed: 11/26/2022]
Abstract
Energy insecurity, the lack of access to adequate, affordable, reliable, acceptable, and clean sources of energy for a healthy and sustainable livelihood, poses a challenge to several households. However, the conceptualization of its dimensions and role in the health outcomes of women, infants, and children in most sub-Saharan African countries have rarely been investigated systematically. We assessed the dimensions and adverse consequences of household energy insecurity (HEINS) in a sample of 347 Ghanaians and 420 Nigerians, with over 80% participation of women. The majority of respondents from Ghana (57%) and Nigeria (80%) had experienced of energy insecurity, at least once in the last four weeks. Following the energy insecurity framework, the experiences of participants were classified into physical, behavioral, and economic dimensions of energy insecurity. The consequences of energy insecurity grouped into psychosocial, nutritional, and disease domains. The development of a national as well as a cross-culturally validated scale that embodies these dimensions and domains will facilitate the assessment of the prevalence, causes, and consequences of HEINS. This will eventually enable the development of interventions and policies to mitigate energy insecurity and unearth modifiable factors that influence deleterious maternal, infant and child health outcomes in low-and middle-income countries.
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Affiliation(s)
- Godfred O Boateng
- Public Health Program, Department of Kinesiology, College of Nursing and Health Innovations, The University of Texas at Arlington, TX, USA.
| | - Mobolanle R Balogun
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Festus O Dada
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Frederick A Armah
- Department of Environmental Science, University of Cape Coast, Cape Coast, Ghana
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49
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Stoler J, Pearson AL, Staddon C, Wutich A, Mack E, Brewis A, Rosinger AY. Cash water expenditures are associated with household water insecurity, food insecurity, and perceived stress in study sites across 20 low- and middle-income countries. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 716:135881. [PMID: 31874751 PMCID: PMC9988664 DOI: 10.1016/j.scitotenv.2019.135881] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/27/2019] [Accepted: 11/30/2019] [Indexed: 05/06/2023]
Abstract
Billions of people globally, living with various degrees of water insecurity, obtain their household and drinking water from diverse sources that can absorb a disproportionate amount of a household's income. In theory, there are income and expenditure thresholds associated with effective mitigation of household water insecurity, but there is little empirical research about these mechanisms and thresholds in low- and middle-income settings. This study used data from 3655 households from 23 water-insecure sites in 20 countries to explore the relationship between cash water expenditures (measured as a Z-score, percent of income, and Z-score of percent of income) and a household water insecurity score, and whether income moderated that relationship. We also assessed whether water expenditures moderated the relationships between water insecurity and both food insecurity and perceived stress. Using tobit mixed effects regression models, we observed a positive association between multiple measures of water expenditures and a household water insecurity score, controlling for demographic characteristics and accounting for clustering within neighborhoods and study sites. The positive relationships between water expenditures and water insecurity persisted even when adjusted for income, while income was independently negatively associated with water insecurity. Water expenditures were also positively associated with food insecurity and perceived stress. These results underscore the complex relationships between water insecurity, food insecurity, and perceived stress and suggest that water infrastructure interventions that increase water costs to households without anti-poverty and income generation interventions will likely exacerbate experiences of household water insecurity, especially for the lowest-income households.
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Affiliation(s)
- Justin Stoler
- Department of Geography and Regional Studies, University of Miami, Coral Gables, FL 33146, USA; Department of Public Health Sciences, University of Miami, Miami, FL 33136, USA.
| | - Amber L Pearson
- Department of Geography, Environment & Spatial Sciences, Michigan State University, East Lansing, MI 48824, USA; Department of Public Health, University of Otago, Wellington 6242, New Zealand.
| | - Chad Staddon
- Centre for Water, Communities and Resilience, University of the West of England, Bristol BS161QY, UK.
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85287, USA.
| | - Elizabeth Mack
- Department of Geography, Environment & Spatial Sciences, Michigan State University, East Lansing, MI 48824, USA.
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85287, USA.
| | - Asher Y Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA 16802, USA; Department of Anthropology, Pennsylvania State University, University Park, PA 16802, USA.
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50
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Choudhary N, Schuster R, Brewis A, Wutich A. Water insecurity potentially undermines dietary diversity of children aged 6-23 months: Evidence from India. MATERNAL & CHILD NUTRITION 2020; 16:e12929. [PMID: 31999395 PMCID: PMC7083507 DOI: 10.1111/mcn.12929] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/17/2019] [Accepted: 11/19/2019] [Indexed: 01/22/2023]
Abstract
Dietary diversity is a crucial pathway to child nutrition; lack of diversity may deprive children of critical macro and micronutrients. Though water along with hygiene and sanitation is a known driver of child undernutrition, a more direct role of household water in shaping dietary diversity remains unexplored. Existing literature provides a sound theoretical basis to expect that water could affect dietary diversity among young children. Here, we test the proposition that suboptimal household access to water and low regional water availability associate with lower dietary diversity among young children. Using the nationally representative 2015-2016 India Demographic and Health Survey data, we conducted a probit analysis on the sample of 69,841 children aged 6-23 months to predict the probability that a child achieves minimum standards of dietary diversity (MDD). After controlling for relevant socioeconomic and gender-related covariates, we found that children in household with suboptimal household water access were two percentage points less likely to achieve MDD, when compared with those from households with optimal water access. Children in high water availability regions had nine percentage points greater probability of achieving MDD compared with children from low water availability regions, accounting for household water access. As dietary diversity is central to nutrition, establishing the role of water access in shaping early childhood dietary diversity broadens the framework on how household material poverty shapes child malnutrition-independent of sanitation and hygiene pathways. This provides additional window for nutrition planning and intervention wherein water-based strategies can be leveraged in multiple ways.
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Affiliation(s)
- Neetu Choudhary
- Center for Global Health, School of Human Evolution and Social ChangeArizona State UniversityTempeArizona
| | - Roseanne Schuster
- Center for Global Health, School of Human Evolution and Social ChangeArizona State UniversityTempeArizona
| | - Alexandra Brewis
- Center for Global Health, School of Human Evolution and Social ChangeArizona State UniversityTempeArizona
| | - Amber Wutich
- Center for Global Health, School of Human Evolution and Social ChangeArizona State UniversityTempeArizona
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