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

Food and water insecurity in households of children and adolescents living with HIV and receiving care in a rural Zambian hospital: A mixed-methods study

Approximately 62,000 Zambian children are living with HIV. HIV care and treatment is generally more limited in rural areas, where a heavy reliance on rain-fed subsistence agriculture also places households at risk of food and water insecurity. We nested a mixed methods study with an explanatory sequential design in a clinical cohort of children and adolescents living with HIV (CHIV) in rural Zambia. We used validated questionnaires to assess household food and water insecurity and examined associations between indicators derived from those scales, household characteristics, and HIV treatment adherence and outcomes using log-binomial regression. We identified caregivers and older CHIV from food insecure households for in-depth interviews. Of 186 participants completing assessments, 72% lived in moderately or severely food insecure households and 2% in water insecure households. Food insecurity was more prevalent in households of lower socioeconomic status (80% vs. 59% for higher scores; p = 0.02) and where caregivers had completed primary (79%) vs. secondary school or higher (62%; p = 0.01). No other characteristics or outcomes were associated with food insecurity. Parents limited both the quality and quantity of foods they consumed to ensure food availability for their CHIV. Coping strategies included taking on piecework or gathering wild foods; livestock ownership was a potential buffer. Accessing sufficient clean water was less of a concern. During periods of drought or service interruption, participants travelled further for drinking water and accessed water for other purposes from alternative sources or reduced water use. Community contributions afforded some protection against service interruptions. Overall, while food insecurity was prevalent, strategies used by parents may have protected children from a measurable impact on HIV care or treatment outcomes. Reinforcing social protection programs by integrating livestock ownership and strengthening water infrastructure may further protect CHIV in the case of more extreme food or water system shocks.

The Influence of Household and Community Food Environments on Food Insecurity in Limpopo Province, South Africa

Insufficient access to enough quality food remains a public health challenge in South Africa. This study aimed to report the influence of community and the household environment, food system inventories, and food procurement on household food security. The findings alluded that food insecurity is prevalent among the rural areas in South Africa. Large household sizes and a limited access to and use of water and food storage facilities for food preservation are the major household determinants. A multi-sectoral nutrition-planning approach that accelerates the achievement of the Sustainable Development Goals should be reinforced. We recommend the promotion of food production for consumption in rural communities.

Concurrence of water and food insecurities, 25 low- and middle-income countries

Objective

To investigate how water and food insecurity were associated in nationally representative samples of individuals from 25 low- and middle-income countries.

Methods

We used data from the 2020 World Gallup Poll in which the Individual Water Insecurity Experiences Scale and the Food Insecurity Experience Scale had been administered to 31 755 respondents. These scales measure insecurity experiences in the previous 12 months. We classified individuals as water insecure if their score was ≥ 12 and food insecure if the Rasch probability parameter was ≥ 0.5. For estimating the proportions, we used projection weights. We estimated the relationships between binary and continuous measures of water insecurity and food insecurity for individuals within each country and region using multivariable logistic and linear regression models, adjusting for key socioeconomic characteristics including income, gender, age and education.

Findings

Among the 18.3% of respondents who experienced water insecurity, 66.8% also experienced food insecurity. The likelihood of experiencing moderate-to-severe food insecurity was higher among respondents also experiencing water insecurity (adjusted odds ratio, aOR: 2.69; 95% confidence interval, CI: 2.43 to 2.98). Similar odds were found in Asia (aOR: 2.95; 95% CI: 2.04 to 4.25), Latin America (aOR: 2.17; 95% CI: 1.62 to 2.89), North Africa (aOR: 2.92; 95% CI: 2.17 to 3.93) and sub-Saharan Africa (aOR: 2.71; 95% CI: 2.40 to 3.06).

Conclusion

Our results suggest that water insecurity should be considered when developing food and nutrition policies and interventions. However, more research is needed to understand the paths between these insecurities.

Tap Water Avoidance Is Associated with Lower Food Security in the United States: Evidence from NHANES 2005-2018

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.

Gender differences in the use of coping strategies to reduce food insecurity in Colombia

This study explores the gender differences in the use of coping strategies to reduce food insecurity in Colombian urban and rural households. Data was collected from the Colombian National Survey of Nutritional Status (ENSIN 2015), and analyzed using ordinal logistic regression models, logistic models, and simultaneous equation models. Results show that rural households have a higher prevalence of food insecurity than their urban counterparts. After adjusting for household characteristics - e.g., head of household schooling level -, urban households were more likely to present severe and moderate food insecurity, whereas rural households were more likely to experience mild food insecurity. This result was explained by self-consumption and certain coping strategies, such as selling seeds from the next harvest or animals, implemented by rural households. Even though female-headed households present on average higher levels of food insecurity than male-headed ones, because they are more likely to use coping strategies, especially in rural areas, they can reduce and even cancel out this gap. Hence, female heads are more successful in mitigating food insecurity.

The co-occurrence of water insecurity and food insecurity among Daasanach pastoralists in northern Kenya

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.

Livelihood Vulnerability Index: Gender Dimension to Climate Change and Variability in REDD + Piloted Sites, Cross River State, Nigeria

Vulnerability to climate change and variability impacts has been identified as a major cog in the wheel of both livelihood and resilience, particularly in vulnerable groups in rural areas. This study aims to assess genders’ vulnerability dimension to climate change and variability in REDD + (Reducing Emission from Deforestation and Forest Degradation+) piloted site/clusters, Cross River State, Nigeria. Data were proportionately collected from selected 200 respondents on gender disaggregated level using questionnaires. The assessment adopted the sustainable livelihood approach (livelihood vulnerability index) and compared the results with the IPCC vulnerability standard of exposure, sensitivity and adaptive capacity weighted mean. The results revealed a significant difference in the vulnerability dimension of both women and men disaggregated levels (LVI: men 0.509, women 0.618). The women category was more vulnerable to six out of seven major components of LVI assessed: (livelihood strategies (0.646), social networks (0.364), water (0.559), health (0.379), food and nutrition (0.507), and natural hazards and climate variability (0.482), while men only vulnerable to socio-demographic major component (0.346). Vulnerability indices also showed women to be more exposed (0.482), and sensitive (0.489) with the least adaptive capacities (0.462) to the climate change and variability impacts. Overall, on the IPCC-LVI index, women are more vulnerable (0.0098) to climate change and variability impacts than men (−0.0093). The study recommends that the women's category resilience and adaptive capacity should be empowered in adaptation projects in climate change such as REDD + (Reducing Emissions from Deforestation and Forest Degradation+) to reduce their vulnerability to impacts of climate change and variability in the context of exposure, sensitivity, and adaptive capacities. This will be instrumental in formulating policies to address the specific needs of gender categories in reducing vulnerability to climate change and variability. This pragmatic approach may be used to monitor gender vulnerability dimension, and livelihood enhancement and evaluate potential climate change adaptation programs. Additionally, the introduction of IPCC-LVI as a baseline instrument will enhance information on gender resilience and adaptive capacity for policy effectiveness in a data-scarce region particularly Africa.

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

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.

Development of water insecurity scale for rural households in Cameroon- Central Africa

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.

Integrated Approach in Addressing Undernutrition in Developing Countries: A Scoping Review of Integrated Water Access, Sanitation, and Hygiene (WASH) + Nutrition Interventions

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.

Water fetching burden: a qualitative study to examine how it differs by gender among rural households in the west region of Cameroon

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.