Search

Household survey data from 27 sites in 22 countries were collected in 2017–2018 in order to construct and validate a cross-cultural household-level water insecurity scale. The resultant Household Water Insecurity Experiences (HWISE) scale presents a useful tool for monitoring and evaluating water interventions as a complement to traditional metrics used by the development community. It can also help track progress toward achievement of Sustainable Development Goal 6 ‘clean water and sanitation for all’. We present HWISE scale scores from 27 sites as comparative data for future studies using the HWISE scale in low- and middle-income contexts. Site-level mean scores for HWISE-12 (scored 0–36) ranged from 1.64 (SD 4.22) in Pune, India, to 20.90 (7.50) in Cartagena, Colombia, while site-level mean scores for HWISE-4 (scored 0–12) ranged from 0.51 (1.50) in Pune, India, to 8.21 (2.55) in Punjab, Pakistan. Scores tended to be higher in the dry season as expected. Data from this first implementation of the HWISE scale demonstrate the diversity of water insecurity within and across communities and can help to situate findings from future applications of this tool. HIGHLIGHTS We present comparison scores of the Household Water Insecurity Experiences (HWISE) scale, a novel household water insecurity index validated for use in low- and middle-income countries.; These scores can aid interpretation of future implementation of the HWISE scale.; The HWISE scale should still be evaluated in new contexts, such as high-income settings.

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

The novel coronavirus disease (COVID-19) pandemic is having a significant global impact on livelihoods, health, and general well-being. This policy brief argues that in low-income countries (LICs) where water, sanitation, and hygiene (WASH) insecurity is widespread and closely entangled with poverty and other vulnerabilities, COVID-19 will have a particularly devastating impact on women and girls because they bear the disproportionate burden of water collection, sanitation, hygiene, and family welfare ‒ responsibilities embedded in longstanding sociocultural norms. WASH insecurity refers to the physical and relational inequities in WASH access. Using three pathways ‒ reproductive and perinatal health, cultural norms and the risk of COVID-19 infections, and physical and mental health ‒ we discuss how WASH insecurity will worsen the impact of COVID-19 on women and girls in LICs.

The COVID-19 pandemic raises questions about the effectiveness of urban planning practice in Africa and offers an opportunity to reflect on more constructive protocols for planning that can promote...

COVID-19 has brought global attention to the critical role of water in managing infectious outbreaks. Although Sub-Saharan Africa could become a COVID-19 hotspot, some are optimistic that given the...

Water insecurity is a critical public-health challenge in Africa's urban informal settlements, where most of the population often lacks access to household taps. In these settings, water fetching is disproportionately performed by women. While water fetching is physically laborious and exposes women to multiple risks, the water-insecurity literature has predominantly focused on household experiences, ignoring women's water-collection journeys. This paper uses the water journey as a window into the embodied dimensions of water insecurity. Combining theoretical insights from embodiment, embodied political ecology of health, and time geographies, we use video-recorded walking interviews to analyze women's everyday water journeys in Ntopwa, an urban informal settlement in Blantyre, Malawi, from initial decision making through exposure to water-fetching risks and household practices regarding use and storage. We identify three principal sources of environmental risk- terrain, built environment, and human behavior-that present challenges for water collectors. Using the walking interview as a heuristic, we show how the seemingly simple practice of water fetching is compounded by complex decision making, constant spatiotemporal trade-offs, and exposure to diverse risks, all of which have embodied health consequences. Based on our findings, we conclude that interventions seeking to improve household water insecurity must consider the embodied effects of water-fetching journeys. This study also provides methodological insights into using walking interviews and videos for water and health research.

In Sub-Saharan Africa, only 35% of the urban population has piped water on premises despite the economic (time savings) and public health benefits that household taps offer. In the urban informal settlements, even fewer people own household taps. However, while there is extensive literature on everyday urban water insecurity in the region, far less attention has focused on whether the urban poor are interested in private taps, and if so, what service attributes are important to them. We implemented a choice experiment in Nima, an urban settlement in Accra, Ghana, to investigate community preferences and willingness to pay (WTP) for household taps. We used a comprehensive set of system attributes including days of service, service hours, water pressure, water quality, connection fees, monthly payment, and management, an attribute very few WTP studies have explored. Results from the choice experiment show that residents are more sensitive to time (not day) of service delivery, quality of water, connection fees, and monthly water bills. Households had no preference between a 24-h supply and 12-h supply during the day. Households preferred Accra Metropolitan Assembly (AMA) to Ghana Water Company Limited (GWCL) as the service provider and were willing to pay more for a system managed by AMA, an indication of declining trust in GWCL. The findings provide valuable information that policymakers and water utilities can use to assess the feasibility and cost effectiveness of extending household taps to poor urban settlements.

This study examines the adoption of latrines provided as part of reconstruction efforts after the 2004 tsunami in India. Primary data from 274 households encompassing 1154 individuals were collected from 14 villages. GLM and GLMM tests indicate that sex (more females adopted than males) is a statistically significant factor in latrine adoption (p = 0.046 and p = 0.005, respectively), while income, education, and male age cohorts were significant only in the GLM model. Regression analyses show that six social and demographic variables are somewhat predictive of latrine usage (R2 = 0.123). Thus, while quantitative methods provided a contextual summation, qualitative methods ultimately explained why individuals chose to adopt or abandon the latrines. Interviews (n = 76) and focus group discussions (n = 14) revealed that latrine adoption is influenced by cultural conceptualizations of purity, pollution, and space. For example, conceptualizations of purity and pollution led some households to deem latrines as profane and thus a barrier to the entry of gods, while spatial constraints forced others to convert latrine space to other beneficial uses (e.g., puja room and storage area). Finally, the cost of pumping septic tanks and shared infrastructure arose as barriers to latrine adoption. These barriers underscore the importance of economics as well as community demand, capacity, and cohesion in latrine adoption.

In urban slums – home to approximately 1 billion people worldwide - access to clean drinking water is woefully inadequate despite the United Nations' declaration that access to safe water is a fundamental human right. Households in slums are frequently forced to rely on multiple drinking water sources to meet their needs. Numerous factors influence choice of water source, including water quality, availability, reliability, and affordability. These factors are not temporally static, but instead vary over multiple timescales (from sub-daily changes to annual changes and beyond) in response to changes in the water source itself and changes in the household's ability to use that source. For example, the cost of water can may change over time in response to water availability (e.g. rainy season versus dry season) and a slum household's ability to pay for water may change over time in response to changes in household income. However, existing national and global monitoring of safe water access, including Sustainable Development Goal 6, overlook these temporal dynamics of water access, quality and health risk in slums. This paper proposes a research agenda for exploring temporal changes in drinking water access and quality in urban slums and their potential influence on health risk. It argues that in the design of research studies, policy interventions, and drinking water monitoring aimed at improving access and health in urban slums, temporal dynamics should be considered over at least three interlinked time scales: short-term (from sub-daily to week-to-week), medium-term (from month-to-month to season-to-season) and long-term (from year-to-year). The paper concludes with recommendations for future research on temporal dynamics of drinking water and health in slums.

Water sharing between households could crucially mitigate short‐term household water shortages, yet it is a vastly understudied phenomenon. Here we use comparative survey data from eight sites in seven sub‐Saharan African countries (Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Malawi, Nigeria, and Uganda) to answer three questions: With whom do households share water? What is expected in return? And what roles do need and affordability play in shaping those transfers? We find that water is shared predominantly between neighbors, that transfers are more frequent when water is less available and less affordable, and that most sharing occurs with no expectation of direct payback. These findings identify water sharing, as a form of generalized reciprocity, to be a basic and consistent household coping strategy against shortages and unaffordability of water in sub‐Saharan Africa.

Safe and secure water is a cornerstone of modern life in the global North. This article critically examines a set of prevalent myths about household water in high-income countries, with a focus on Canada and the United States. Taking a relational approach, we argue that household water insecurity is a product of institutionalized structures and power, manifests unevenly through space and time, and is reproduced in places we tend to assume are the most water-secure in the world. We first briefly introduce "modern water" and the modern infrastructural ideal, a highly influential set of ideas that have shaped household water provision and infrastructure development over the past two centuries. Against this backdrop, we consolidate evidence to disrupt a set of narratives about water in high-income countries: the notion that water access is universal, clean, affordable, trustworthy, and uniformly or equitably governed. We identify five thematic areas of future research to delineate an agenda for advancing scholarship and action-including challenges of legal and regulatory regimes, the housing-water nexus, water affordability, and water quality and contamination. Data gaps underpin the experiences of household water insecurity. Taken together, our review of water security for households in high-income countries provides a conceptual map to direct critical research in this area for the coming years. This article is categorized under: Human Water > Human Water Peter Wall Institute for Advanced Study, University of British Columbia; PLUS Alliance; Texas AM University; U.S. National Science FoundationNational Science Foundation (NSF) [BCS-17759972] Peter Wall Institute for Advanced Study, University of British Columbia; PLUS Alliance; Texas A&M University; U.S. National Science Foundation, Grant/Award Number: BCS-17759972

Background The use of mHealth by primary health care providers is a unique opportunity to improve maternal and child health in Sub-Saharan Africa. However, few studies have examined the effects of primary health care providers’ knowledge and attitudes of mHealth for maternal and child health promotion in low-resource settings. Therefore, this study assesses the knowledge and attitudes of primary health care providers on the use of mobile technologies such as internet-enabled smartphones for maternal and child health services. Methods We used data from a cross-sectional study of seven urban local government areas in Lagos, Nigeria. A total of 518 primary health care providers were surveyed for information on the use of mobile technologies, attitudes, and actual use of mobile technologies for maternal and child health services. Data were analyzed using descriptive and multivariable linear and logistic regression models. Results Our study showed that smartphone ownership is not a predictor of high mHealth knowledge; however, having an internet-enabled smart phone was a strong predictor of higher knowledge of mHealth (regression coefficient, ß=1.20, 95% confidence interval, CI=0.61-1.79) among primary health care providers. Owning a smartphone (ß=1.00, 95% CI=0.12-1.89) and having internet-enabled phone (ß=1.14, 95% CI=0.18-2.10) were both predictors of positive mHealth attitude. Primary health care providers with higher scores on mHealth knowledge were 1.32 times more likely to use mHealth for maternal and child health services. Similarly, those with positive attitude towards mHealth were 1.15 times more likely to use mobile technology for maternal and child health services. Conclusion The results suggest the use of mHealth tools by primary health care providers to render maternal and child health services is affected by their knowledge and attitude towards mHealth. Interventions that focus on increasing mobile technologies with internet enabled devices like smartphones are needed to improve knowledge, attitudes, and use of mHealth in maternal and child health services.

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.

The failure of the conventional public and private (market-based) water policies to improve urban water access in the global South has prompted growing interest in alternative models such as community–state co-production. However, there is little evidence of whether co-production can improve water service delivery in the informal settlements of sub-Saharan Africa where a disproportionately high percentage of the urban poor lives. This paper uses household surveys, key informant interviews, and focus groups to examine the impact of co-production on household water access and service delivery in the informal settlements of Lilongwe, Malawi. Co-production increased water accessibility, reduced the cost of water, increased the number of community water kiosks, and resulted in more effective financial management and accountability. However, challenges related to poor infrastructure and limited community capacity threaten the long-term sustainability of the co-production model. Urban informal residents lamented worsening water-supply interruptions and longer waiting times after co-production, challenges that require state intervention.

Global drinking water monitoring programmes and studies on water quality in urban slums often overlook short-term temporal changes in water quality and health risks. The aim of this study was to quantify daily changes in household water access and quality in an urban slum in Malawi using a mixed-method approach. Household drinking water samples (n = 371) were collected and monitored for E. coli in tandem with a water access questionnaire (n = 481). E. coli concentrations in household drinking water changed daily, and no household had drinking water that was completely safe to drink every day. Seasonal changes in drinking water availability, intermittent supply, limited opening hours, and frequent breakdown of public water points contributed to poor access. Households relied on multiple water sources and regularly switched between sources to meet daily water needs. There were generally similar E. coli levels in water samples considered safe and unsafe by residents. This study provides the first empirical evidence that water quality, water access, and related health risks in urban slums change at much finer (daily) temporal scales than is conventionally monitored and reported globally. Our findings underscore that to advance progress towards Sustainable Development Goal (SDG) Target 6.1, it is necessary for global water monitoring initiatives to consider short-term changes in access and quality.

Water sharing offers insight into the everyday and, at times, invisible ties that bind people and households with water and to one another. Water sharing can take many forms, including so-called “pure gifts,” balanced exchanges, and negative reciprocity. In this paper, we examine water sharing between households as a culturally-embedded practice that may be both need-based and symbolically meaningful. Drawing on a wide-ranging review of diverse literatures, we describe how households practice water sharing cross-culturally in the context of four livelihood strategies (hunter-gatherer, pastoralist, agricultural, and urban). We then explore how cross-cutting material conditions (risks and costs/benefits, infrastructure and technologies), socio-economic processes (social and political power, water entitlements, ethnicity and gender, territorial sovereignty), and cultural norms (moral economies of water, water ontologies, and religious beliefs) shape water sharing practices. Finally, we identify five new directions for future research on water sharing: conceptualization of water sharing; exploitation and status accumulation through water sharing, biocultural approaches to the health risks and benefits of water sharing, cultural meanings and socio-economic values of waters shared; and water sharing as a way to enact resistance and build alternative economies.

The relative significance of indicators and determinants of health is important for local public health workers and planners. Of similar importance is a method for combining and evaluating such markers. We used a recently developed index, the Urban Health Index (UHI), to examine the impact of environmental variables on the overall health of cities. We used the UHI to rank 57 of the world&rsquo, s largest cities (based on population size) in low- and middle-income countries. We examined nine variables in various combinations that were available from the Demographic and Health Surveys conducted in these countries. When arranged in ascending order, the distribution of UHIs follows the previously described pattern of gradual linear increase, with departures at each tail. The rank order of cities did not change materially with the omission of variables about women&rsquo, s health knowledge or childhood vaccinations. Omission of environmental variables (a central water supply piped into homes, improved sanitation, and indoor solid fuel use) altered the rank order considerably. The data suggest that environmental indicators, measures of key household level risk to health, may play a vital role in the overall health of urban communities.

International audience; For the next decade, the global water crisis remains the risk of highest concern, and ranks ahead of climate change, extreme weather events, food crises and social instability. Across the globe, nearly one in ten people is without access to an improved drinking water source. Least Developed Countries (LDCs) especially in sub-Saharan Africa (SSA) are the most affected, having disproportionately more of the global population without access to clean water than other major regions. Population growth, changing lifestyles, increasing pollution and accelerating urbanization will continue to widen the gap between the demand for water and available supply especially in urban areas, and disproportionately affect informal settlements, where the majority of SSA's urban population resides. Distribution and allocation of water will be affected by climate-induced water stresses, poor institutions, ineffective governance, and weak political will to address scarcity and mediate uncertainties in future supply. While attempts have been made by many scientists to examine different dimensions of water scarcity and urban population dynamics, there are few comprehensive reviews, especially focused on the particular situation in Sub-Saharan Africa. This paper contributes to interdisciplinary understanding of urban water supply by distilling and integrating relevant empirical knowledge on urban dynamics and water issues in SSA, focusing on progress made and associated challenges. It then points out future research directions including the need to understand how alternatives to centralized water policies may help deliver sustainable water supply to cities and informal settlements in the region.

Almost a billion people globally lack access to potable water. In the early 1990’s, attempts to improve potable water access in the global south included a massive push for water services privatization, often involving the transfer of public water services to private companies. Critics of water privatization claim it rarely improves access to water, and in most cases, unfairly affect poor people. Proponents on the other hand argue that it is necessary for efficient management and capital investment in the water sector. Although development NGOs play an important role in developing country water provision, hardly any studies have sought to understand their perceptions about the potential role of water privatization towards improving access to potable water in developing countries. We interviewed the key staff among 28 international and national NGO staff about water privatization, its opportunities and constraints. Their perceptions were mixed. While most criticized water privatization as increasing water costs to the poor, some noted that privatization is necessary for improving water access through increased capital investment. We present the findings and discuss larger implications for water policies and reforms in developing countries.

Background The causes and health risks associated with obesity in young people have been extensively documented, but elderly obesity is less well understood, especially in sub-Saharan Africa. This study examines the relationship between obesity and the risk of chronic diseases, cognitive impairment, and functional disability among the elderly in Ghana. It highlights the social and cultural dimensions of elderly obesity and discusses the implications of related health risks using a socio-ecological model. Methodology We used data from wave 1 of the Ghana Study on Global Ageing and Adult Health (SAGE) survey-2007/8, with a restricted sample of 2,091 for those 65 years and older. Using random effects multinomial, ordered, and binary logit models, we examined the relationship between obesity and the risk of stage 1 and stage 2 hypertension, arthritis, difficulties with recall and learning new tasks, and deficiencies with activities of daily living and instrumental activities of daily living. Findings Elderly Ghanaians who were overweight and obese had a higher risk of stage 1 and stage 2 hypertension, and were more likely to be diagnosed with arthritis and report severe deficiencies with instrumental activities of daily living. Those who were underweight were 1.71 times more likely to report severe difficulties with activities of daily living. A sub analysis using waist circumference as a measure of body fat showed elderly females with abdominal adiposity were relatively more likely to have stage 2 hypertension. Conclusions These findings call for urgent policy initiatives geared towards reducing obesity among working adults given the potentially detrimental consequences in late adulthood. Future research should explore the gendered pathways leading to health disadvantages among Ghanaian women in late adulthood.