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1. Chronic Stress and Severe Water Insecurity During the Historic 2022 Drought in Northern Kenya Were Associated With Inflammation Among Daasanach Seminomadic Pastoralists

   https://doi.org/10.1002/ajhb.70009  

   Roba, Kedir Teji; Jacobson, Hannah; McGrosky, Amanda; Sadhir, Srishti; Ford, Leslie B; Pfaff, Marcela; Kim, Elizabeth Y; Nzunza, Rosemary; Douglass, Matthew; Braun, David R; et al (February 2025, American Journal of Human Biology)

   ABSTRACT ObjectiveExtreme climatic events, like droughts, are increasing in frequency and severity. Droughts disrupt community livelihoods and resources with serious implications for human biology. This study investigated how chronic stress, measured by fingernail cortisol concentration (FCC), and water insecurity status were predictive of C‐reactive protein (CRP), a biomarker of inflammation, during a historic drought among Daasanach seminomadic pastoralists. MethodsData were collected at the height of the 2022 drought from 128 Daasanach household heads aged 16–80 years in northern Kenya using household surveys, anthropometric measurements, and dried blood spots to assess CRP levels and fingernails to assess FCC. We employed mixed‐effects linear and logistic regression models to examine the relationships between log‐transformed FCC, high water insecurity status measured via the Household Water Insecurity Experiences (HWISE ≥ 24) scale, and serum‐equivalent CRP (log‐transformed and dichotomized at mild, low‐grade inflammation ≥ 1 mg/L) adjusted for covariates. ResultsThe mean serum‐equivalent CRP was 4.1 mg/L and 56.3% of Daasanach adults had at least mild, low‐grade inflammation. Linear models indicated that ln(FCC) was positively associated with ln(CRP) (β = 0.56, SE = 0.12;p < 0.001). Further, logistic models demonstrated that ln(FCC) (OR = 2.69, 95% CI: 1.84–3.95;p < 0.001) and high water insecurity (OR = 2.23, 95% CI: 1.34–3.72;p = 0.002) were both associated with greater odds of low‐grade inflammation. ConclusionThis study provides evidence for how chronic stress and severe water insecurity may impact inflammation levels among pastoralists during drought. Since inflammation is central to cardiometabolic disease etiology, this is an additional reason to mitigate the negative health impacts of droughts and water insecurity exacerbated by climate change. 

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2. Is household water insecurity a link between water governance and well-being? A multi-site analysis

   https://doi.org/10.2166/washdev.2020.165  

   Miller, Joshua D.; Vonk, Jaynie; Staddon, Chad; Young, Sera L. (April 2020, Journal of Water, Sanitation and Hygiene for Development)

   Abstract Improving water governance is a top priority for addressing the global water crisis. Yet, there is a dearth of empirical data examining whether better water governance is associated with lower water insecurity and improved well-being. We, therefore, pooled household data from two Sustainable Water Effectiveness Reviews conducted by Oxfam GB in Zambia (n = 997) and the Democratic Republic of Congo (DRC, n = 1,071) to assess the relationship between perceived water governance (using a 12-item indicator), water insecurity [using the Household Water Insecurity Experiences (HWISE) Scale], and four indicators of well-being: life satisfaction, drinking unsafe water, diarrhea, and resilience to cholera outbreak. Using generalized structural equation models controlling for wealth and primary water source, each point increase in water governance score was associated with a 0.69-point decrease in HWISE Scale scores. Good water governance was also directly associated with greater odds of life satisfaction (aOR 1.24) and lower odds of both drinking unsafe water (aOR 0.91) and severe cholera impact (aOR 0.92). Furthermore, the relationships between water governance and drinking unsafe water, diarrhea, and cholera impact were mediated by household water insecurity. Improving water governance has the potential to meaningfully impact entrenched public health issues through changes in water insecurity. 

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

   https://doi.org/10.1136/bmjgh-2019-001750  

   Young, Sera L; Boateng, Godfred O; Jamaluddine, Zeina; Miller, Joshua D; Frongillo, Edward A; Neilands, Torsten B; Collins, Shalean M; Wutich, Amber; Jepson, Wendy E; Stoler, Justin (September 2019, BMJ Global Health)

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

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4. In pursuit of ‘safe’ water: the burden of personal injury from water fetching in 21 low-income and middle-income countries

   https://doi.org/10.1136/bmjgh-2020-003328  

   Venkataramanan, Vidya; Geere, Jo-Anne L; Thomae, Benjamin; Stoler, Justin; Hunter, Paul R; Young, Sera L (October 2020, BMJ Global Health)

   null (Ed.)

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

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

   https://doi.org/10.1017/S1368980022001689  

   Bethancourt, Hilary J; Swanson, Zane S; Nzunza, Rosemary; Young, Sera L; Lomeiku, Luke; Douglass, Matthew J; Braun, David R; Ndiema, Emmanuel K; Pontzer, Herman; Rosinger, Asher Yoel (March 2023, Public Health Nutrition)

   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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