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ABSTRACT The Household Water Insecurity Experiences (HWISE) and Individual Water Insecurity Experiences (IWISE) Scales are globally suitable tools for comparably measuring water insecurity experiences among households and adults, respectively. The potential range for HWISE and IWISE scores is 0–36. When the WISE Scales were first published, scores of 12 and higher were considered indicative of water insecurity, but additional cut-points are needed to provide more nuanced insights. We therefore sought to develop a practical set of cut-points for the WISE Scales using HWISE data from 13 sites across 12 countries (n = 3,293) and nationally representative samples of IWISE data from 38 countries collected by the Gallup World Poll (n = 52,343). We selected cut-points in water insecurity scores to establish four ordinal categories: no-to-marginal (0–2), low (3–11), moderate (12–23), and high (24–36) water insecurity. These categories were monotonically associated with increasing odds of reporting water dissatisfaction and helped to differentiate the breadth of water insecurity across populations with heterogenous water insecurity experiences and frequencies. These four water insecurity categories can be used to better understand how water insecurity may be related to livelihoods, health, and well-being, both at low and high water insecurity. 

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. 

Abstract ObjectivesInvestigations of early childhood growth among small‐scale populations are essential for understanding human life history variation and enhancing the ability to serve such communities through global public health initiatives. This study characterizes early childhood growth trajectories and identifies differences in growth patterns relative to international references among Daasanach semi‐nomadic pastoralist children living in a hot, arid region of northern Kenya. MethodsA large sample of height and weight measures were collected from children (N = 1756; total observations = 4508; age = 0–5 years) between 2018 and 2020. Daasanach growth was compared to international reference standards and Daasanach‐specific centile growth curves and pseudo‐velocity models were generated using generalized additive models for location scale and size. ResultsCompared to World Health Organization (WHO) reference, relatively few Daasanach children were stunted (14.3%), while a large proportion were underweight (38.5%) and wasted (53.6%). Additionally, Daasanach children had a distinctive pattern of growth, marked by an increase in linear growth velocity after 24 months of age and relatively high linear growth velocity throughout the rest of early childhood. ConclusionsThese results identify a unique pattern of early childhood growth faltering among children in a small‐scale population and may reflect a thermoregulatory adaptation to their hot, arid environment. As linear growth and weight gain remain important indicators of health, the results of this study provide insight into growth velocity variations. This study has important implications for global public health efforts to identify and address sources of early growth faltering and undernutrition in small‐scale populations. 

Abstract ObjectivesThis study compared the prevalence of concentrated urine (urine specific gravity ≥1.021), an indicator of hypohydration, across Tsimane' hunter‐forager‐horticulturalists living in hot‐humid lowland Bolivia and Daasanach agropastoralists living in hot‐arid Northern Kenya. It tested the hypotheses that household water and food insecurity would be associated with higher odds of hypohydration. MethodsThis study collected spot urine samples and corresponding weather data along with data on household water and food insecurity, demographics, and health characteristics among 266 Tsimane' households (N = 224 men, 235 women, 219 children) and 136 Daasanach households (N = 107 men, 120 women, 102 children). ResultsThe prevalence of hypohydration among Tsimane' men (50.0%) and women (54.0%) was substantially higher (P < .001) than for Daasanach men (15.9%) and women (17.5%); the prevalence of hypohydration among Tsimane' (37.0%) and Daasanach (31.4%) children was not significantly different (P= .33). Multiple logistic regression models suggested positive but not statistically significant trends between household water insecurity and odds of hypohydration within populations, yet some significant joint effects of water and food insecurity were observed. Heat index (2°C) was associated with a 23% (95% confidence interval [CI]: 1.09‐1.40,P= .001), 34% (95% CI: 1.18‐1.53,P < .0005), and 23% (95% CI: 1.04‐1.44,P= .01) higher odds of hypohydration among Tsimane' men, women, and children, respectively, and a 48% (95% CI: 1.02‐2.15,P= .04) increase in the odds among Daasanach women. Lactation status was also associated with hypohydration among Tsimane' women (odds ratio = 3.35, 95% CI: 1.62‐6.95,P= .001). ConclusionThese results suggest that heat stress and reproductive status may have a greater impact on hydration status than water insecurity across diverse ecological contexts.