Data from: Community water improvement, household water insecurity, and women’s psychological distress: an intervention and control study in Ethiopia

Background: Over 650 million people worldwide lack access to safe water supplies, and even among those who have gained access to ‘improved’ sources, water may be seasonally unreliable, far from homes, expensive, and provide insufficient quantity. Measurement of water access at the level of communities and households remains crude, and better measures of household water insecurity are urgently needed to inform needs assessments and monitoring and evaluation. We set out to assess the validity of a quantitative scale of household water insecurity, and to investigate (1) whether improvements to community water supply reduce water insecurity, (2) whether water interventions affect women’s psychological distress, and (3) the impacts of water insecurity on psychological distress, independent of socio-economic status, food security, and harvest quality. Methods and Findings: Measures were taken before and one to six months after a community water supply improvement in three villages in rural northern Ethiopia. Villages similar in size and access to water sources and other amenities did not receive interventions, and served as controls. Household water insecurity was assessed using a 21-item scale based on prior qualitative work in Ethiopia. Women’s psychological distress was assessed using the WHO Self-Reporting Questionnaire (SRQ-20). Respondents were either female heads of household or wives of the heads of household (n = 247 at baseline, n = 223 at endline); 123 households provided data at both rounds. The intervention was associated with a decline of approximately 2 points on the water insecurity scale between baseline and endline compared to the control (beta -1.99; 95% CI’s -3.15, -0.84). We did not find evidence of impact of the intervention on women’s psychological distress. Water insecurity was, however, predictive of psychological distress (p <0.01), independent of household food security and the quality of the previous year’s harvest. Conclusion: These results contribute to the construct validity of our water insecurity scale, and establish our approach to measuring water insecurity as a plausible means of evaluating water interventions. Improvements to community water supplies were effective in reducing household water insecurity, but not psychological distress, in this population. Water insecurity was an important predictor of psychological distress. This study contributes to an emerging literature on quantitative assessment of household water insecurity, and draws attention to the potential impact of improved access to water on women’s mental well-being.

研究背景：全球有超过6.5亿人口无法获取安全饮用水，即便已获得“改良型”水源的人群，其用水仍可能存在季节性供应不稳定、取水距离过远、费用高昂且供水量不足等问题。当前针对社区与家庭层面的用水评估手段仍较为粗疏，亟需更完善的家庭用水不安全状况量化工具，以支撑需求评估、监测与评价工作。本研究旨在评估家庭用水不安全状况量化量表的效度，并探究三个问题：（1）社区供水改良是否可降低家庭用水不安全程度；（2）供水干预是否会对女性心理困扰产生影响；（3）在控制社会经济地位、粮食安全状况与收成质量等混杂因素后，用水不安全状况对心理困扰的独立影响。
研究方法与结果：在埃塞俄比亚北部农村的三个村庄，我们于社区供水改良措施实施前后分别开展数据采集，后续数据采集时间为措施落地后1至6个月。选取规模、水源可及性及其他公共设施配套水平相近的村庄作为对照，未实施供水干预。家庭用水不安全状况通过基于埃塞俄比亚既往质性研究开发的21条目量表进行评估。女性心理困扰状况采用世界卫生组织自我报告问卷（WHO Self-Reporting Questionnaire, SRQ-20）进行测评。研究对象为女性户主或户主配偶，基线调查共纳入247名受访者，终线调查为223名，其中123户在两轮调查中均提供了有效数据。相较于对照组，干预组在基线至终线期间的用水不安全量表得分平均下降约2分（β=-1.99；95%置信区间：-3.15, -0.84）。未发现供水干预对女性心理困扰存在显著影响的证据。然而，用水不安全状况可显著预测心理困扰（p<0.01），且该关联不受家庭粮食安全状况与前一年收成质量的影响。
研究结论：本研究结果为所开发的用水不安全量表的结构效度提供了实证支撑，并验证了本研究采用的用水不安全状况评估方法可作为评估供水干预效果的可靠手段。在本次研究人群中，社区供水改良措施可有效降低家庭用水不安全程度，但未能改善女性心理困扰状况。用水不安全状况是心理困扰的重要预测因子。本研究为日益增长的家庭用水不安全状况量化评估相关研究领域贡献了新的证据，并提请学界关注供水可及性改善对女性心理健康福祉的潜在影响。