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.