ObjectiveProgress 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.MethodsCross-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.FindingsTwelve 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.ConclusionsThe 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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As the COVID-19 pandemic progresses, an understanding of the structure and organization of beliefs in pandemic conspiracy theories and misinformation becomes increasingly critical for addressing the threat posed by these dubious ideas. In polling Americans about beliefs in 11 such ideas, we observed clear groupings of beliefs that correspond with different individual-level characteristics (e.g., support for Trump, distrust of scientists) and behavioral intentions (e.g., to take a vaccine, to engage in social activities). Moreover, we found that conspiracy theories enjoy more support, on average, than misinformation about dangerous health practices. Our findings suggest several paths for policymakers, communicators, and scientists to minimize the spread and impact of COVID-19 misinformation and conspiracy theories.

Population growth in West Africa has outpaced local efforts to expand potable water services, and private sector sale of packaged drinking water has filled an important gap in household water security. Consumption of drinking water packaged in plastic sachets has soared in West Africa over the last decade, but the long-term implications of these changing consumption patterns remain unclear and unstudied. This paper reviews recent shifts in drinking water, drawing upon data from the 2003 and 2008 Demographic and Health Surveys, and provides an overview of the history, economics, quality, and regulation of sachet water in Ghana’s Accra-Tema Metropolitan Area. Given the pros and cons of sachet water, we suggest that a more holistic understanding of the drinking water landscape is necessary for municipal planning and sustainable drinking water provision.

Intraurban differentials in safe drinking water in developing cities have been exacerbated by rapid population growth that exceeds expansion of local water infrastructure. In Accra, Ghana, municipal water is rationed to meet demand, and the gap in water services is increasingly being filled by private water vendors selling packaged “sachet” water. Sachets extend drinking water coverage deeper into low-income areas and alleviate the need for safe water storage, potentially introducing a health benefit over stored tap water. We explore correlates of using sachets as the primary drinking water source for 2,093 women in 37 census areas classified as slums by UN-Habitat, and links between sachet water and reported diarrhea episodes in a subset of 810 children under five. We find that neighborhood rationing exerts a strong effect on a household's likelihood of buying sachet water, and that sachet customers tend to be the poorest of the poor. Sachet use is also associated with higher levels of self-reported overall health in women, and lower likelihood of diarrhea in children. We conclude with implications for sachet regulation in Accra and other sub-Saharan cities facing drinking water shortages.