Water security is one of the central global issues today. This study aimed to describe and test the validity and reliability of a household water insecurity scale, and to assess the impact of household water insecurity on psychological distress among 371 women living in urban Nepal. A household interview survey was conducted using a structured questionnaire. Approximately 70% of the participants experienced collecting less water than they needed. Four domains of household water insecurity emerged from the principal components factor analysis: (i) difficulties in house-work related to water, (ii) lost opportunity costs and social interactions related to water, (iii) an insufficient safe water supply, and (iv) difficulties in basic activities related to water. Multivariate regression analysis showed that the domains of ‘lost opportunity costs and social interactions’, ‘difficulties in house-work’ and ‘difficulties in basic activities’ were associated with psychological distress among women. The impact of household water insecurity on psychological distress differed by water supply service levels. The current household water insecurity scale is a simple instrument which can be used to prioritise the target population for water interventions. Further research should be conducted towards the development of a universally applicable measurement tool.

The results suggest that improving water security is necessary to foster maternal psychological health in developing countries.

ObjectiveTo assess the associations between diarrhoea and types of water sources, total quantity of water consumed and the quantity of improved water consumed in rapidly growing, highly populated urban areas in developing countries.DesignCross-sectional analysis using population-representative secondary data obtained from an interview survey conducted by the Asian Development Bank for the 2009 Kathmandu Valley Water Distribution, Sewerage and Urban Development Project.SettingKathmandu Valley, Nepal.Participants2282 households.MethodsA structured questionnaire was used to collect information from households on the quantity and sources of water consumed; health, socioeconomic and demographic status of households; drinking water treatment practices and toilet facilities.ResultsFamily members of 179 households (7.8%) reported having developed diarrhoea during the previous month. For households in which family members consumed less than 100 L of water per capita per day (L/c/d), which is the minimum quantity recommended by WHO, the risk of contracting diarrhoea doubled (1.56-fold to 2.92-fold). In households that used alternative water sources (such as wells, stone spouts and springs) in addition to improved water (provided by a water management authority), the likelihood of contracting diarrhoea was 1.81-fold higher (95% CI 1.00 to 3.29) than in those that used only improved water. However, access to an improved water source was not associated with a lower risk of developing diarrhoea if optimal quantities of water were not consumed (ie, <100 L/c/d). These results were independent of socioeconomic and demographic variables, daily drinking water treatment practices, toilet facilities and residential areas.ConclusionsProviding access to a sufficient quantity of water—regardless of the source—may be more important in preventing diarrhoea than supplying a limited quantity of improved water.