Household water insecurity will complicate the ongoing COVID-19 response: Evidence from 29 sites in 23 low- and middle-income countries

• Type of Material: Article
• Authors: Justin Stoler, University of Miami; Joshua D. Miller, University of North Carolina; Alexandra Brewis, Arizona State University-Tempe; Matthew Freeman, Emory University; Leila M. Harris, University of British Columbia; Wendy Jepson, Texas A&M University; Amber L. Pearson, Michigan State University; Asher Y. Rosinger, Pennsylvania State University; Sameer H. Shah, University of British Columbia; Chad Staddon, University of West England; Cassandra Workman, University of North Carolina Greensboro; Amber Wutich, Arizona State University-Tempe; Sera L. Young, Northwestern University
• Language: English
• Date: 2021-03-15
• Publisher: Elsevier GmBh
• Publication Version: Final Published Version
• Copyright Statement: © 2021 Elsevier GmbH. All rights reserved.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijheh.2021.113715
• Title of Journal or Parent Work: International Journal of Hygiene and Environmental Health
• Volume: 234
• Start Page: 113715
• End Page: 113715
• Grant/Funding Information: SLY was supported by the National Institutes of Health (NIMH R21 MH108444; NIMH K01 MH098902). WEJ was supported by the National Science Foundation (BCS-1560962) and the Texas A&M University-CONACYT Research Collaborative Grant.; The authors acknowledge the support of the Household Water Insecurity Experiences Research Coordination Network (HWISE RCN) funded by National Science Foundation grant number BCS-1759972.; The HWISE study was funded with the Competitive Research Grants to Develop Innovative Methods and Metrics for Agriculture and Nutrition Actions (IMMANA).; This project was also supported by the Buffett Institute for Global Studies and the Center for Water Research at Northwestern University; Arizona State University’s Center for Global Health at the School of Human Evolution and Social Change and Decision Center for a Desert City (National Science Foundation SES-1462086); the Office of the Vice Provost for Research of the University of Miami; and the National Institutes of Health grant NIEHS/FIC R01ES019841 for the Kahemba Study, DRC.; IMMANA is funded with UK Aid from the UK government.; CS was supported by the Lloyd’s Register Foundation.
• Keywords: Sanitation; WASH; Science & Technology; Global health; Infectious Diseases; COVID-19; Life Sciences & Biomedicine; SARS-CoV-2; Public, Environmental & Occupational Health; Water insecurity
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health; Health Sciences, Occupational Health and Safety

Abstract

In March 2020, the World Health Organization (WHO) issued a set of public guidelines for Coronavirus Disease 2019 (COVID-19) prevention measures that highlighted handwashing, physical distancing, and household cleaning. These health behaviors are severely compromised in parts of the world that lack secure water supplies, particularly in low- and middle-income countries (LMICs). We used empirical data gathered in 2017–2018 from 8,297 households in 29 sites across 23 LMICs to address the potential implications of water insecurity for COVID-19 prevention and response. These data demonstrate how household water insecurity presents many pathways for limiting personal and environmental hygiene, impeding physical distancing and exacerbating existing social and health vulnerabilities that can lead to more severe COVID-19 outcomes. In the four weeks prior to survey implementation, 45.9% of households in our sample either were unable to wash their hands or reported borrowing water from others, which may undermine hygiene and physical distancing. Further, 70.9% of households experienced one or more water-related problems that potentially undermine COVID-19 control strategies or disease treatment, including insufficient water for bathing, laundering, or taking medication; drinking unsafe water; going to sleep thirsty; or having little-to-no drinking water. These findings help identify where water provision is most relevant to managing COVID-19 spread and outcomes.