Water insecurity is associated with greater food insecurity and lower dietary diversity: panel data from sub-Saharan Africa during the COVID-19 pandemic.

There is growing recognition that water insecurity - the inability to reliably access sufficient water for all household uses - is commonly experienced globally and has myriad adverse consequences for human well-being. The role of water insecurity in food insecurity and diet quality, however, has received minimal attention. Data are from panel surveys conducted during 2020-21 among adults involved in smallholder agriculture in Niger (n = 364, 3 rounds), Nigeria (n = 501, 5 rounds), Senegal (n = 501, 5 rounds), and Ghana (n = 543, 5 rounds). We hypothesized that household water insecurity (measured using the brief Household Water Insecurity Experiences Scale) would be associated with greater individual food insecurity (using 5 of the 8 Food Insecurity Experiences Scale items) and lower dietary diversity (using the Minimum Dietary Diversity Score for Women). At baseline, 37.1% of individuals were living in water-insecure households and of these, 90.6% had some experience of food insecurity. In multilevel mixed-effects regressions, individuals living in water-insecure households had 1.67 (95% CI: 1.47, 1.89) times higher odds of reporting any food insecurity experience and were estimated to consume 0.38-fewer food groups (95% CI: -0.50, -0.27) than those living in water-secure households. Experiences with suboptimal water access and use are associated with poor nutrition. The pathways by which water insecurity impacts nutrition should be identified. Global and national food and nutrition security policies could be strengthened by monitoring and developing strategies to address household water insecurity.