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.

There is rapidly evolving literature on water insecurity in the general adult population, but the role of water insecurity during the vulnerable periods of pregnancy and postpartum, or in the context of HIV, has been largely overlooked. Therefore, we conducted an exploratory study, using Go Along interviews, photo-elicitation interviews, and pile sorts with 40 pregnant and postpartum Kenyan women living in an area of high HIV prevalence. We sought to (1) describe their lived experiences of water acquisition, prioritisation, and use and (2) explore the consequences of water insecurity. The results suggest that water insecurity is particularly acute in this period, and impacts women in far-reaching and unexpected ways. We propose a broader conceptualisation of water insecurity to include consideration of the consequences of water insecurity for maternal and infant psychosocial and physical health, nutrition, and economic well-being.

IntroductionA wide range of water-related problems contribute to the global burden of disease. Despite the many plausible consequences for health and well-being, there is no validated tool to measure individual- or household-level water insecurity equivalently across varying cultural and ecological settings. Accordingly, we are developing the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts.Methods and analysisAfter domain specification and item development, items were assessed for both content and face validity. Retained items are being asked in surveys in 28 sites globally in which water-related problems have been reported (eg, shortages, excess water and issues with quality), with a target of at least 250 participants from each site. Scale development will draw on analytic methods from both classical test and item response theories and include item reduction and factor structure identification. Scale evaluation will entail assessments of reliability, and predictive, convergent, and discriminant validity, as well as the assessment of differentiation between known groups.Ethics and disseminationStudy activities received necessary ethical approvals from institutional review bodies relevant to each site. We anticipate that the final HWISE Scale will be completed by late 2018 and made available through open-access publication. Associated findings will be disseminated to public health professionals, scientists, practitioners and policymakers through peer-reviewed journals, scientific presentations and meetings with various stakeholders. Measures to quantify household food insecurity have transformed policy, research and humanitarian aid efforts globally, and we expect that an analogous measure for household water insecurity will be similarly impactful.

Water sharing offers insight into the everyday and, at times, invisible ties that bind people and households with water and to one another. Water sharing can take many forms, including so-called “pure gifts,” balanced exchanges, and negative reciprocity. In this paper, we examine water sharing between households as a culturally-embedded practice that may be both need-based and symbolically meaningful. Drawing on a wide-ranging review of diverse literatures, we describe how households practice water sharing cross-culturally in the context of four livelihood strategies (hunter-gatherer, pastoralist, agricultural, and urban). We then explore how cross-cutting material conditions (risks and costs/benefits, infrastructure and technologies), socio-economic processes (social and political power, water entitlements, ethnicity and gender, territorial sovereignty), and cultural norms (moral economies of water, water ontologies, and religious beliefs) shape water sharing practices. Finally, we identify five new directions for future research on water sharing: conceptualization of water sharing; exploitation and status accumulation through water sharing, biocultural approaches to the health risks and benefits of water sharing, cultural meanings and socio-economic values of waters shared; and water sharing as a way to enact resistance and build alternative economies.

Tracking progress towards Target 6.1 of the United Nations Sustainable Development Goals, "achieving universal and equitable access to safe and affordable drinking water for all", necessitates the development of simple, inexpensive tools to monitor water quality. The rapidly growing field of synthetic biology has the potential to address this need by isolating DNA-encoded sensing elements from nature and reassembling them to create field-deployable "biosensors" that can detect pathogenic or chemical water contaminants. Here, we describe current water quality monitoring strategies enabled by synthetic biology and compare them to previous approaches used to detect three priority water contaminants (i.e., fecal pathogens, arsenic, and fluoride), as well as explain the potential for engineered biosensors to simplify and decentralize water quality monitoring. We conclude with an outlook on the future of biosensor development, in which we discuss their adaptability to emerging contaminants (e.g., metals, agricultural products, and pharmaceuticals), outline current limitations, and propose steps to overcome the field's outstanding challenges to facilitate global water quality monitoring.

Objectives: Infant feeding plays a critical role in child health and development.Few studies to date have examined the link between household water insecurity and infant feeding, and none in a cross-cultural context. Therefore, we examined the perceived impact of household water insecurity in four domains: breastfeeding, non-breastmilk feeding, caregiver capabilities, and infant health. Our research was conducted as part of the Household Water Insecurity Experiences (HWISE) study. Methods:We interviewed respondents from 19 sites in 16 low-and middleincome countries (N = 3303) about the link between water insecurity and infant feeding. We then thematically analyzed their open-ended textual responses. In each of the four domains (breastfeeding, non-breastmilk feeding, caregiver capabilities, infant health), we inductively identified cross-cultural metathemes. We analyzed the distribution of themes across sites quantitatively and qualitatively.Results: Water was perceived to directly affect breastfeeding and nonbreastmilk feeding via numerous pathways, including timing and frequency of feeding, unclean foods, and reduced dietary diversity. Water was perceived to indirectly affect infant feeding through caregiver capabilities by increasing time demands, exacerbating disease, undernutrition, and mortality, and requiring greater efficacy of caregivers. Respondents made connections between water challenges and infant health, for example, increased risk of infectious diseases, undernutrition, and mortality.Conclusions: These findings suggest that water presents many, and sometimes unexpected, challenges to infant feeding. By systematically investigating HWISE-RCN Co-Authors: Jam

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