Household Water and Food Insecurity Are Positively Associated with Poor Mental and Physical Health among Adults Living with HIV in Western Kenya

Abstract

Background Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. Objectives We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. Methods Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0–27) and WI (using a modified scale developed for this region, range: 0–51) in the prior month (n = 716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0–100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. Results Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P < 0.001) and 2.92 times greater odds of probable depression (P < 0.001). Conclusions Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. This trial was registered at clinicaltrials.gov as NCT02815579.

Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya

“…Problems with water are common in regions with high HIV prevalence (e.g., sub-Saharan Africa), although few studies have considered both conditions concurrently [6][7][8]. Understanding the relationship between water insecurity, i.e.…”

“…Water insecurity is distinct from, but related to, food insecurity (i.e., the inability to access sufficient nutritious foods) and poverty [6,7,[10][11][12]. Food insecurity is a critical social determinant of health, including HIV-related clinical outcomes [13][14][15][16].…”

Household water and food insecurity negatively impacts self-reported physical and mental health in the Vietnamese Mekong Delta

“…Inadequate WASH and food insecurity has been linked to poorer physical health [ 6 ]. Increasingly however, using untreated drinking water in low- and middle-income countries (LMICS) has been found to impact mental health by increasing depression and anxiety [ 7 , 8 ].…”

Water and Emotion: Testing a New Approach for Monitoring Water Security Among Afar Pastoralists in Ethiopia

“…The first cross cultural and ecological household water security index includes 12 measures three of which are connexion to emotional issues of anger, worry and shame (Young et al, 2018(Young et al, , 2019. Recent research has shown the influence of household water insecurity on mental disorders, such as depression and anxiety (Brewis et al, 2019;Miller et al, 2021).…”