‘We Are Drinking Diseases’: Perception of Water Insecurity and Emotional Distress in Urban Slums in Accra, Ghana

Abstract

Water security is critical to the health and well-being of people around the world, especially among populations experiencing water stresses and rapid urbanization in low- to middle-income countries (LMICs). Recent research suggests water insecurity is associated with negative mental health outcomes. Despite global improvement in access to safe water across the world, the World Health Organization (WHO) reports that access to safe water in urban areas has not changed significantly or has stagnated in certain countries. In most African cities, entrepreneurial water vendors have stepped up to fill supply gaps in the formal delivery system by selling vended water. As part of a larger research program that aims to assess and analyze public perceptions around vended water, this paper explores the links connecting water insecurity and emotional distress among urban slum dwellers who mostly use vended water in Accra, Ghana. We used a parallel mixed-methods approach. Our quantitative results show that water-insecure households (OR = 2.23, p = 0.01) were more likely to report emotional distresses compared to water-secure households. However, households with improved sanitation (OR = 0.28, p = 0.01) and those willing to participate for improved water and sanitation (OR = 0.28, p = 0.01) were less likely to report emotional distress. Our qualitative results offered support for the quantitative results, as participants not only hold various perceptions regarding the safety and quality of vended water but expressed emotional distresses such as fear of contamination, discomfort, worry over arbitrary change in prices, and anxiety. The implications of the results for policy and practice, specifically to ensuring access to safe water, are discussed.

Water and mental health

“…Stevenson et al (2012), the first to do so, found that Ethiopian women's experiences of water insecurity were associated with psychosocial distress, as measured by the Falk Self-Reporting Questionnaire (SRQ-F). Since then, a number of investigative teams have documented a robust relationship between water insecurity and systematically-assessed emotional distress (Cooper, Hutchings, et al, 2019;Harris, Kleiber, Goldin, Darkwah, & Morinville, 2017;Kangmennaang, Bisung, & Elliott, 2020;Thomas & Godfrey, 2018) or symptoms of stress, distress or common mental disorders (Aihara, Shrestha, Kazama, & Nishida, 2015;Aihara, Shrestha, & Sharma, 2016;Boateng et al, 2018;Boateng et al, 2020;Brewis, Choudhary, & Wutich, 2019a, 2019bChindarkar, Chen, & Gurung, 2019;Cooper-Vince et al, 2017Espinosa-Montero et al, 2016;Maxfield, 2020;Mushavi et al, 2020;Shrestha et al, 2018;Slekiene & Mosler, 2019;Snodgrass, Upadhyay, Debnath, & Lacy, 2016;Subbaraman et al, 2012Subbaraman et al, , 2014Tallman, 2016Tallman, , 2019Tsai et al, 2016;Workman & Ureksoy, 2017;Young et al, 2019). Most of these studies have been conducted in lower-income economies, but scholarship based in the United States-in Texas colonias (Jepson, 2014;Jepson & Vandewalle, 2016) and Flint, Michigan (Cuthbertson, Newkirk, Ilardo, Loveridge, & Skidmore, 2016;Fortenberry et al, 2018;Sneed, Dotson, Brewer, Pugh, & Johnson-Lawrence, 2020)-has documented similar associations between water insecurity, emotional distress, and mental ill-health.…”

“…Stigma is closely tied to shame, a psychologically distressing emotional state. Several studies have identified that humiliations and shame around mistreatment while water purchasing, such as from vendors, can generate feelings of anger and shame (e.g., Kangmennaang et al, 2020;Mushavi et al, 2020). For example, in Bolivia, women in informal settlements reported the abject humiliation of having to run after and beg water truck vendors to sell them water (Wutich, 2020;Wutich, Beresford, & Carvajal, 2016;Wutich, Brewis, Chavez, & Jaiswal, 2016;Wutich & Ragsdale, 2008).…”

“…Unsafe water and the challenges of fetching water can raise worries around becoming ill or getting hurt. A recent study in informal settlements in Ghana, Kangmennaang et al (2020) reported that participants described distress around perceived contaminants in vended water as "drinking diseases." Much of this unease was focused on how their children's exposure to unclean water could make them sick.…”

Socio‐environmental confounders of safe water interventions

“…For example, low and intermediate water access was associated with higher blood pressure in women in both urban and rural Nepal, with the highest pressure associated with the lowest access (Brewis, Choudhary, & Wutich, 2019b). Limited water access has been found to be associated with increased anxiety, worry, stress, feelings of hopelessness, and arguments over water (Brewis, Choudhary, & Wutich, 2019a; Kangmennaang, Bisung, & Elliott, 2020; Krumdieck et al, 2016; Ženko & Menga, 2019). People with poor mental health in rural Malawi—in contrast to those with good mental health—perceived that the collection of safe water required time and effort and that it was therefore difficult to collect enough water; they also felt more vulnerable to disease from not collecting safe water (Slekiene & Mosler, 2019).…”

COVID-19: Implications for Food, Water, Hygiene, Sanitation, and Environmental Safety in Africa: A Case Study in Ghana

“…water for drinking (Kangmennaang et al, 2020) or to perform other functions (washing, cooking, etc.) in the house (Fig5).According to the WHO, from a work that was done byCasanova et al (2009), coronaviruses could remain infectious in water contaminated with faeces for days to weeks (WHO, water sanitation brief 2020) and was also been documented to survive in wastewater for 2 to 4 days(Gundy et al, 2009).…”