Whereas sub-Saharan Africa’s (SSA) water scarcity, food, nutrition and health challenges are well-documented, efforts to address them have often been disconnected. Given that the region continues to be affected by poverty and food and nutrition insecurity at national and household levels, there is a need for a paradigm shift in order to effectively deliver on the twin challenges of food and nutrition security under conditions of water scarcity. There is a need to link water use in agriculture to achieve food and nutrition security outcomes for improved human health and well-being. Currently, there are no explicit linkages between water, agriculture, nutrition and health owing to uncoordinated efforts between agricultural and nutrition scientists. There is also a need to develop and promote the use of metrics that capture aspects of water, agriculture, food and nutrition. This review identified nutritional water productivity as a suitable index for measuring the impact of a water-food-nutrition-health nexus. Socio-economic factors are also considered as they influence food choices in rural communities. An argument for the need to utilise the region’s agrobiodiversity for addressing dietary quality and diversity was established. It is concluded that a model for improving nutrition and health of poor rural communities based on the water-food-nutrition-health nexus is possible.
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