Food Insecurity and Water Insecurity in Rural Zimbabwe: Development of Multidimensional Household Measures
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Setting and Population
2.2. Data Collection
2.3. Sample Selection
2.4. Item Variable Selection
2.5. Statistical Analyses
2.5.1. Descriptives
2.5.2. Item Reduction
2.5.3. Validity Assessments
2.5.4. Sensitivity Analysis
3. Results
3.1. Participant Characteristics
3.2. Multiple Correspondence Analysis (MCA)
3.3. Validity Assessments
4. Discussion
4.1. Food Insecurity (FI)
4.2. Water Insecurity (WI)
4.3. Validity Assessments
4.4. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Insecurity | Dimension | Item Variable * | Description of Item Variable | Data Collection | Variable Parameterization ** | Recall Period |
---|---|---|---|---|---|---|
Food | Availability | Stock of staple food | Number of days of staple foods available for all household members. | Reported by participating women | 8 ordered categories (days): (1) 0–7, (2) 8–30, (3) 31–60, (4) 61–90, (5) 91–120, (6) 121–180, (7) 181–270, (8) >270 | Present |
Garden | Household has a garden to grow fruits and/or vegetables | Reported by participating women | Yes vs. No | Present | ||
Leftover food a | Food left over from last cooking time for the household. | Observed by interviewer | Yes vs. No | Present | ||
Access | Food not preferred | Household relies on inexpensive and less prefered food. | Reported by participating women | Yes vs. No | Month | |
Insufficient food | Household members skip entire days without eating, limit portion sizes or reduce number of meals. | Reported by participating women | Yes vs. No | Month | ||
Food help | Household requires help from family and friends for food, sends members to eat elsewhere or begs for food. | Reported by participating women | Yes vs. No | Month | ||
Food on credit | Household borrows or purchases food on credit. | Reported by participating women | Yes vs. No | Month | ||
Assets sold for food | Household sells possessions and assets to afford food. | Reported by participating women | Yes vs. No | Past 3–4 months | ||
Time to food market | Time taken to go from the homestead to the closest food market (one-way). | Estimated by participating women | 4 ordered categories (minutes): (1) 0–20, (2) 21–40, (3) 41–60, (4) >60 | Usual | ||
Transportation a | Method of transportation to get to the food market. | Reported by participating women | Categorical: On foot vs. Other (Motor vehicle or bicycle) | Usual | ||
Utilization | Household diet diversity | Household dietary diversity score calculated from FFQ with reported consumption of 12 food groups. | Reported by participating women | <6 food groups vs. ≥6 food groups | Past 24 h | |
Handwashing | Responded volunteered answer “Washed hands prior to food handling” when asked reasons for handwashing. | Reported by participating women | Yes vs. No | Usual | ||
Food storage location | Location of leftover food: on the floor or in an elevated position. | Observed by interviewer | Elevated vs. floor | Present | ||
Food container a | Leftover foods stored in open or closed containers. | Observed by interviewer | Covered vs. Not covered | Present | ||
Reliability | Social shocks | Household experienced conflict, legal issues or divorce. | Reported by participating women | Yes vs. No | Past year | |
Economic shocks | Household experienced job loss, business failure or loss of assets. | Reported by participating women | Yes vs. No | Past year | ||
Agriculture shocks | Household experienced loss of crops and/or livestock. | Reported by participating women | Yes vs. No | Past year | ||
Health shocks | Household members experienced death, disease and/or injury. | Reported by participating women | Yes vs. No | Past year | ||
Water | Availability | Water volume | Total quantity of water immediately available to household. | Calculated from observed data | 4 categories: (1) 0–20 L, (2) >20–40 L, (3) >40–60 L, (4) >60 L | Present |
Irrigation water a | Household has access to water for irrigation. | Reported by participating women | Yes vs. No | Present | ||
Access | Time to drinking source | Time taken to get to main source of drinking water from homestead (one-way). | Estimated by participating women | <15 min vs. ≥15 min | Usual | |
Distance to drinking source | Distance to main drinking water source from homestead (one-way). | Estimated by participating women | <1000 m vs. ≥1000 m | Usual | ||
Time to non-drinking source | Time taken to get to main source of non-drinking water (one-way). | Estimated by participating women | <15 min vs. ≥15 min | Usual | ||
Distance to non-drinking source | Distance to main source of water for non-drinking purposes(one-way). | Estimated by participating women | <1000 m vs. ≥1000 m | Usual | ||
Water purchase a | Does the household purchase water usually? | Reported by participating women | Yes vs. No | Usual | ||
Utilization | Drinking source type | Water source: (1) piped into dwelling, (2) piped into yard or plot, (3) piped into public tap or standpipe, (4) borehole, (5) protected deep well, (6) unprotected deep well, (7) protected shallow well, (8) unprotected shallow well, (9) improvised shallow well, (10) protected spring, (11) unprotected spring, (12) surface water from river/dam/stream/lake, (13) river bank, (14) rainwater harvester, (15) water truck/Bowser, (16) bottled | Reported by participating women | 3 categories: (1) piped, protected sources, bottled, water truck and rainwater harvester, (2) unprotected ground water and improvised water sources, (3) surface water and river banks. | Usual | |
Non-drinking source type | Same as drinking source type above | Same as above | Same as above | Usual | ||
Water satisfaction | Satisfaction with smell, color and taste of water from main water sources. | Reported by participating women | 3 categories: Satisfied/Neutral/Unsatisfied | Usual | ||
Water treatment | Household treats water to make it safe for consumption e.g., boiling, bleaching, use chlorine, etc. | Reported by participating women | Yes vs. No | Usual | ||
Water container | Water meant for drinking was kept in covered containers. | Observed by interviewer | Covered vs. Not covered | Present | ||
Reliability | Drinking water frequency | Frequency at which main source for drinking water runs dry. | Reported by participating women | Ever vs. Never | Anytime over past year | |
Non-drinking water frequency | Frequency at which main source for non-drinking water runs dry. | Reported by participating women | Ever vs. Never | Anytime over past year |
Type of Validity | Purpose | Assessment Methods |
---|---|---|
Internal | To determine the extent to which the dimensions obtained are consistent within the sample and across time. | 1. CFA with a sub-sample of the population at baseline to cross-validate the number of dimensions and loading patterns. |
2. CFA with the same households reporting information at 18 months to cross-validate the results across time. | ||
Predictive | To determine the extent to which the dimension scores predict known related outcomes. | Linear regression to estimate the associations between dimensions of: |
2. Water insecurity and perceived health status and depression symptomatology. | ||
1. Food insecurity and perceived health status and depression symptomatology. | ||
Discriminant | To determine the extent to which the dimension scores are differentiated as expected according to known groups. | Tests of differentiation between dimension scores across known groups using linear regression: |
1. Food insecurity: season (hungry vs plenty), SES-status, HIV-status. | ||
2. Water insecurity: season (rainy vs dry), wealth index, HIV-status. | ||
Convergent | To determine the extent to which the dimension scores are associated with other constructs that are closely related. | Linear regression to estimate association between dimensions of: |
1. Food insecurity and receiving food aid. | ||
2. Water insecurity and frequency of water collection. |
Characteristics | Food Sample | Water Sample |
---|---|---|
Socio-demographic *, N | 3551 | 3311 |
Trial arm, n (%) | ||
SOC | 803 (22.61) | 772 (22.61) |
IYCF | 872 (24.56) | 780 (24.56) |
WASH | 914 (25.74) | 856 (25.74) |
WASH + IYCF | 962 (27.09) | 903 (27.09) |
Living with HIV, n/N (%) | 556/3537 (15.66) | 524/3297 (15.66) |
Rainy season at interview, n/N (%) | - | 1473/3310 (45.17) |
Hungry season at interview, n/N(%) | 1030/3545 (29.01) | 942 (29.01) |
Woman’s education, n (%) | ||
Primary | 640 (18.02) | 596 (18.02) |
Some secondary | 1263 (35.57) | 1199 (35.57) |
Completed secondary | 1510 (42.52) | 1382 (42.52) |
Women employed, n/N(%) | 298/3241 (8.39) | 284/3302 (8.39) |
SES tercile, n (%) | ||
lower | 1141 (32.13) | 1079 (32.13) |
middle | 1192 (33.57) | 1117 (33.57) |
upper | 1214 (34.19) | 1111 (34.19) |
Women partnered, n/N(%) | 3233/3384 (91.04) | 3015/3156 (91.04) |
Parous 1, n/N(%) | 1885/2254 (53.08) | 1964/2330 (59.32) |
Religion: Apostolic, n/N(%) | 1596/3411 (44.95) | 1513/3176 (44.95) |
Depression, n/N(%) | 201/3485 (5.66) | 155/3170 (5.66) |
Woman’s age, n/mean (SD) | 3401/26.42 (6.72) | 3171/26.32 (6.68) |
Household size, n/median (IQR) | 3432/5 (3) | 3199/5 (3) |
Perceived health status 1, n/mean (SD) | 3065/3.42 (0.99) | 2874/3.42 (0.99) |
Food item variables **, N | 3551 | |
Staple food stocks | ||
>270 days | 402 (11.32) | - |
181–270 days | 370 (10.42) | - |
121–180 days | 584 (16.45) | - |
91–120 days | 296 (8.34) | - |
61–90 days | 447 (12.59) | - |
31–60 days | 459 (12.93) | - |
8–30 days | 562 (15.83) | - |
0–7 days | 431 (12.14) | - |
Garden, N (%) | 2904 (81.78) | - |
Leftover food, N (%) | 1705 (48.01) | - |
Food not preferred | 2478 (69.78) | - |
Insufficient food | 866 (24.39) | - |
Food help | 477 (13.43) | - |
Food on credit | 898 (25.29) | - |
Assets sold for food | 404 (11.38) | - |
Time to food market, n (%) | ||
0–20 min | 985 (27.74) | - |
21–40 min | 842 (23.71) | - |
41–60 min | 1005 (28.3) | - |
>1 h | 719 (20.25) | - |
Transportation, n (%) | ||
Bicycle/Motor | 150 (4.22) | - |
Walking | 3384 (95.3) | - |
Household meets diet diversity | 2581 (72.68) | - |
Handwashing prior to food handling | 3198 (90.06) | - |
Food storage location | ||
Elevated position | 2091 (58.88) | - |
On floor | 1460 (41.12) | - |
Food container covered | 3513 (98.93) | - |
Social shocks | 261 (7.35) | - |
Economic shocks | 472 (13.29) | - |
Agriculture shocks | 893 (25.15) | - |
Health shocks | 1670 (47.03) | - |
Water item variables **, N | 3311 | |
Volume | ||
>60 L | - | 370 (11.17) |
41 to 60 L | - | 458 (13.83) |
21 to 40 L | - | 1093 (33.01) |
0–20 L | - | 1390 (41.98) |
Water for irrigation | - | 699 (21.11) |
One-way ≤ 15 min to drinking water source | - | 2411 (72.82) |
Distance ≤ 1000 m to drinking source | - | 2902 (87.65) |
One-way ≤ 15 min to non-drinking source | - | 2470 (74.6) |
Distance ≤ 1000 m to non-drinking source | - | 2918 (88.13) |
Purchase of water | - | 5 (0.15) |
Type of drinking source | ||
Improved (piped, protected) | - | 2097 (63.33) |
Unprotected ground | - | 954 (28.81) |
Surface water | - | 260 (7.85) |
Type of non-drinking source | ||
Improved (piped, protected) | - | 1105 (33.37) |
Unprotected ground | - | 970 (29.3) |
Surface water | - | 1236 (37.33) |
Satisfaction with main water source | ||
Satisfied | - | 2677 (80.85) |
Neither satisfied not unsatisfied | - | 343 (10.36) |
Unsatisfied | - | 291 (8.79) |
Drinking water treated | - | 412 (12.44) |
Drinking water containers covered | - | 2143 (64.72) |
Drinking water always available | - | 2892 (87.35) |
Water for non-drinking purposes always available | - | 2951 (89.13) |
Food Insecurity (N = 3551) | Water Insecurity (N = 3311) | ||||||
---|---|---|---|---|---|---|---|
MCA Food Dimensions | 1 | 2 | 3 | MCA Water Dimensions | 1 | 2 | 3 |
Dimension Names | Poor Food Access | Household Shocks | Low Food Availability and Quality | Dimension Names | Poor Water Access | Poor Water Quality | Low Water Reliability |
Stock of staple food | 0.11 | 0.05 | 0.31 | Water volume | 0.01 | 0 | 0.01 |
Garden | 0 | 0 | 0.32 | Time to drinking source | 0.56 | 0 | 0 |
Food not preferred | 0.48 | 0.01 | 0.0 | Distance to drinking source | 0.48 | 0 | 0 |
Insufficient food | 0.52 | 0 | 0.01 | Time to non-drinking source | 0.58 | 0 | 0 |
Food help | 0.47 | 0 | 0 | Distance to non-drinking source | 0.49 | 0 | 0 |
Food on credit | 0.47 | 0.01 | 0 | Drinking source | 0.09 | 0.76 | 0.06 |
Assets sold for food | 0.02 | 0.04 | 0.05 | Non-drinking source | 0.10 | 0.66 | 0.01 |
Time to food market | 0.03 | 0.05 | 0.11 | Water satisfaction | 0.04 | 0.30 | 0 |
Handwashing | 0 | 0.01 | 0.02 | Water treatment | 0 | 0.04 | 0 |
Food storage location | 0.01 | 0 | 0.11 | Water container | 0 | 0 | 0.01 |
Household diet diversity | 0.03 | 0.06 | 0.25 | Frequency of availability of drinking water at the source | 0 | 0 | 0.70 |
Social shocks | 0.01 | 0.07 | 0.03 | ||||
Economic shocks | 0.02 | 0.32 | 0.01 | Frequency of availability of non-drinking water at the source | 0 | 0 | 0.70 |
Agriculture shocks | 0.01 | 0.36 | 0 | ||||
Health shocks | 0 | 0.34 | 0 | ||||
Eigenvalue | 2.17 | 1.32 | 1.22 | Eigenvalue | 2.36 | 1.78 | 1.50 |
% variance | 9.06 | 5.93 | 5.13 | % variance | 13.29 | 9.93 | 8.14 |
Median score (IQR)* | −0.32 (1.35) | −0.14 (1.36) | −0.07 (1.34) | Median (IQR) | −0.48 (1.40) | −0.28 (2.01) | −0.32 (0.26) |
Min, max score * | −1.33, 3.39 | −2.25, 3.41 | −2.81, 3.93 | Min, max | −1.04, 3.63 | −1.41, 2.43 | −1.46, 3.46 |
Measure | Food Insecurity | Water Insecurity | ||
---|---|---|---|---|
Groups | Baseline Test Sample 1 | 18 months 2 | Baseline Test Sample 1 | 18 months |
N | 2132 | 3612 | 1998 | 3879 |
RMSEA ≤ 0.05 (range: 0, 0.10) | 0.04 (0.03, 0.04) | 0.04 (0.03, 0.04) | 0.04 (0.04, 0.05) | 0.06 (0.06, 0.07) |
CFI ≥ 0.95 | 0.88 | 0.90 | 0.96 | 0.97 |
TLI ≥ 0.90 | 0.87 | 0.88 | 0.95 | 0.97 |
SRMR ≤ 0.08 | 0.07 | 0.08 | 0.07 | 0.09 |
Food Insecurity (N = 3551) β [95% CI] | Water Insecurity (N = 3311) β [95% CI] | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Validity | Variable | Expected direction | n/N Median (IQR) | Poor food access | Household shocks | Low food quality and availability | n/N Median (IQR) | Poor water access | Poor water quality | Low water reliability |
−0.38 (1.34) | −0.18 (1.35) | −0.08 (1.40) | −0.47 (1.40) | −0.27 (1.99) | −0.33 (0.28) | |||||
Predictive | a Perceived health status | Negative | 3065 | −0.16 | −0.13 | −0.05 | 2874 | −0.04 | −0.04 | −0.07 |
[−0.19, −0.12] | [−0.17, −0.09] | [−0.08, −0.01] | [−0.08, −0.01] | [−0.08, −0.01] | [−0.11, −0.03] | |||||
a Depression | Positive | 3485 | 0.52 | 0.37 | 0.26 | 3236 | 0.22 | 0.22 | 0.23 | |
[0.38, 0.66] | [0.23, 0.51] | [0.12, 0.41] | [0.07, 0.36] | [0.07, 0.36] | [0.08, 0.37] | |||||
Discriminant | b Season: Hungry vs. Plenty | Positive | 1030/3545 | 0.12 | 0.04 | 0.25 | - | - | - | - |
[0.05, 0.20] | [−0.03, 0.12] | [0.18, 0.32] | ||||||||
b Season: Dry vs. Rainy | Positive | - | - | - | - | 1837/3310 | 0.16 | 0.03 | −0.11 | |
[0.09, 0.22] | [−0.04, 0.10] | [−0.18, −0.04] | ||||||||
c Middle SES vs. High SES | Positive | 1192/3547 | 0.29 | −0.14 | 0.27 | 1111/3307 | 0.05 | 0.18 | 0.05 | |
[0.21, 0.37] | [−0.22, −0.06] | [0.19, 0.35] | [−0.03, 0.13] | [0.09, 0.26] | [−0.03, 0.14] | |||||
c Low SES vs. High SES | Positive | 1141/3548 | 0.56 | −0.27 | 0.61 | 1117/3308 | 0.15 | 0.32 | 0.01 | |
[0.48, 0.64] | [−0.35, −0.19] | [0.53, 0.69] | [0.07, 0.24] | [0.24, 0.40] | [−0.07, 0.10] | |||||
d HIV-positive vs. HIV negative | Positive | 556/3547 | 0.21 | −0.01 | 0.16 | 524/3297 | 0.06 | 0.05 | −0.02 | |
[0.12, 0.30] | [−0.05, 0.02] | [0.07, 0.24] | [−0.03, 0.15] | [−0.04, 0.15] | [−0.11, 0.07] | |||||
Convergent | c Receive food aid vs. no food aid | Positive | 316/3551 | 0.12 | 0.19 | 0.06 | - | - | - | - |
[0.00, 0.23] | [0.07, 0.30] | [−0.05, 0.18] | ||||||||
a Water collection- Weekly vs. Daily | Positive | - | - | - | - | 488/3306 | 0.17 | 0 | 0.05 | |
[0.07, 0.27] | [−0.09, 0.10] | [−0.05, 0.15] | ||||||||
a Water collection- Monthly vs. Daily | Positive | - | - | - | - | 140/3307 | 0.24 | −0.09 | −0.08 | |
[0.07, 0.41] | [−0.26, 0.08] | [−0.25, 0.09] |
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Koyratty, N.; Jones, A.D.; Schuster, R.; Kordas, K.; Li, C.-S.; Mbuya, M.N.N.; Boateng, G.O.; Ntozini, R.; Chasekwa, B.; Humphrey, J.H.; et al. Food Insecurity and Water Insecurity in Rural Zimbabwe: Development of Multidimensional Household Measures. Int. J. Environ. Res. Public Health 2021, 18, 6020. https://doi.org/10.3390/ijerph18116020
Koyratty N, Jones AD, Schuster R, Kordas K, Li C-S, Mbuya MNN, Boateng GO, Ntozini R, Chasekwa B, Humphrey JH, et al. Food Insecurity and Water Insecurity in Rural Zimbabwe: Development of Multidimensional Household Measures. International Journal of Environmental Research and Public Health. 2021; 18(11):6020. https://doi.org/10.3390/ijerph18116020
Chicago/Turabian StyleKoyratty, Nadia, Andrew D. Jones, Roseanne Schuster, Katarzyna Kordas, Chin-Shang Li, Mduduzi N. N. Mbuya, Godfred O. Boateng, Robert Ntozini, Bernard Chasekwa, Jean H. Humphrey, and et al. 2021. "Food Insecurity and Water Insecurity in Rural Zimbabwe: Development of Multidimensional Household Measures" International Journal of Environmental Research and Public Health 18, no. 11: 6020. https://doi.org/10.3390/ijerph18116020