Assessing reliability, change after intervention, and performance of a water insecurity scale in rural Ethiopia

There is growing interest in the phenomenon of water insecurity, yet a relative paucity of tools to assess the occurrence and severity of water insecurity at the household level. We sought to assess the validity and reliability of a household water insecurity scale in a rural Ethiopian context. Secondary data on water insecurity from up to 1934 rural Ethiopian households that had participated in a water and sanitation intervention was analysed. Exploratory factor analysis and Cronbach's alpha were used to assess dimensionality of the water insecurity responses and parametric and non-parametric tests used to test for differences in household water insecurity scores across household types and objective measures of household water access. Factor analysis revealed one dominant factor and the Cronbach's alpha of the water insecurity scale was 0.94. Households with access to improved water sources, that lived close to water collection points, that did not farm, and that felt they had enough water all scored as significantly more water secure on the household water insecurity scale (P < 0.05). The household water insecurity scale also predicted the occurrence of diarrhea among children in the household (aOR 1.2, 95 % CI 1.08, 1.33) whereas no other measure of water access did. Finally, household water insecurity scores improved by 55 % after a water and sanitation intervention. Our results suggest the possibility of an effective water insecurity tool, which might be deployed to assess the epidemiology of water insecurity including its causes and consequences. Future research should aim to validate the tool against behavioral observations and to link shifts in water insecurity to changes in health and wellbeing.