Development of water insecurity scale for rural households in Cameroon- Central Africa

Figures & data

Figure 1. Description of steps involved in the ground-up development and validation of the household water insecurity experience scale (WATINE) conducted in rural areas in West Cameroon – Central Africa

Table 1. Summary of the step by step procedure and tests that were carried out during the phase 3 involving testing of the household water insecurity experience  scale (WATINE) in rural areas in West Cameroon-Central Africa (n = 250)^†

Step	Purpose	Methodology	Outcome
Item Reduction and Dimensionality Analyses
Response rates	Assess response rate of participants to each statement	Percentage of participants answering no or not applicable to each statement Statements with >10% non-response rate considered for deletion
Item difficulty index	Determine whether the statement is too easy or too hard for the participants to rightly associate them to their water insecurity experience	Defined as the proportion of answers coded ≥1 for each statement Statements with percentages ≤ 30 or ≥80 considered for deletion	Led to reduction of HWINS into 21 items
Item discrimination index	Determine the ability of the statements to separate participants based on their water insecurity status	Corrected point-biserial correlation coefficient Statements with scores either ≥0.86 or ≤0.14 considered for deletion
Exploratory factor analysis	Explore the latent components of statements	Direct quartimin and varimax rotation tested Statement with low factor loadings and cross loadings were considered for deletion	Led to reduction of WATINE to 17 item
Reliability and Validity Testing of WATINE 17
Cronbach Alpha	Assess reliability of the scale	Calculated for the initial version of the scale as well as the reduced version of the scale alpha >0.80 acceptable; >0.90 excellent reliability	Excellent reliability α(WATINE-25) = 0.932 α(WATINE-17) = 0.923
Predictive validity	Test the ability of the scale to predict future water insecurity-related outcomes	Food insecurity score: Pearson correlation Food insecurity categories: One way ANOVA Diarrhea incidence among children 5 or younger age: one way ANOVA	The scale predicted food insecurity with a dose-response relationship The scale predicted the incidence of diarrhea in the past 4 weeks
Concurrent validity	Test how well the scale compares to well established standard	Reference daily water intake of 2.7 liters for women: Pearson Correlation	No correlation for daily intake Correlation for the frequency of intake
Construct validity	Test the correlation of the scale score to other constructs known to assess water insecurity	Time spent to fetch water: Pearson correlation Amount of water available in storage containers: Pearson correlation	Positive correlation

Testing of HWINS was carried out with 250 women who were main person involved in managing water fetching for the household.

Table 2. Progressive versions of the household water insecurity scale (WATINE) tested in rural areas in West Cameroon- Central Africa

WATINE-25^†	WATINE-21	WATINE-17
Psychosocial distress due to inconsistent or limited water access
S1. .were you dissatisfied with the water situation of your house?	S1. X	–
S2. .did you worry that there would not be enough water for your house?	S2. R	S2. R
S3. .were you upset because the water source dried up, or was not working, or water service was interrupted?	S3. R	S3. R
S4. .did you get into an argument or fight over getting water for your home?	S4. R	S4. R
S5. .did you have to pay or give food or flatter somebody to get some water for the house?	S5. R	X
S6. .did you borrow water from others because there was not enough water in the house and going to a water source was not an option?	S6. R	X
Quantity of water
S7. .were you not able to properly finish your daily work/chores due to not having enough water ?	S7. R	X
S8. .were you not able to cook because there was not enough water in the house?	S8. R	S8. R
S9. .did you have to cook something different than you wanted to because there was not enough water in the house?	S9. R	S9. R
S10. .were you not able to wash dirty utensils because there was not enough water in the house?	S10. R	S10. R
S11. .were you not able to wash your dirty clothes on an habitual laundry day because there was not enough water in the house?	S11. R	S11. R
S12. .were you not able to clean yourself or take a bath because there was not enough water in the house?	S12. R	S12. R
S13. .were you not able to wash your hands when you wanted to because there was not enough water in the house?	S13. R	S13. R
S14. .were you not able to clean latrines/toilets because there was not enough water in the house?	S14. R	S14. R
S15. .did your children go to school late because water fetching took too long?	S15. X	–
S16. .did you miss farm work or your job work because of water issues?	S16. R	S16. R
S17. .did it occur that there was no water in the house and there was no way of getting water immediately?	S17. R	S17. R
S18. .did you stop raising pigs or other livestock, such as goats or chicken because there wasn’t enough water to take care of them	S18. X	–
S19. .did you stop cultivating/watering a home garden because there wasn’t enough water?	S19. X	–
S20. .did you wake up earlier than usual time to fetch water for the house?	S20. R	S20. R
WATINE-25^†	WATINE-21	WATINE-17
Quantity of water – Specifically in reference to drinking or daily intake of water
S21. .did you drink less than you feel you should because there was not enough water in the house?	S21. R	S21. R
S22. .did you sleep thirsty because there was not enough water in the house?	S22. R	S22. X
Water quality
S23. .did you use the same water for multiple usages, such as same water to wash clothes, wash utensils, or wash hands and then wash something else?	S23. R	S23. R
S24. .did you drink muddy, unclear, or bad smelling water because there was not enough water in the house?	S24. R	S24. R
S25. .were you not able to drink water because it did not taste good?	S25. R	S25. R

^†All the statements started with ‘in the past 4 weeks …’ R: Retained. X: removed at that version; – removed at the previous version.

Table 3. Socio-demographic characteristics, food security status, water fetching and water use among women in rural areas in West Cameroon-Central Africa (n = 250)

Socio-demographic and water-related characteristics	Mean ± SD^#
Women’s age (in years)	44 ± 16
Total household size	5 ± 2
No. of children living in the household (<18 years)	3 ± 2
Time it took to fetch water per trip (in minutes) ^†	37 ± 39
Amount of water available in the household (in liters) ^‡	25 ± 33
Amount of water used by the household in the last 24 hours (in liters)	65 ± 42
	n (%)^Δ
Education
No formal schooling	32 (13)
Elementary school	93 (37)
Middle school	74 (30)
High school and higher	52 (20)
Occupation^§
Working on the farm	112 (45)
Housewife	40 (16)
Small scale business owner	47 (19)
Salaried	21 (9)
Others	27 (11)
Food Security Status^¶	43 (17)
Food secure	14 (6)
Mild food insecurity	36 (14)
Moderate food insecurity	157 (63)
Severe food insecurity
Owned a farm	32 (13)
Owned a livestock	163 (66)
Electricity in the household	235 (94)
Owned TV	139 (56)
Used wood or charcoal as a fuel	200 (80)
Mud flooring the household	148 (59)

^†Time represented to and fro and queuing time at the water source per trip.

^‡n = 169 participants were able to recall the amount of water available in the household at the time of interview;

^§Other in the occupation referred to those who were not have consistency in job or were students;

^¶It was measured using FAO- Household Food Insecurity Access Scale;

^#SD = Standard deviation rounded to the nearest full digit;

^ΔPercentages are rounded to the nearest full digit.

Table 4. Assessment of association between the household water insecurity experience scale (WATINE) and related indicators for validity testing in rural areas in West Cameroon-Central Africa (n = 250)^†.

Indicators	Values	Sig
Predictive validity
Food Insecurity score^‡	r = 0.492	p < 0.001
Food in/security status^§	HWINS-17 score
Food Secure	7.3 ± 9.6	p < 0.001
Mildly food insecure	8.3 ± 8.2
Moderately food insecure	16.2 ± 14.8
Severely food insecure	25.9 ± 16.3
Incidence of diarrhea among children 5 years or younger^§¶
No	13.26 ± 12.04	p = 0.091
Yes	18.05 ± 9.24
Concurrent validity^‡
Amount of water drank in the past 24 hours	r = 0.045	p = 0.494
Number of times drank water in the past 24 hours	r = 0.174	p = 0.007
Convergent Validity^‡
Time spent to fetch water per trip^#	r = 0.296	p < 0.001
Amount of water stored in the household^Δ	r = −0.175	p = 0.023
Amount of water used in the household in the past 24 hours	r = −0.157	p = 0.016

^†The participants were women who were the main person involved in managing water for the household.

^‡Pearson correlation coefficient;

^§One way ANOVA;

^¶n = 110 households with an index child;

^#Includes to and fro and queuing time.

^Δn = 169 participants were able to recall the amount of water available in the household at the time of interview.