Associations of drinking water access, household water and food security, and mental well-being of prenatal women in low-income, urban neighborhoods of Beira, Mozambique Restricted; Files Only

O'Brien, Lilly (Spring 2023)

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Background: Few studies exist that study the influence of drinking water access on mental well-being, but those that do find that unimproved conditions are associated with poorer mental well-being. Quantifying the relationships between drinking water access, water and food security, and mental well-being can inform programs and policies that facilitate health equity. This may be particularly important among prenatal women, as prenatal stress and poor mental well-being has been shown to be associated with negative impacts on fetal and child development. This study aims to address this gap by analyzing the relationships between drinking water access and water and food security with mental well-being amongst prenatal women in low-income, urban neighborhoods of Beira, Mozambique.

Methods: Data for this cross-sectional analysis were collected among pregnant women in their third trimester in Beira, Mozambique from February 2021 through September 2022. Validated, cross-cultural scale measures of mental well-being and household water and food insecurity were administered to gain insight into participants’ experienced states of each factor. Drinking water access was categorized as either on-premise (inside the household’s compound) or not. We used generalized estimating equations, binary logistic regression, and causal mediation analysis to examine the associations and mediation of factors along the pathway of drinking water access to mental well-being.

Results: Data from 741 pregnant women were included in our analysis. We did not find drinking water access to be associated with mental well-being (OR 1.01; 95%CI 0.73, 1.39), water security (OR 0.86; 95%CI 0.60, 1.25), or food security (OR 1.01; 95%CI 0.70, 1.46). We found evidence that water security (OR 1.42; 95%CI 0.99, 2.04) and food security (OR 2.23; 95%CI 1.50, 3.31) were individually associated with mental well-being. When food insecurity was included in the model with water security and mental well-being, food security had a mediating effect (ACME 0.05; 95%CI 0.02, 0.07; ADE 0.56; 95%CI 0.04, 0.13).

Conclusion: Our findings support growing literature that water and food insecurity impact the population’s mental well-being and, therefore, overall health. Further research is needed to confirm causality along these pathways and determine the specific mechanisms through which these interactions take place.

Table of Contents

Table of Contents



Study Population 4

Data Source 4

Variables 6

Statistical Analyses 8






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