Assessing the Impact of Water, Sanitation, and Hygiene (WASH) on Household Food Insecurity and Nutritional Outcomes of Women and Children in Nepal

Abstract

This study explores the relationship between Water, Sanitation, and Hygiene (WASH) conditions and three critical public health outcomes in Nepal: household food insecurity, child malnutrition, and women’s nutritional status. Using data from the 2022 Nepal Demographic and Health Survey (DHS), we analyze how WASH factors influence food security, child nutrition, and women’s Body Mass Index (BMI) across diverse populations. Among the 13,786 households surveyed, 6,007 were classified as food insecure. Households relying on spring water experienced the highest levels of food insecurity, while those with on-premises drinking water, private sanitation, and handwashing resources had lower food insecurity levels. Ordinary least squares regression confirmed that the presence of soap, water treatment, and improved sanitation significantly reduced food insecurity, whereas poverty and shared sanitation facilities increased the risk. Further analysis examined the impact of WASH on child malnutrition among children aged 0–59 months. Binary logistic regression results revealed that water on-premises was protective against stunting, while children from poor and middle-income households had higher odds of being stunted or underweight. Urban residence was associated with lower odds of stunting and underweight, but wasting was more prevalent in urban areas. Additionally, access to piped water reduced the likelihood of underweight and wasting, while a higher number of young children in a household increased the probability of stunting and being underweight. The study also assessed the association between WASH conditions and women’s BMI among 6,291 non-pregnant women aged 15–49. Multinomial logistic regression results indicated that women with access to water on premises and piped water had higher odds of being overweight or obese. Additionally, women from non-Hindu and non-Brahmin/Chhetri ethnic groups, those with access to flush toilets, and those residing in urban areas were more likely to be overweight or obese. These findings underscore the role of WASH infrastructure in shaping food security, child nutrition, and women’s health outcomes in Nepal. Strengthening WASH infrastructure and addressing socioeconomic disparities through integrated policy interventions may thus improve food insecurity, child malnutrition, and women nutrition.