Household water insecurity, missed schooling, and the mediating role of caregiver depression in rural Uganda
Open accessAbstract
Background: School attendance rates in sub-Saharan Africa are among the lowest worldwide, placing children at heightened risk for poor educational and economic outcomes. One understudied risk factor for missed schooling is household water insecurity, which is linked to depression among women and may increase children's water-fetching burden at the expense of educational activities, particularly among children of depressed caregivers. In this study conducted in rural Uganda, we assessed the association between household water insecurity and child school participation and the mediating pathways behind these associations. Method: We conducted a population-based, cross-sectional study of female household heads (N = 257) and their children ages 5–17 (N = 551) in the rural regions surrounding the town of Mbarara, in southwestern Uganda. We used multivariable linear regressions to estimate the association between water insecurity and missed schooling. We then assessed the extent to which the association was mediated by caregiver depression. Results: Among children, water insecurity had a statistically significant association with the number of missed school days (a standard deviation increase in water insecurity resulted in 0.30 more missed school days in the last week). The estimated association was partially mediated by caregiver depression. When stratified by sex, this mediating pathway remained significant for boys, but not among girls. Conclusions: Water insecurity is a risk factor for missed schooling among children in rural Uganda. Caregiver depression partially mediated this relationship. Also addressing caregiver mental health in water insecure families may more fully address the needs of sub-Saharan African families and promote educational participation among youth.
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In Uganda, outside of refugee contexts, water insecurity has been associated with increased risk of emotional distress, sexual violence, and missed educational opportunities.
“In Uganda, outside of refugee contexts, water insecurity has been associated with increased risk of emotional distress (Mushavi et al. 2020), sexual violence (Pommells et al. 2018), and missed educational opportunities (Cooper-Vince et al. 2017).”
From Water insecurity and sexual and gender-based violence among refugee youth: qualitative insights from a humanitarian setting in Uganda (2022) · cites this paper as Cooper-Vince et al. 2017
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“This discrepancy could potentially be explained by the increased levels of instrumental support in water fetching that girls tend to provide their mothers, relative to boys (Sorenson et al. 2011; Graham et al. 2016).”
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- Authors
- Cooper-Vince, C. E., Kakuhikire, B., Vorechovska, D., McDonough, A. Q., Perkins, J., Venkataramani, A. S., Mushavi, R. C., Baguma, C., Ashaba, S., Bangsberg, D. R., & Tsai, A. C.
- Affiliations
- Mbarara University of Science and Technology (UG)
- Johns Hopkins University (US)
- Massachusetts General Hospital (US)
- Harvard University (US)
- Portland State University (US)
- ORCID
- Venue
- Global Mental Health
- Publisher
- Cambridge University Press (CUP)
- Published
- 2017
- Volume
- 4
- Pages
- e15-e15
- ISSN
- 2054-4251 (ISSN-L)
- PMC
- PMC5719478
- OpenAlex
- W2747975611
- Cited by
- 36
- References
- 10
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 5 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 2 · 2017: 1
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Cambridge Prisms Global Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- PDXScholar (Portland State University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (K23MH096620, T32MH093310)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Social Sciences › Safety Research › Poverty, Education, and Child Welfare
- Physical Sciences › Environmental Science › Water Science and Technology › Water Resource Management and Quality
- Keywords
- household water insecurity, caregiver depression, mediation, rural Uganda, gender differences, maternal mental health, children's education
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