Water insecurity, food insecurity, and dietary diversity among Awajún adults living in the Peruvian Amazon

Resource insecurity is a major concern for Indigenous populations worldwide who are often reliant upon local ecosystems for food, water, and livelihoods. This study examined the association between water insecurity, food insecurity, and dietary diversity among the Awajún, an Indigenous population in the Peruvian Amazon. Cross-sectional data from 212 Awajún adults were analyzed using linear and logistic regression models with robust standard errors. Both food and water insecurity were prevalent among the Awajún. In adjusted linear regression models, higher composite water insecurity scores were significantly associated with higher food insecurity scores (β = 0.24; 95% CI: 0.11, 0.36; p < 0.001), but not with dietary diversity. Importantly, indicators within the composite water insecurity score, were more strongly associated with food insecurity and dietary diversity outcomes, than the composite water insecurity score itself. This includes significant associations between food insecurity scores and being “unable to collect water due to distance” (β 0.61; 95% CI 0.19, 1.03 p = 0.005), being “unable to collect water due to illness or weakness” (β = 0.68; 95% CI: 0.20, 1.16; p = 0.006), and “not boiling water” (β = 0.60; 95% CI: 0.15, 1.05; p = 0.009). Going for “extended periods of time without drinking water” was associated with lower dietary diversity scores (β = -0.79; 95% CI: -1.43, -0.16; p = 0.01). The findings that constituent lived experiences of water insecurity—including barriers to water collection, water treatment practices, and extended periods of water deprivation—were more strongly associated with food insecurity and dietary diversity than composite water insecurity scores, suggests that attention to specific dimensions of water insecurity may improve efforts to identify, monitor, and address resource insecurity in vulnerable populations.These findings have implications for health surveillance efforts and interventions aiming to promote SDG 6 (Clean Water and Sanitation) and SDG 2 (Zero Hunger) among vulnerable populations.