Optimal Household Water Access Fosters the Attainment of Minimum Dietary Diversity among Children Aged 6-23 Months in Malawi.

Along with sanitation and hygiene, water is a well-known driver of child undernutrition. However, a more direct role of household (HH) water access in shaping dietary diversity remains unexplored. We assessed the association between HH water access and achievement of minimum dietary diversity (MDD) among young children. We utilized nationally-representative cross-sectional data from the 2015/16 Malawi Demographic and Health Survey, which included 4727 mother-child dyads, respectively, (26.8 ± 6.8 years, range 15-49 years) and (13.9 ± 4.9 months, range 6-23 months). HH water access was categorized as (1) basic or no access, (2) intermediate, or (3) optimal. MDD was defined as feeding a child, during the previous day, at least four of the food groups defined by the World Health Organization. Only 27.7% of the children achieved MDD standards; most of the children who achieved MDD were from HHs with optimal water access (58.4%, p < 0.001). However, only 5.9% of the mother-child dyads were from HHs with optimal water access. After adjusting for covariates, children from HHs with optimal water access had higher odds of achieving MDD than those from HHs with basic or no water access (aOR = 1.74, CI = 1.24-2.46). Our results highlight the need to incorporate water-based strategies into national nutritional policies to increase dietary diversity among Malawian infants and young children.