Items:

In the last four weeks …

1. How frequently did you or anyone in your household worry you would not have enough water for all of your household needs?
2. How frequently has your household water supply from your main water source been interrupted?
3. How frequently has there not been enough water in the household to wash clothes?
4. How frequently have you or anyone in your household had to change schedules or plans due to problems with your water situation, such as problems getting or distributing water within the household? Activities that may have been interrupted include caring for others, doing household chores, etc.
5. How frequently have you or anyone in your household had to change what was being eaten because there wasn’t enough water (e.g., for washing foods, cooking, etc.)?
6. How frequently have you or anyone in your household had to go without washing hands after dirty activities (e.g., defecating or changing diapers, cleaning animal dung) because of problems with water?
7. How frequently have you or anyone in your household had to go without washing their body because there wasn’t enough water?
8. How frequently has there not been as much water to drink as you would like for you or anyone in your household?
9. How frequently did you or anyone in your household feel angry about your water situation?
10. How frequently have you or anyone in your household gone to sleep thirsty?
11. How frequently has there been no water whatsoever in your household?

Response Options:
Never (0 times) - 0
Rarely (1–2 times) - 1
Sometimes (3–10 times) - 2
Often or always (11–20 times or more than 20 times) - 3