BackgroundThe Sustainable Development Goals include commitments to end poverty, and promote education for all, gender equality, the availability of water and decent work for all. An important constraint is the fact that each day, many millions of women and children, and much less frequently men, carry their household’s water home from off-plot sources. The burden of fetching water exacerbates gender inequality by keeping women out of education and paid employment. Despite speculation about the potential health impacts of fetching water, there is very little empirical evidence. We report the first large study of the health impacts of carrying water on women and children.MethodsA cross-sectional survey was conducted in South Africa, Ghana and Vietnam during 2012. It investigated water carrying methods and health status. Because areas of self-reported pain were correlated we undertook factor analysis of sites of reported pain, to interpret patterns of pain reporting. Regression analysis using Generalised Estimating Equations (GEE) investigated water carrying as a risk factor for general health and self-reported pain.ResultsPeople who previously carried water had increased relative risk of reporting pain in the hands (risk ratio RR 3.62, 95% confidence interval CI 1.34 to 9.75) and upper back (RR 2.27, 95% CI 1.17 to 4.40), as did people who currently carry water (RR hand pain 3.11, 95% CI 1.34 to 7.23; RR upper back pain 2.16, 95% CI 1.25 to 3.73). The factor analysis results indicate that factor 1, ‘axial compression’, which is correlated with pain in the head and upper back, chest/ribs, hands, feet and abdomen/stomach, is associated with currently (0.30, 95% CI 0.17 to 0.43) or previously (0.21, 95% CI 0.01 to 0.42) carrying water. Factor 2, ‘soft tissue strain’, which is correlated with pain in the neck, shoulders/arms, lower back and hips/pelvis or legs, is marginally negatively associated with currently (-0.18, 95% CI -0.32 to -0.04) carrying water. The factor ‘axial compression’ was more strongly associated with carrying water containers on the head.ConclusionsParticipants who reported a history of current or past water carrying more frequently reported pain in locations most likely to be associated with sustained spinal axial compression in the cervical region. Given the fact that cervical spinal conditions are globally one of the more common causes of disability, our findings suggest that water carrying, especially by head loading is a major contributing factor in musculoskeletal disease burden in low income countries. Our findings support the proposed indicator for monitoring SDG6.1: “Percentage of population using safely managed drinking water services at home.”

The Lost Boys of Sudan were separated from their families by civil war and subsequently lived in 3 other countries-Ethiopia, Kenya, and the United States. In-depth interviews were conducted with 10 refugees who located surviving family members in Sudan after an average separation of 13.7 years. The interviews probed their experiences of ambiguous loss, relationships in the refugee camps, the search for family, and reestablishing relationships with family members living on another continent. With guidance from elders, peer groups functioned as surrogate families until the youth reestablished relationships with surviving members of their biological families.

This study explores the adaptation of unaccompanied Sudanese refugee minors resettled in the US. Seven years after resettlement, in-depth interviews were conducted with 19 Sudanese youths and 20 foster parents regarding factors that contributed to successful adaptation. The youths emphasized personal agency and staying focused on getting an education. Foster parents emphasized the contribution of youths' developmental histories to individual differences in personal attributes that, with contextual supports, influenced their trajectories after resettlement. Parents and youths differed in their views on the role that mental health and cultural obligations to family members in Africa played in successful adaptation.Children who immigrate to a new country with their families experience many challenges (Suarez-Orozco et al., 2006). Among these are adjusting to a new culture, often learning a new language, adapting to unfamiliar schools, forming new peer relationships and rethinking their identity and roles. Refugee children face additional challenges related to their war experiences and exposure to trauma (Lustig et al., 2004;Shaw, 2003), and unaccompanied minors, who resettle without their parents, are a small but particularly vulnerable group of refugee children. In the US, they are resettled in foster families and receive help until the age of 21 or sometimes 23. This study focuses on Sudanese unaccompanied minors, known in the media as the Lost Boys of Sudan, and addresses the research question: What factors contribute to individual differences in adaptation among these youths following resettlement? Of particular interest are factors related to successful adaptation.

The Lost Boys of Sudan were separated from their families by civil war and subsequently lived in three other countries-Ethiopia, Kenya, and the United States. In-depth interviews were conducted with 10 refugees about their experiences of separation from parents and ambiguous loss, and the coping strategies the youth used when they did not know if other members of their family were dead or alive. All of the youth reported using both emotion-focused and problem-focused coping strategies. The youth also discussed the importance of support from peers and elders while they lived in the refugee camps. In addition, they reflected on the psychological presence of parents who were physically absent, and the important role that hope of being reunited with parents played as they struggled with survival issues and ambiguous loss.