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.”

This study assessed the quality of the Aboabo River and examined the anthropogenic factors that lead to river pollution. Physico-chemical and bacteriological assessment of water samples showed that water from the Aboabo river was polluted and therefore not suitable for domestic consumption. Observation, in-depth interviews, informal conversation and a cross-sectional survey of 396 households in the river basin were employed to elicit qualitative and quantitative data. Direct anthropogenic factors identified were indiscriminate dumping of refuse, channelling of raw sewage, open defecation and indiscriminate dumping of industrial waste into the Aboabo River. Remote factors identified were population growth and institutional challenges. Recommendations made include enforcement of by-laws, provision of adequate sanitation facilities and the encouragement of opinion leaders to play an active role in promoting the inculcation of environmentally friendly practices amongst residents.

This study was conducted in January 2013 to identify risk factors associated with diarrhea morbidity among children younger than 5 years in the Atwima Nwabiagya District, Ghana. A total of 378 households were drawn from four Atwima Nwabiagya District communities in the dry season using a systematic random sampling strategy. Quantitative data was collected from eligible households using interviewer-administered questionnaires and spot-checks. The relationships of socio-demographic, environmental, and behavioral factors with childhood diarrhea were assessed via logistic regression. The mother's age [adjusted odds ratio (aOR) = 3.52, 95% confidence interval (CI) = 1.11-11.16] and educational level (aOR = 4.77, 95% CI = 1.85-12.28) and frequent playing on the bare ground with soil by the index child (aOR = 3.14, 95% CI = 1.40-7.05) were significant risk factors of childhood diarrhea. Water storage outside of the dwelling was significantly associated with a lower risk of diarrhea (aOR = 0.42, 95% CI = 0.19-0.89). In the study communities, we recommend providing more education to mothers regarding environmentally-related disease transmission mechanisms, encouraging safe disposal of children's stools, discouraging children from playing with soil on bare floors, and promoting safe drinking water storage.

Purpose This study aims to determine the impact of resource use behaviours of students of a public university in Ghana on ecological sustainability. It examines the land area required to provide the resources used and also to assimilate the wastes produced. It also suggests an effective way to initiate participative discussions on environmental sustainability and consequences of resource use in a university setting. Design/methodology/approach This study adopts a mixed methods approach to gather and analyse data on students’ lifestyles concerning ecological footprint. The data was analysed using the Predictive Analytics Software and a modified version of the ecological footprint analysis (EFA). Findings The current ecological footprint of students in the university is not environmentally sustainable. The sample population had high average ecological footprint of 3.62 hectares, representing an ecological impact score of 135.85. The findings provide lessons on how universities and analogous institutions interested in sustainable practices could foster ecologically sustainable development. Research limitations/implications Additional data collection methods such as a longitudinal study would provide a more comprehensive assessment of the impact of resource use behaviour of students in a public university in Ghana on ecological sustainability. Social implications EFA and findings can support universities to effectively integrate sustainability practices into their policies and practices to help students contribute to making society more sustainable. Originality/value This is an original research and makes a contribution to EFA and sustainable practices of public universities in Ghana.

Background Globally, acute respiratory infection (ARI) is a leading cause of infant and childhood morbidity and mortality. Currently, it is estimated that 50 million cases of childhood ARI are untreated. In this study, we identified determinants of the type of treatment sought for symptoms of childhood acute respiratory infection (ARI), including non-treatment, amongst a nationally representative sample of children under five years in Ghana. Methods In total, 1 544 children were studied by a secondary analysis of pooled survey data from the 1993, 1998, 2003, 2008, and 2014 Ghana Demographic and Health Surveys (GDHS). Cross-tabulations, chi-square, multinomial logistic regression, and Bayesian hierarchical spatial logistic regression analyses were used to identify relationships between the type of treatment sought and maternal socio-economic and household characteristics. Results Seeking medical care was significantly associated with child age (RRR= 1.928, 95 % CI 1.276 – 2.915), maternal employment status (RRR = 1.815, 95 % CI 1.202 – 2.740), maternal health insurance status, (RRR = 2.618, 95 % CI 1.801 – 3.989), children belonging to middle (RRR = 2.186, 95 % CI 1.473 – 3.243), richer (RRR = 1.908, 95 % CI 1.145 – 3.180) and richest households (RRR = 2.456, 95 % CI 1.363 – 4.424) and the 1998 survey period (RRR = 0.426, 95 % CI 0.240 – 7.58). Seeking self-care or visiting a traditional healer was significantly associated with maternal educational status (RRR = 0.000, 95 % CI 0.000 – 0.000), and the 1998 (RRR= 0.330, 95 % CI 0.142 – 0.765), 2003 (RRR= 0.195, 95 % CI 0.071 – 0.535), 2008 (RRR= 0.216, 95 % CI 0.068 – 0.685) and 2014 (RRR= 0.230, 95 % CI 0.081 – 0.657) GDHS periods. The probability that the odds ratio of using medical care exceeded 1 was higher for mothers/caregivers in the Western, Ashanti, Upper West, and Volta regions. Conclusions Government policies that are aimed at encouraging medical care-seeking for children with ARI may yield positive results by focusing on improving maternal incomes, maternal NHIS enrolment, and maternal household characteristics. Improving maternal education could be a positive step towards addressing challenges with self-care or traditional healing amongst children with ARI.