Carrying water may be a major contributor to disability from musculoskeletal disorders in low income countries: a cross-sectional survey in South Africa, Ghana and Vietnam

Abstract

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.”

Household water insecurity is strongly associated with food insecurity: Evidence from 27 sites in low‐ and middle‐income countries

“…In much of the world, women are the primary household water managers (Cole & Ferguson, ; Sultana & Loftus, ), just as they are often the primary preparers of food (Wutich & Brewis, ). A recent meta‐analysis of 42 studies found that there is moderate quantitative evidence and strong qualitative evidence to demonstrate that carrying water heightens fatigue and other physical ailments (Geere et al, ; Geere, Cortobius, Geere, Hammer, & Hunter, ). Many households that access off‐plot water require women and girls to negotiate water source access, walk to public sources, transfer water into containers, and carry it to their homes for use and storage.…”

Measuring Human Water Needs

“…Ingestion of contaminated water produces a range of viral (eg, hepatitis A), bacterial (eg, cholera), and protozoal (eg, amoebiasis) diseases; 2.4 million deaths annually are believed to be preventable with improved water provision, sanitation, and hygiene (Bartram & Cairncross, ). The act of carrying water can result in pain and disability related to excess loads, falls, assaults, and other traumas (Geere et al, ; Sorensen, Morssink, & Campos, ). Water insecurity also has indirect effects on growth and development.…”

Socio‐environmental confounders of safe water interventions

“…The physical effects of water fetching have traditionally focused on the musculoskeletal impacts of carrying containers on the head (Geere, Bartram, et al, 2018; Porter et al, 2013). But water fetching has been found to be associated with a wide range of physical injuries, such as neck and leg pain, and mental health effects (Geere, Cortobius, Geere, Hammer, & Hunter, 2018), as well as maternal and child health risks (Geere & Hunter, 2020).…”