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.

ࡗ Factors Related to Successful Outcomes AmongPreschool Children Born to Low-Income Adolescent MothersThe purpose of this study was to describe how the experiences and circumstances of the most successful children born to low-income adolescent mothers differed from the experiences and circumstances of the least successful children over the first 54 months of their lives. Success was defined as scoring in the top quartile for this sample on the Peabody Picture Vocabulary Test-Revised (PPVT-R) when the children were 54 months old and about to make the transition to kindergarten. The experiences of the 22 children with the highest scores on the PPVT-R were contrasted with the experiences of the 22 children who had the lowest scores on the PPVT-R for this sample. The two groups differed markedly on measures of caregiving and home environment assessed when the children were 12, 24, 36, and 54 months old. In addition, mothers of the most successful children achieved more years of education, were more likely to be employed, had fewer children on average, tended to live in more desirable neighborhoods, and were more likely to be living with

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.

BackgroundSeasonal Malaria Chemoprevention (SMC) is currently recommended for children under five in areas where malaria transmission is highly seasonal. We explored children’s caregivers’ and community health workers’ (CHWs) responses to an extended 5-month SMC programme.MethodsThirteen in-depth interviews and eight focus group discussions explored optimal and suboptimal ‘uptake’ of SMC to examine facilitators and barriers to caregivers’ uptake.ResultsThere did not appear to be major differences between caregivers of children with optimal and sub-optimal SMC uptake in terms of their knowledge of malaria, their perceptions of the effect of SMC on a child’s health, nor their understanding of chemoprevention. Caregivers experienced difficulty in prioritising SMC for well children, perceiving medication being for treatment rather than prevention. Prior to the study, caregivers had become accustomed to rapid diagnostic testing (RDT) for malaria, and therefore blood testing for malaria during the baseline survey at the start of the SMC programme may have positively influenced uptake. Facilitators of uptake included caregivers’ trust in and respect for administrators of SMC (including CHWs), access to medication and supportive (family) networks. Barriers to uptake related to poor communication of timings of community gatherings, travel distances, absence during SMC home deliveries, and limited demand for SMC due to lack of previous experience. Future delivery of SMC by trained CHWs would be acceptable to caregivers.ConclusionA combination of caregivers’ physical access to SMC medication, the drug regimen, trust in the medical profession and perceived norms around malaria prevention all likely influenced caregivers’ level of uptake. SMC programmes need to consider: 1) developing supportive, accessible and flexible modes of drug administration including home delivery and village community kiosks; 2) improving demand for preventive medication including the harnessing of learnt trust; and 3) developing community-based networks for users to support optimal uptake of SMC.

Background: People experiencing homelessness have an increased risk of hepatitis C virus (HCV) infection, with rates higher than the general population. However, their access to HCV diagnosis is limited and treatment uptake is low.Objectives: To identify and describe the barriers and facilitators for HCV screening and treatment for adults with lived experience of homelessness in highly developed countries. Methods: Bibliographic databases (Embase, MEDLINE, CINAHL and SocINDEX) and grey literature (Google, EThOS, the Health Foundation, Social Care Online, the World Health Organisation, Shelter, Crisis and Pathway) were searched. Two reviewers independently screened and appraised all studies. The Critical Appraisal Skills Programme tool and the Joanna Briggs Institute checklist were used. The analysis involved a three-stage process: coding, theme generation and theme mapping under Penchansky and Thomas's modified access model. Results: Twelve papers/reports were included in the review. Several interacting factors influence access of people with lived experience of homelessness to HCV testing and treatment. Some mirror those identified for the general population. The precarious conditions associated with the lived experience of homelessness along with the rigidity of hospital settings and lack of awareness emerged as dominant barriers. Flexibility, outreach, effective communication, tailoring and integration of

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