Domestic water carrying and its implications for health: a review and mixed methods pilot study in Limpopo Province, South Africa

Abstract

BackgroundLack of access to safe water remains a significant risk factor for poor health in developing countries. There has been little research into the health effects of frequently carrying containers of water. The aims of this study were to better understand how domestic water carrying is performed, identify potential health risk factors and gain insight into the possible health effects of the task.MethodsMixed methods of data collection from six were used to explore water carrying performed by people in six rural villages of Limpopo Province, South Africa. Data was collected through semi-structured interviews and through observation and measurement. Linear regression modelling were used to identify significant correlations between potential risk factors and rating of perceived exertion (RPE) or self reported pain. Independent t-tests were used to compare the mean values of potential risk factors and RPE between sub-groups reporting pain and those not reporting pain.ResultsWater carrying was mainly performed by women or children carrying containers on their head (mean container weight 19.5 kg) over a mean distance of 337 m. The prevalence of spinal (neck or back) pain was 69% and back pain was 38%. Of participants who carried water by head loading, the distance walked by those who reported spinal pain was significantly less than those who did not (173 m 95%CI 2-343; p = 0.048). For head loaders reporting head or neck pain compared to those who did not, the differences in weight of water carried (4.6 kg 95%CI -9.7-0.5; p = 0.069) and RPE (2.5 95%CI -5.1-0.1; p = 0.051) were borderline statistically significant. For head loaders, RPE was significantly correlated with container weight (r = 0.52; p = 0.011) and incline (r = 0.459; p = 0.018)ConclusionsTypical water carrying methods impose physical loading with potential to produce musculoskeletal disorders and related disability. This exploratory study is limited by a small sample size and future research should aim to better understand the type and strength of association between water carrying and health, particularly musculoskeletal disorders. However, these preliminary findings suggest that efforts should be directed toward eliminating the need for water carrying, or where it must continue, identifying and reducing risk factors for musculoskeletal disorders and physical injury.

Health impacts of pedestrian head-loading: A review of the evidence with particular reference to women and children in sub-Saharan Africa

“…For this reason, it has been argued (e.g. Geere et al, 2010b) that it is important to investigate relationships between load-carrying history (intensity, frequency and duration) and symptoms such as neck or back pain and functional disability, rather than relying on findings from radiographic examination alone.…”

“…It also reported neck pain as a major source of discomfort from water carrying among head-loaders (and their mothers and grand-mothers). Two other recent papers, also based on small samples, focus on health implications of domestic water carrying in Limpopo Province, South Africa (Geere et al, 2010a(Geere et al, , 2010b. In the first paper, based on qualitative research with 30 children, the authors suggest that since children have lower tolerance limits for physical stress (citing Nuckley et al, 2007), they may be particularly affected by water carrying, with potential impacts on pain, joint mobility, energy/drive, physical endurance, and emotional function.…”

UN World Water Development Report 2016: "Water and Jobs"

“…In 1995, these figures were 52% and 80% respectively (ILO, Carrying water appears to have direct detrimental impacts on the mental and physical health of the carrier, and his or her ability to participate in domestic, formal and informal work. Both children and adults link persisting pain or movement problems with water fetching (Geere et al, 2010a(Geere et al, , 2010bLloyd et al, 2010) and the task may be an important factor in pain and disability linked to spinal musculoskeletal disorders and cervical compression syndromes (Evans et al, 2013).…”

Development of Neural Network Model to Classify Women Carrying Water Jobs in Terms of Physiological Risk

“…Physical loading of the body within an individual's capacity for adaptive responses may lead to tissue strengthening, however, frequent loading beyond capacity for adaptation or repair may lead to injury through fatigue failure, accumulation of fatigue damage [1] or early degenerative changes in bone and soft tissues [11,9]. However, water carrying is a physical activity and carrying heavy loads for prolonged periods covering long distance put the postural muscles under continuous contraction leading to muscular fatigue and resulted into sever musculoskeletal injuries such as spinal pain or other joint problems [9,23].…”

“…However, water carrying is a physical activity and carrying heavy loads for prolonged periods covering long distance put the postural muscles under continuous contraction leading to muscular fatigue and resulted into sever musculoskeletal injuries such as spinal pain or other joint problems [9,23]. A woman feels more evident pain while carrying load back home, such as in neck, upper arm, shoulder joints, upper leg, lower back and calf.…”