In pursuit of ‘safe’ water: the burden of personal injury from water fetching in 21 low-income and middle-income countries

Abstract

IntroductionWater fetching for household needs can cause injury, but documentation of the burden of harm globally has been limited. We described the frequency, characteristics and correlates of water-fetching injuries in 24 sites in 21 low-income and middle-income countries in Asia, Africa and Latin America and the Caribbean.MethodsIn a survey of 6291 randomly selected households, respondents reported whether and how they had experienced water-fetching injuries. Responses were coded for injury type, mechanism, bodily location and physical context. We then identified correlates of injury using a multilevel, mixed-effects logistic regression model.ResultsThirteen per cent of respondents reported at least one water-fetching injury. Of 879 injuries, fractures and dislocations were the most commonly specified type (29.2%), and falls were the most commonly specified mechanism (76.4%). Where specified, 61.1% of injuries occurred to the lower limbs, and dangerous terrain (69.4%) was the most frequently reported context. Significant correlates included being female (aOR=1.50, 95% CI 1.15 to 1.96); rural (aOR=4.80, 95% CI 2.83 to 8.15) or periurban residence (aOR=2.75, 95% CI 1.64 to 4.60); higher household water insecurity scores (aOR=1.09, 95% CI 1.07 to 1.10) and reliance on surface water (aOR=1.97, 95% CI 1.21 to 3.22) or off-premise water sources that required queueing (aOR=1.72, 95% CI 1.19 to 2.49).ConclusionThese data suggest that water-fetching injuries are an underappreciated and largely unmeasured public health challenge. We offer guidelines for comprehensive data collection on injuries to better capture the true burden of inadequate water access. Such data can guide the design of interventions to reduce injury risk and promote equitable water access solutions.

The Physical Burden of Water Carrying and Women’s Psychosocial Well-Being: Evidence from Rural Nepal

“…Interestingly, higher functioning in daily activities was found for women carrying downhill. These findings align with previous studies that showed that certain terrains can put an added risk to physical health [7]. Beyond previous results, our study showed that terrain also moderates the relationship between physical burden and psychosocial well-being.…”

“…In 2017, 25% of the global population collected water from sources that are located off premises [2]. Previous research on the health consequences of sub-optimal water access has described adverse impacts of low water quality [3,4], the transport of water [5][6][7] water insecurity [8,9], and poor menstrual hygiene management [10,11].…”

“…Past research investigating the consequences of water carrying largely focused on physical health effects and disability [26]. They neglected context-specific conditions of water carrying that can pose an added risk to health [7]. For example, when water containers are carried in challenging or uneven terrain, the risk of falling and injury is high [7,13].…”

“…They neglected context-specific conditions of water carrying that can pose an added risk to health [7]. For example, when water containers are carried in challenging or uneven terrain, the risk of falling and injury is high [7,13]. Hence, terrain could moderate the relationship between the physical burden of water carrying and psychosocial well-being.…”

Household water insecurity will complicate the ongoing COVID-19 response: Evidence from 29 sites in 23 low- and middle-income countries

“…Physical distancing guidelines would also seemingly discourage water fetching in groups, which eliminates a way of maintaining social capital and an important safety buffer for women and children, who frequently suffer harassment, assault, and accidents while fetching water throughout the world ( Collins et al, 2019 ; Venkataramanan et al, 2020 ). This reality can shape water-related decision making and cause women to take risks, such as using alternative inferior sources or navigating physically dangerous terrain to obtain water elsewhere ( Smiley and Stoler, 2020 ).…”