%0 Journal Article
%@ 2047-2986
%A Geere, J-A
%A Bartram, J
%A Bates, L
%A Danquah, L
%A Evans, B
%A Fisher, MB
%A Groce, N
%A Majuru, B
%A Mokoena, MM
%A Mukhola, MS
%A Nguyen-Viet, H
%A Duc, PP
%A Williams, AR
%A Schmidt, W-P
%A Hunter, PR
%D 2018
%F discovery:10044693
%J Journal of Global Health
%N 1
%T 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
%U https://discovery.ucl.ac.uk/id/eprint/10044693/
%V 8
%X Background: The 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. / Methods: A 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. / Results: People 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. / Conclusions: Participants 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.”
%Z This work is licensed under a Creative Commons Attribution   4.0 International License (http://creativecommons.org/licenses/by/4.0/).