Water collection practice and health

1. Graduate Seminar I on:
Challenges of collecting drinking water and
associated musculoskeletal disorders among
women of the least developed countries
By: Adane Ermias (PhD student, GSR/4552/12)
(Program: WaHe)
February, 2020
AAU, Ethiopia
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2. Outline
Introduction
International perspective
Safe drinking water and women
Water collection practice and potential health impacts
Neglected concerns
Acknowledgement
References
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3. African
women
Indian women
Ethiopian girls
Carriage, Collection practice
Fig 1: Water carriage and collection practice in different settings; taken from Google map
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4. Carriage, Collection practice
Fig 2: Water carriage and collection practice in different settings; taken from Google map
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5. The term skeleton is a structure provides a supportive
framework
internal framework of the human body
around 270 bones at birth–decreases to 206 bones by
adulthood after some bones get fused together
(fig 3: below)
Introduction
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6. Human skeleton
Fig 3: Human skeletal system division
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7. A skeletal muscle refers to multiple bundles (fascicles) of
cells joined together called muscle fibers
Musculoskeletal system-muscular and skeletal system
Muscle tissue is categorized into three distinct types
skeletal
cardiac and
smooth
Introduction…
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8. Introduction…
Each has a unique structure and a specific role
Skeletal muscle moves bones and other structures
Cardiac muscle contracts the heart to pump blood
 Smooth (involuntary) muscle: push fluids and solids along the digestive
tract and perform varied functions in other vital systems
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9. Introduction…
MSD- is a health problem affecting the muscles, tendons, ligaments,
cartilage, the vascular system, nerves or other soft tissues and joints of the
musculoskeletal system.
(EU-OSHWIKI, 2017, Roter D. L. and Hall J. A., 2004)
Lack of ease of function and movement is a characteristics of MSD
with presentation difference in male and female population
(Merriam-Webster., 2019, Richard B. et al., 2013, Roter D. L. and Hall J. A., 2004)
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10. Introduction…
Aggravating factor
is work itself and it can affect the upper limb extremities, the neck and
shoulders, the lower back area, and the lower limbs.
Ranges
from discomfort, minor aches and pains,
to more serious medical conditions which can lead to permanent
disability
(EU-OSHWIKI, 2017, Roter D. L. and Hall J. A., 2004)
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11. Introduction…
Water is one of the components of human right and is critical for human
survival and development
A person averagely needs 20-50L/d for activities like
drinking
cooking and
washing
For their daily use, each household member hauls between 44 and 110
pounds of water (Bethany C, 2017)
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12. Introduction…
Water carrying, especially by head loading is a major contributing
factor for musculoskeletal disease burden in low income countries
(Geere J. et al., 2018)
Time queuing at “improved” water sources is another burden posing
for prolonged fatigue, chest pain and headache
(Richard B. et al., 2013)
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13. Introduction…
Traditionally, fetching water has been a woman's job
extremely strenuous activity since water carriage is heavy duty
consumes an enormous amount of their time and energy
(Assefa M. and Chris M., 1992, Bimla. et al., 2003)
 burden of water collection falls disproportionately on women
(UN., 2015).
Children and women walk distances of <0.5 or >2 km on
rugged and hilly roads and paths
carrying water on their heads or by hand
(Richard B. et al., 2013).
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14. Introduction…
Water carriage has a number options to measure.
Literatures suggest measurement indicators like
time to walk and fetch the water from the sources
distance
caloric expenditure and opportunity costs to be used
suggested to be measured simultaneously to show an integrated effect
(Richard B. et al., 2013, Sorenson et al., 2011)
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15. Introduction…
Risk can be shown by
vessel`s weight
terrain condition and
load or drudgery of the work
the risk of road casualties, assaults and attacks, and
related health concerns (E.g. neck and back injuries)
(Sorenson et al., 2011).
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16. Objectives
To introduce water collection system and related MSD among women
To summarize international perspectives or attention paid on water collection
challenges and related health defects
To review interrelationship of safe drinking water collection and women`s role
To review water collection practice and potential health impacts among women
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17. Methods
Peer reviewed articles and published and unpublished reports, focusing on
developing and least developed countries, were searched
Sources: Google, Google Scholar and data bases of Medline, WHO
(http://extranet.who.int/hinari/en/journals.php and
https://www.who.int/nmh/databases/en/) and PubMed
(https://www.ncbi.nlm.nih.gov/pubmed/)
Refining MSD related with water collection and other activities
Theming findings into related messages
Abstracting
Referencing by EndNoteX5
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18. Author Objective Pop., design Prevalence
(Deyyas W.K.
and Tafese A.,
2014), 2012
Prevalence and associated
risk factors of work
related elbow and wrist
MSD among sewing
machine operators in
Galan City
422 sewing
machine operators
of garment
industries
Cross-sectional
Prevalence of
self-reported
work related
MSD of elbow
(40%) and wrist
(37.7%)
Table.1: Studies reviewed for MSD related with activities other than water collection in Ethiopia, 2020
Ethiopia..........Tables of summary for MSD 12FEb2020.docx
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19. (Yitayeh A. et
al., 2015);
2013
Annual prevalence
of self-reported
WMSD and
associated factors
728, Nurses in Gondar
town governmental
health institutions
Cross-sectional
Self-reported work
related MSD (57.1%)
(Girma Z.,
2016);
2016
Determine
prevalence of
WMSD and its
associated factors
422 garment workers,
AA.
Cross-sectional study
One year prevalence of
work related MSD was
65.4%
Table. 1: List of studies…
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20. (Bedru W.,
2016);
2016
Magnitude and
associated
factors of self-
reported WMSD
among hair
dressers
609 hair
dressers, AA.
Cross-sectional
Prevalence of WMSD was
76.6%
Most commonly affected body
parts were, the lower back
(71.5%), shoulder (51.6%) and
hand or wrist (46.6%)
Table. 1: List of studies…
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21. (Henok
A. and
Bekele
T.,
2017);
2016
Musculoskeletal
pain and factors
with kyphosis
among pedestrian
back-loading
women in Bench-
Maji
422 women
who sell fire
woods by
carrying it on
their back
Cross sectional
Prevalence of upper back pain,
lower back pain, shoulder pain,
elbow pain, wrist pain, knee pain
and feet pain were 67.3, 60.4,
68.2, 47.2, 36.7, 46.9 and 44.1%
respectively.
Prevalence of kyphosis* (59.7%)
Table. 1: List of studies…
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*spinal disorder, excessive outward curve “roundback" or in the case of a severe curve as "hunchback."
21

22. (Mekonnen
T.H., 2017),
2017
Prevalence and
factors affecting
back and lower
extremity disorders
among barbers in
Gondar town,
434
barbers
Cross-
sectional
Prevalence of work-related low back
pain in the previous 12 months
(55.7%) & in the last 7 days (32.6%)
Prevalence of knee/leg and ankle pain
was 39.4% and 25.6%, respectively
Table. 1: List of studies…
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23. (Delele
M. et al.,
2018),
2018
Musculoskeletal
pain and
associated factors
among elementary
school children in
Gondar
723 elementary
schools`
children
Cross-sectional
Prevalence of self-
reported musculoskeletal
pain (62%)
Shoulder, neck and lower
leg/knee were most
commonly reported
Table. 1: List of studies…
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24. International perspectives
Basic drinking water service provided with <30 minutes round trip
lacked by 785 million people around the globe
206 million spent more than recommended distance.
Remainder relied on unimproved (435 million) or surface water sources
(144 million),
most often also require >30 mins to walk to, collect water and return
home
(WHO and UNCIEF, 2019)
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25. International…
In 2015, the burden has got an attention by UN and
set a 15 years agenda for SDG with motto of `leave no one behind`,
transforming this world by 2030, (only left with less than 10 years)
17 goals based on sustainable integrated and indivisible to balance the
social, economic and environmental dimensions of SD
Focuses on one of the agenda
human rights, achieve gender equality and the empowerment of women
and girls, and ensure ‘no one will be left behind
(Geere et al., 2018, UN., 2015, WHO, 2017).
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26. International…
Water carriage is a potential threat for achieving many of SDGs
associated with health of the livelihoods (Geere et al., 2018)
Generally speaking, many of the SDGs have a likely link with the
aforementioned adverse health impacts of water carriage
(UN, 2015, WHO, 2017, WHO and UNCIEF, 2019)
“End poverty in all its forms” (SDG 1).
When women spend much day fetching water, not have the time to devote
to activities that could increase their income
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27. International…
‘SDG 3 ‘ensure healthy lives and promote well-being for all at all ages’
“Ensure inclusive and equitable quality education and promote lifelong
learning opportunities for all” (SDG 4).
When girls, spend time carrying water, prevents accessing education
“Promote sustained, inclusive and sustainable economic growth, (SDG 8)
is less likely in those societies where half the work force spends much of
its time fetching water (UN, 2015)
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28. Safe drinking water and women
Uneven burden of water works women bearing are not well understood
Women and girls suffer more than other members of their family with
regards to water collection and carriage.
This disproportional responsibility is higher among rural settings.
Has negative implication on the amount of water supplied
Mostly forced to insufficient supply of safe and
poses extra risks and challenges for women and girls
(Bethany C, 2017)
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29. 2/12/2020 29
In a selected villages of Limpopo
Province, some methods of carrying
water
head loading of water-filled containers
rolling a water-filled drum and
pushing a wheel barrow weighted with
filled water containers.
Among these, head loading, was the
commonest among women (82%)
(Geere J.A. et al., 2010).
Water collection practice

30. Water collection…
A linear distance to water source and the time taken for a trip to sources of
improved water is a determining factor for women
(Geere J.A. et al., 2010, Sorenson et al., 2011, Thompson J et al., 2002).
The time spent fetching the water also varies with gender differences.
In Mauritania, Somalia and Yemen, for instance, the average trip takes over an
hour, and two of every three water carriers are women
(Richard B. et al., 2013, Sorenson et al., 2011).
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31. Water collection…
In a study conducted in 44 countries, women are water fetchers
the time they invest each day is substantial, nearly 1hr/trip (Sorenson et al., 2011).
Average distance walked/time to reach an improved water source is also noted.
They walk 5.75 km at a speed of 2.8 km/h on her onward journey and
3.5 km/h on return journey and spends 138 min/d (Bimla. et al., 2003).
This contradicts the standard set by JMP (WHO/ UNICEF JMP, 2008).
That is why it is dealt here as single trip of walk and the time elapsed along the
route is important for wellbeing of the water collectors.
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32. Water collection…
The other factors contributing for the aggravating condition of women
and children being affected by MSD are depending on
#family of household size,
#distance to water source,
seasons of collection (dry or wet or rainy or not), and
$#household income.
Still women are the most common water carriers, and they spend
considerable time supplying water to their households.
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33. Water collection…
In the 44 countries, on average, women (58.6%) are the most common water
fetchers followed by men (30.4%) and children (9.1%).
There is a direct positive association between not having access to an
improved water source and the percent of water fetchers who were women
(r=0.35)
A higher association was noted between not having improved water on
premises and the percent of water fetchers who were women (Sorenson et
al., 2011)
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34. Potential health impacts of water carrying
direct and indirect
Water carrying is associated with potential health impacts
(Geere J.A. et al., 2010, WHO, 2007)
But this has not been adequately studied, may be confounded
Studies suggest the direct effect on the health and wellbeing of water
carrier because it is associated with
 pain
 fatigue and
 emotional distress that the work of water fetching
(Geere J.A. et al., 2010, Wuticha A. and Ragsdaleb K., 2008).
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35. Potential health…
Indirectly, the water carrying has also lead to poorer health.
For example: it might limit
uptake of health services (Geere et al., 2018), or
 a person's capacity to engage with occupations which would
otherwise enhance personal and family wellbeing, such as paid
employment,
vending or caring for young children (Wrisdale L. et al., 2017).
Water-borne diseases are common in developing countries
(WHO and UNCEF, 2008).
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36. Potential health…
centrality of women in ensuring the health of family is widely
acknowledged
little research addresses the specific, and negative, health aspects
Long-term back injuries
micronutrient deficiencies due to high caloric expenditure during food
scarcity periods, or
negative impacts on the health status of young children are
mentioned rarely and
often only as a secondary adverse effect
The water fetchers are almost secondary to the water itself
(Sorenson et al., 2011).
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37. Potential health…
Bimla. et al identified musculoskeletal problems among women of 21-40
analyze the magnitude of body pain and
categorized from sever to very sever
It was noted around shoulder joints
Upper back and lower arm, especially while drawing water.
Complain of pain was recorded in the neck, upper arm, shoulder joints,
upper leg, lower back while carrying load back home.
Severity of pain was more evident in aforementioned parts of the body
(Bimla. et al., 2003).
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38. Potential health…
most of the women and youths carry 20 l jerry cans (Geere J.A. et al., 2010)
Done for prolonged periods while covering a long distance.
identified as a risk factor
MSD of ligaments, joints, and spinal discs is a possibility due to the
aforesaid risk factor.
keeping postural muscles under continuous contraction leads to muscular
fatigue
the frequent event`s condition for longer causes severe muscular injury
(Bimla. et al., 2003).
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39. Potential health…
69% reported spinal pain.
as pain reported or indicated through gesture by participants to be in
the head, neck, thoracic or lumbosacral region
38% of the participants reported back pain and
41% reported neck or head pain
(Geere L J. et al., 2010).
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40. Potential health…
The reported ailments among women population include
chest pain (64.4%), nasal bleeding (0.8%),
headache (6.7%), fatigue (13.6%),
back pain (1.9%) and spinal problems (0.3%).
Whereas, reported ailments among female youth include
chest pain (42.6%), nasal bleeding (3.5%),
headache (19.1%) and fatigue (19.1%)
(Asaba B. R et al., 2013)
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41. Potential health risk factors
i) Individual factors
Only women and children (aged 16 or less) were observed carrying water,
other than one 18 year old unmarried man.
Qualitative data supports that water carrying is usually a woman’s task
performed by men only when there are no women or female children
available
“Male won`t collect water, female has to collect water, but its not
everybody who support the ideas. There are also possibility in other
household that you find the male people without girls so those males has to
go an collect water’(young girl, informal natural group meeting)
(Geere J.A. et al., 2010)
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42. ii) Weight of water carried (fig 1)
Most commonly used containers fully filled 20-25L plastic buckets or drums
By head loading method, women typically carry one container per trip.
However, if using a wheel barrow, people carried up to five containers,
the mean total weight ranging up to 111 kg
For all carrying methods, the mean filled container weight as a percentage of
body weight determined was 59%,
For head loading, the mean container weight as percentage of body weight value
was determined to be 41% ranging from 16 to 78%
(Geere J.A. et al., 2010)
Potential health risk…
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43. Figure 1: Scatter plot showing a strong
correlation between force due to wt of water
against age of children head loading containers,
(Geere J.A. et al., 2010)
Potential health risk…
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44. iii) Equipment and environmental factors
The containers and carrying equipment are generally not suited to the
environment
Container sides are smooth and often wet
making them difficult to grasp securely
inadequate or absent handles
Potential health risk…
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45. (Geerea
J.A. and
Huntera
P.R.,
2019)
Objective: analyzing
the association of
water fetching,
unimproved water
supplies, and usage
of improved
sanitation facilities
with indicators of
women's and
children's health
Design: Cross-sectional & 2009 and 2014
Population (n): Mothers and under-five years
children (2,740,855 people from 539,915 HHs)
Findings: Poorer maternal and child health
outcomes is associated with fetching water not
located in the home or yard is.
 Childhood death, diarrheal disease, with
 Reduced uptake of ANC
 Leaving a child under five alone for an hour or
more, one or more days per week.
Conclusions:
Fetching water
is associated
with poorer
maternal and
child health
outcomes,
depending on
who collects
water
Table.2: Summary of Reviewed Articles on challenges of safe water collection and associated MSD, 2019
2/12/2020
Tables of summary for MSD 12FEb2020.docx
45

46. (Geere
et al.,
2018)
Summarizing
evidence on
whether, and
how, water
carriage is
associated
with health
Design: A systematic review
Findings: Water carriage is
associated with pain,
fatigue, perinatal health
problems and violence
against vulnerable.
Association with stress or
self-reported mental health
and general health status.
Conclusions: Water carriage is a
potential barrier to SDG 6 target
and target 3
Recommendations: Efforts
should focus on providing water
on premises, and where this is
not possible, providing water
close to home and reducing risk
of gender-based violence.
contd…
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47. (Geer
e J. et
al.,
2018)
Evaluating
relationship
b/n water
carriage
from an off-
plot
water source
and physical
health status
Design: Cross-sectional, 2012
Population (n): 210 Women, 255 children and 208
HHs
Findings: People who previously carried water had
increased relative risk of reporting pain in the hands
and upper back as did people who currently carry
Conclusion: Current or past water carrying history
was reported to cause pain in spinal axial
compression in the cervical region.
Head loading is a major contributing factor in MSD
burden in low income countries
Recommendation
Support the
proposed
indicator for
monitoring
SDG6.1: % of pop.
using safely
managed drinking
water services at
home
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48. (Geere
J.A. et
al.,
2010)
Understanding
how domestic
water carrying
is performed,
identify
potential
health risk
factors
& gain insight
into the health
effects
Design:
Mixed,
quantitative
(Ergonomic
principles
with cross-
sectional
survey) &
qualitative
(phenomen
ology)
Population (n): Women and
children (43)
Findings: Prevalence of neck
or back pain (69%) and back
pain (38%).
Mainly women or children
carry on their head.
Mean wt. of container &
distance to water source
respectively 19.5kg and 337
m.
Conclusion: Water
carrying methods impose
physical loading with
potential to produce
MSD and related
disability
Recommendation:
eliminating the need for
water carrying.
Identifying and reducing
risk factors for MSD
contd…
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49. Neglected concerns
Recommended facts that should be considered on future research works
that will be conducted on water fetching
Road casualties which are known to be an important risk for MSD
In rural areas, there is poor provision of transportation infrastructure
Walking on poorly designed and chaotic roadways
A substantial proportion of the population collecting and carrying water
are pedestrians and vulnerable for injuries and death.
(Sorenson et al., 2011, WHO, 2009)
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50. Acknowledgement
Almighty God
AU EiWR
Dr Sirak R
Colligues
My wife
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51. References
ASABA B. R, FAGAN H.G., KABONESA C. & MUGUMYA F. 2013. Beyond Distance and Time:
Gender and the Burden of Water Collection in Rural Uganda. Journal of Gender and Water, 2.
ASSEFA M. & CHRIS M. 1992. Gender differences in time and energy costs of distance for regular
domestic chores in rural Zimbabwe: A case study in the Chiduku communal area. Elsevier Ltd., 20
Pages 1675-1683.
BEDRU W. 2016. Self-Reported Work Related Musculoskeletal Disorders and Determinant Factors
Of Female Beauty Salon Hair Dressers, In Addis Ababa, Ethhiopia MPH, Addis Ababa University.
BETHANY C 2017. Women still carry most of the world’s water.
BIMLA., GANDHI S., DILBAGHI M. & RAINA K. 2003. Rural women carry the load of fetching
water. . Indian Journal of Social Work, 64, 65-75.
DATA 360. n.d. Average water use per person per day. (data from 2002) [Online]. Available:
http://www.data360.org/dsg.aspx?Data_Set_Group_Id=757 [Accessed 27 December 2019].
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