skip to main content


Title: In pursuit of ‘safe’ water: the burden of personal injury from water fetching in 21 low-income and middle-income countries
Introduction Water 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. Methods In 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. Results Thirteen 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). Conclusion These 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.  more » « less
Award ID(s):
1759972
NSF-PAR ID:
10271580
Author(s) / Creator(s):
; ; ; ; ;
Date Published:
Journal Name:
BMJ Global Health
Volume:
5
Issue:
10
ISSN:
2059-7908
Page Range / eLocation ID:
e003328
Format(s):
Medium: X
Sponsoring Org:
National Science Foundation
More Like this
  1. null (Ed.)
    Objective To assess the links between structural and household determinants of household water insecurity and test three water insecurity measures against self-reported diarrhoea, dengue fever and perceived stress in the middle-income and low-income urban areas of Torreón, Mexico. Design Cross-sectional household survey conducted in two waves (rainy and dry seasons). Participants 500 households selected via multistage cluster sample in selected communities. Socioeconomic status determined the selection of participant neighbourhoods; five were identified in low socioeconomic status neighbourhoods and five in low-medium socioeconomic status neighbourhoods. We examine how the context of urban water provision is related to a new cross-culturally valid Household Water Insecurity Experiences (HWISE) Scale. Primary outcome measures The HWISE Scale, self-reported diarrhoea, dengue fever and the Perceived Stress Scale. Results Water system intermittency (adjusted OR (AOR) 3.96, 95% CI 2.40 to 6.54, p<0.001), unpredictability (AOR 2.24, 95% CI 1.34 to 3.74, p=0.002) and the dry season (AOR 3.47, 95% CI 2.18 to 5.52, p<0.001) were structural correlates of the HWISE Scale. This study also found that the HWISE Scale was associated with two health outcomes, self-reported diarrhoea (AOR 1.09, 95% CI 1.03 to 1.15, p=0.002) and perceived stress (β=0.28, SE=0.07, t =4.30, p<0.001), but not self-reported dengue fever (AOR 1.02, 95% CI 0.98 to 1.06). A 3-item hygiene subscore and a 3-item water worry subscore were also both positively associated with self-reported diarrhoea and perceived stress. Conclusion Short-form screeners of water insecurity may be useful for assessing certain health risks by lay survey workers in settings with limited healthcare resources, particularly in lieu of more expensive microbiological tests that require specialised training and facilities. 
    more » « less
  2. Abstract

    Household water insecurity is a complex socioecological challenge with a range of consequences for health and wellbeing. Understanding individual and household‐level coping strategies, i.e., responses or adaptations to manage water insecurity, can shape future research and development practice. We therefore (a) systematically describe the characteristics and contexts of 173 studies documenting coping strategies and (b) classify the types of strategies within four domains of water insecurity: access, use, quality, and reliability. Most studies were from Sub‐Saharan Africa or South Asia. In the domain of access, the most common coping strategies were building infrastructure, and storing, purchasing, and sharing water. For use, changing food consumption, agricultural practices, and hygiene were most frequently mentioned. For quality, water treatment was the most common strategy. To ensure water reliability, people most frequently reported changing routines or relocating their homes altogether. Our review provides a useful framework to understand coping strategies, but more research is needed to address three gaps in particular. First, we recommend more representative exploration of the range of coping strategies, particularly in middle‐ and high‐income countries. Second, the links between coping with water insecurity and a range of other nutritional, social, financial, and health outcomes need to be better understood to address overall household wellbeing. Third, we recommend the development of a metric to quantify individual and household‐level water insecurity‐related coping strategies. This line of inquiry can enable practitioners to design and implement context‐specific interventions that leverage preexisting strategies to improve experiences of water insecurity.

    This article is categorized under:

    Human Water > Water Governance

    Engineering Water > Planning Water

     
    more » « less
  3. Abstract Objectives

    Food and water insecurity have both been demonstrated as acute and chronic stressors and undermine human health and development. A basic untested proposition is that they chronically coexist, and that household water insecurity is a fundamental driver of household food insecurity.

    Methods

    We provide a preliminary assessment of their association using cross‐sectional data from 27 sites with highly diverse forms of water insecurity in 21 low‐ and middle‐income countries across Africa, Asia, the Middle East, and the Americas (N = 6691 households). Household food insecurity and its subdomains (food quantity, food quality, and anxiety around food) were estimated using the Household Food Insecurity Access Scale; water insecurity and subdomains (quantity, quality, and opportunity costs) were estimated based on similar self‐reported data.

    Results

    In multilevel generalized linear mixed‐effect modeling (GLMM), composite water insecurity scores were associated with higher scores for all subdomains of food insecurity. Rural households were better buffered against water insecurity effects on food quantity and urban ones for food quality. Similarly, higher scores for all subdomains of water insecurity were associated with greater household food insecurity.

    Conclusions

    Considering the diversity of sites included in the modeling, the patterning supports a basic theory: household water insecurity chronically coexists with household food insecurity. Water insecurity is a more plausible driver of food insecurity than the converse. These findings directly challenge development practices in which household food security interventions are often enacted discretely from water security ones.

     
    more » « less
  4. Abstract Objectives

    Infant feeding plays a critical role in child health and development. Few studies to date have examined the link between household water insecurity and infant feeding, and none in a cross‐cultural context. Therefore, we examined the perceived impact of household water insecurity in four domains: breastfeeding, non‐breastmilk feeding, caregiver capabilities, and infant health. Our research was conducted as part of the Household Water Insecurity Experiences (HWISE) study.

    Methods

    We interviewed respondents from 19 sites in 16 low‐ and middle‐income countries (N = 3303) about the link between water insecurity and infant feeding. We then thematically analyzed their open‐ended textual responses. In each of the four domains (breastfeeding, non‐breastmilk feeding, caregiver capabilities, infant health), we inductively identified cross‐cultural metathemes. We analyzed the distribution of themes across sites quantitatively and qualitatively.

    Results

    Water was perceived to directly affect breastfeeding and non‐breastmilk feeding via numerous pathways, including timing and frequency of feeding, unclean foods, and reduced dietary diversity. Water was perceived to indirectly affect infant feeding through caregiver capabilities by increasing time demands, exacerbating disease, undernutrition, and mortality, and requiring greater efficacy of caregivers. Respondents made connections between water challenges and infant health, for example, increased risk of infectious diseases, undernutrition, and mortality.

    Conclusions

    These findings suggest that water presents many, and sometimes unexpected, challenges to infant feeding. By systematically investigating biocultural pathways by which water impacts infant and young child feeding, it will be possible to understand if, and how, water security can be leveraged to improve child nutrition and health.

     
    more » « less
  5. Context Temporal prediction of lower extremity (LE) injury risk will benefit clinicians by allowing them to better leverage limited resources and target athletes most at risk. Objective To characterize instantaneous risk of LE injury by demographic factors sex, sport, body mass index (BMI), and previous injury history. Instantaneous injury risk was defined as injury risk at any given point in time following baseline measurement. Design Descriptive epidemiology study. Setting NCAA Division I athletic program. Patients or Other Participants 278 NCAA Division I varsity student-athletes (119 males, 159 females). Main Outcome Measure(s) LE injuries were tracked for 237±235 days. Sex-stratified univariate Cox regression models investigated the association between time to first LE injury and BMI, sport, and previous LE injury history. Relative risk ratios and Kaplan-Meier curves were generated. Variables identified in the univariate analysis were included in a multivariate Cox regression model. Results Females displayed similar instantaneous LE injury risk compared to males (HR=1.29, 95%CI=[0.91,1.83], p=0.16). Overweight athletes (BMI>25 kg/m2) had similar instantaneous LE injury risk compared with athletes with BMI<25 kg/m2 (HR=1.23, 95%CI=[0.84,1.82], p=0.29). Athletes with previous LE injuries were not more likely to sustain subsequent LE injury than athletes with no previous injury (HR=1.09, 95%CI=[0.76,1.54], p=0.64). Basketball (HR=3.12, 95%CI=[1.51,6.44], p=0.002) and soccer (HR=2.78, 95%CI=[1.46,5.31], p=0.002) athletes had higher risk of LE injury than cross-country athletes. In the multivariate model, females were at greater LE injury risk than males (HR=1.55, 95%CI=[1.00,2.39], p=0.05), and males with BMI>25 kg/m2 were at greater risk than all other athletes (HR=0.44, 95%CI=[0.19,1.00], p=0.05). Conclusions In a collegiate athletic population, previous LE injury history was not a significant contributor to risk of future LE injury, while being female or being male with BMI>25 kg/m2 resulted in increased risk of LE injury. Clinicians can use these data to extrapolate LE injury risk occurrence to specific populations. 
    more » « less