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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. 

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