Article Text
Abstract
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.
- maternal health
- public health
- injury
- cross-sectional survey
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Footnotes
Handling editor Sanni Yaya
Twitter @vvram15, @GeereJo, @profserayoung
Collaborators Household Water Insecurity Experiences Research Coordination Network (HWISE RCN): Ellis Adams (University of Notre Dame, Notre Dame, IN, USA); Jam Farooq Ahmed (University of Washington, Seattle, WA, USA); Mallika Alexander (Johns Hopkins University-Byramjee Jeejeebhoy Medical College Clinical Trials Unit, Pune, India); Mobolanle Balogun (College of Medicine of the University of Lagos, Lagos, Nigeria); Michael J. Boivin (Michigan State University, East Lansing, MI, USA); Alexandra Brewis (Arizona State University, Tempe, AZ, USA); Genny Carrillo (Texas A&M University, College Station, TX, USA); Kelly Chapman (University of Florida, Gainesville, FL, USA); Stroma Cole (University of the West of England, Bristol, UK); Shalean M. Collins (Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA); Jorge Escobar-Vargas (Pontificia Universidad Javeriana, Bogotá, Colombia); Hassan Eini-Zinab (Shahid Beheshti University of Medical Sciences, Tehran, Iran); Matthew C. Freeman (Emory University, Atlanta, GA, USA); Hala Ghattas (American University of Beirut, Beirut, Lebanon); Monet Ghorbani (Arizona State University, Tempe, AZ, USA); Ashley Hagaman (Yale University, New Haven, CT, USA); Zeina Jamaluddine (American University of Beirut, Beirut, Lebanon); Wendy E. Jepson (Texas A&M University, College Station, TX, USA); Divya Krishnakumar (Anode Governance Lab, Bengaluru, India); Kenneth Maes (Oregon State University, Corvallis, OR, USA); Jyoti Mathad (Weill Cornell Medicine, Center for Global Health, New York, NY, USA); Jonathan Maupin (Arizona State University, Tempe, AZ, USA); Hugo Melgar-Quiñonez (McGill University, Ste-Anne-de-Bellevue, Quebec, Canada); Joshua D. Miller (Northwestern University, Evanston, IL, USA); Milton Marin Morales (Universidad Autónoma del Beni José Ballivián, Bolivia); Javier Moran (Autonomous University of Coahuila, Coahuila, Mexico); Nasrin Omidvar (Shahid Beheshti University of Medical Sciences, Tehran, Iran); Patrick M. Owuor (Northwestern University, Evanston, IL, USA); Sabrina Rasheed (International Centre for Diarrhoeal Disease Research Bangladesh, Mohakhali, Dhaka 1212, Bangladesh); Asher Y. Rosinger (Pennsylvania State University, State College, PA, USA); Luisa Samayoa-Figueroa (McGill University, Ste-Anne-de-Bellevue, Quebec, Canada); Marianne V. Santoso (Northwestern University, Evanston, IL, USA); Roseanne C. Schuster (Arizona State University, Tempe, AZ, USA); Mahdieh Sheikhi (Shahid Beheshti University of Medical Sciences, Tehran, Iran); Sonali Srivastava (Anode Governance Lab, Bengaluru, India); Chad Staddon (University of the West of England, Bristol, UK); Andrea Sullivan (University of Miami, Coral Gables, FL, USA); Yihenew Tesfaye (Bahir Dar University, Bahir Dar, Ethiopia); Nathaly Triviño (Pontificia Universidad Javeriana, Bogotá, Colombia); Alex Trowell (University of Amsterdam, Amsterdam, The Netherlands); Desire Tshala-Katumbay (Oregon Health & Science University, Portland, OR, USA); Raymond Tutu (Delaware State University, Dover, DE, USA); Amber Wutich (Arizona State University, Tempe, AZ, USA).
Contributors JS, SLY and HWISE RCN collaborators collected data across the 24 sites. SLY, JS, and VV initiated the analysis. VV and BT conducted the qualitative analysis, with guidance from J-ALG. PRH, J-ALG and VV conducted the statistical analyses, with input from JS and SLY. VV wrote the first draft of the paper, with input from J-ALG, BT, JS and SLY. All authors contributed to discussions and interpretation of the data, to revisions of the manuscript, and approved the final draft of the manuscript.
Funding This project was funded by the Competitive Research Grants to Develop Innovative Methods and Metrics for Agriculture and Nutrition Actions (IMMANA). IMMANA is funded with UK Aid from the UK Government. The Household Water Insecurity Experiences Research Coordination Network (HWISE RCN) is supported by the National Science Foundation (NSF) BCS-1759972. The project was also supported by the Buffett Institute for Global Studies, the Center for Water Research, and the Resnick Family Social Impact Fund, Institute for Sustainability and Energy at Northwestern University; and the Office of the Vice Provost for Research of the University of Miami.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval Study activities were reviewed and approved by all relevant ethical review boards.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on request.