Table 9

Water carriage and social vulnerability

First author and datePopulationStudy typeDatesKey findingQuality
Devoto 201230Morocco: 845 households in Tangiers, not connected to a city water network, comparing subgroup of households reporting above median baseline time fetching waterCohort study2007–2008Significant reduction in risk of being in conflict with people from his/her family on water matters with (a) allocation to water supply ‘encouragement’ project (−0.06, p=0.05), which remained significant and decreased further for households with above median baseline time fetching water (−0.09, p=0.10) or (b) actual connection to piped water supply (−0.12, p=0.05), which was similar but not significant for households with above average baseline water fetching time.Good*
Nepal: 120 households distributed among ten selected communities, with at least 2 years experience of rainwater harvestingMixed methods‡2008–2009Perceived benefits from rainwater harvesting reported as being particularly helpful to vulnerable groups, described as older people, disabled people and children.Fair†
Ethiopia: 296 home based care clients living with HIV/AIDS, drawn from two NGOs in Gondar cityMixed methods2009Bivariate analysis indicated that being forced to go far distance associated with unimproved water status (crude OR 3.91, 95% CI 1.13 to 13.47, p<0.05); needing help with walking associated with improved water status (crude OR 0.11, 95% CI 0.01 to 0.89, p<0.05), but not significant in multiple logistic regression; adjusted OR for forced to go far 3.84 (95% CI 0.41 to 35.27); for needing help walking 0.13 (95% CI 0.01 to 1.44).Poor*
Asaba 201331Uganda: survey of 602 (~35%) households in Makondo Parish, and in-depth interviews, focus group discussions and participant observation in four villagesMixed methods2011–2012Water points are sites of positive social interactions, however, fights resulting in verbal and physical attacks were also observed and reported to occur at ‘improved’ water points, particularly at those with queues.Poor*
Robson 201332Malawi: 1504 children aged 9–18 years from 12 field sites in each of 3 regionsMixed methods2006–2009Hazards of water fetching reported to be harassment, verbal abuse or attack from people, and ‘meeting criminals’.Poor*†
Various countries§QualitativeNRCase studies indicate that gender-based violence occurs during water fetching in many countries. Violence may be sexual, psychological, physical or sociocultural.Poor†
Uganda: 127 survey respondents from Bwaise II and Kisenyi III parishes (informal settlements in Kampala). Semi- structured interviews with 10 NWSC staff. Three focus groups, 2 with 12 leaders of the parishes and 1 of 4 NGO membersMixed methods¶NRReasons cited for choice of tap included securing young children from being sexually abused and preventing children from ‘picking up bad habits from bad company’.Good†
Uganda: 450 respondents, with 222 from HIV/AIDS affected, 228 from HIV/AIDS non-affected households of rural districts Mpigi and GombaCross-sectional surveyNRBivariate analysis: perceptions that fetching water takes a lot of time (OR=2.44; 95% CI 1.65 to 3.61) and requires a lot of energy (OR=1.83; 95% CI 1.26 to 2.67) strongly associated with buying water from water vendors. Multivariable analysis: perception that fetching water takes lot of time (AOR=2.15; 95% CI 1.21 to 3.82), district location (AOR=1.92; 95% CI 1.25 to 2.95), presence of person living with HIV/AIDS in household (AOR=0.58; 95% CI 0.38 to 0.88) significant predictors of buying water from vendors.Fair*
Mukhulani 201450Zimbabwe: respondents from three suburbs in Bulawayo affected by water scarcityQualitativeNRSexual assault and harassment reported at water points, during early morning queueing for water, or at night when travelling to boreholes 500 m–2 km away.Fair†
South Africa: 30 women aged 60–75 years and impacted by HIV in some way, from phase I of the ‘Gogo Project’, in rural subdistrictQualitativeNRFetching water is an activity associated with the respondents’ (older women) own health and level of family support.Good†
Subbaraman 201554India: 40 adults of Mumbai slum; 3 focus groups (FGs) 6–9 women; 3 FGs 6–9 menQualitative2011Reports of social conflict and extortion when bringing water containers home.Good†
Ghosh 201655India: 79 mothers from 8 groups of 8–10 mothers who had at least one child below 6 years of age across 4 villages in three blocks in the Sundarbans region of West BengalQualitativeNRMothers did not get sufficient rest in pregnancy, perceived that this led to birth of malnourished children. ’The women have to fetch water from a distant source even in their last few months of pregnancy. They force themselves to do so to avoid the quarrels with the mother-in-law’. Some beaten by in-laws.Good†
Cook 201640Kenya: 387 households near Kianjai, north-central KenyaCross-sectional survey2013Water sources are a cause of social conflict. Proportion of respondents who thought using water source would be ’somewhat' or ’very' likely to lead to conflict: public well 0.69, public borehole 0.51, public piped connection 0.56, surface, other public 0.62. Among well-owners, 85% reported allowing neighbours to use well, of these 28% said that sharing led to conflict with neighbours.Poor*
Krumdieck 201641Kenya: 323 women at 33 weeks gestation, of mixed HIV status, recruited from seven clinics in Nyanza provinceQuantitative2014–2015Water acquisition posed psychological stress and physical risk, 77.3% stating that they felt ‘somewhat or strongly concerned’ for their physical safety during trips for water.Poor*
Kenya: 52 semi-structured interviews among primary water gatherers and their families after receiving nearby water accessQualitativeNRPrimary water gatherers report feeling ‘scared and fearful when gathering water, unhappy with water-gathering situation’Good†
Ayoade 201758Nigeria: 800 girls aged 5–15 years in periurban areas of Abeokuta, Ogun StateQualitative2013–2014456 (55%) reported sexual assault and/or harassment; 99 (11%) reported physical punishment by parents or guardians when containers got lost or exchanged at water points; 184 (23%) reported punishment by parents or guardians who believed they were wasting water; 122 (14%) reported fear of returning home with empty containers.Poor†
Dapaah 201742Ghana: 120 survey respondents in Ga-Mashie, Accra and 80 in Madina, AccraMixed methods**NRIncidence of fights at water collection points 102 (85.0%) in Ga-Mashie; 34 (42.5%) in Madina; 136 (68.0%) in total.Poor*
  • *Methodological quality rating of cohort study or cross-sectional survey.

  • †Methodological rating of qualitative study or qualitative findings of a mixed methods study.

  • ‡Quantitative data reported by Domènech et al were water quality testing.

  • §Sudan, DRC, Solomon Islands, Liberia, Guinea, Sierra Leone, Kenya, India, Cameroon, South Africa, Tanzania, Uganda, Zambia, Haiti, Afghanistan, Cambodia, Somalia, Philippines, Nigeria, Ghana, Mozambique, Pacific Islands, Pakistan, Angola, Malawi, Sudan, Iran, Nepal, Timor-Leste, Bangladesh, Sri Lanka.

  • ¶Quantitative data reported by Isoke and Van Dijk were not analysed for association with health outcomes.

  • **Qualitative data were not about health outcomes.

  • AOR, adjusted OR; NGO, non-governmental organisation; NWSC, National Water and Sewerage Corporation.