Table 6

Water carriage and energy expenditure or fatigue

First author and datePopulationStudy typeDatesKey findingQuality
Ethiopia: agropastoralist community, 1548 women aged 15–49 years in a demographic survey of 1976 HHs and subsample of 682 children (<15 years) and 264 women (15–49 years) in anthropometric survey in four villagesCohort study2003Odds of a woman with ‘energy saving’ water points closer to home giving birth in any given month was three times greater than a woman without an improved water supply (OR 3.78, p=0.009).Fair*
Hemson 200726South Africa: 1052 children aged 5–17 years from 366 households, in three villages with no piped water supply; two dry flat villages in Limpopo and one hilly village with natural springs in Kwazulu NatalMixed methodsNR17% of children surveyed on recent illness reported fatigue for which 4% had sought treatment. Of children reporting worsened health, 96% described water carrying as tiring, 75% reported fatigue.Poor*
India: 22 rural women aged 18–45 years from villages about 30–40 km from Pune city, MaharashtraCross-sectional surveyNRPAL‡ of drawing water from a well and using hand pump were categorised as moderate; carrying two containers on the head was categorised as heavy.Poor*
Borah 201028India: 30 rural women with normal blood pressure and temperature aged 21–40 years in Jorhat district of upper Brahmaputra Valley Zone of AssamObservational studyNRCompared with walking to water point and drawing water, the return journey with water-filled containers had maximum heart rate (HR) and energy expenditure (EE) for 21–30 age group (115 bpm and 9.56 kJ/min) and for 31–40 age group (113 bpm and 9.24 kJ/min); on basis of average HR and EE, workload for drawing water and return journey classified as moderately heavy; on basis of peak HR and EE, workload for drawing water and return was classified as heavy or very heavy; rating of perceived exertion was highest with the return journey while carrying water, and highly correlated with HR (r=0.84–0.92) for both age groups at all parts of the water fetching cycle.Poor*
Geere 2010a46South Africa: subgroup of 29 people interviewed, drawn from convenience sample of 39 adults and children fetching water in six rural villages of Limpopo ProvinceMixed methods2008Rating of perceived exertion significantly correlated with container weight (r=0.52; p=0.011) and path incline (r=0.459; p=0.018) during water carriage.Poor*
Geere 2010b46South Africa: 39 adults and children observed to fetch water in six rural villages of Limpopo ProvinceQualitative2008Children link water carriage to tiredness in qualitative interviews.Good†
Nepal: 120 households equally distributed among 10 selected communities and with at least 2 years of experience with rainwater harvestingMixed methods§2008–2009Rainwater harvesting reduced water fetching (6.4 hours/day less in the rainy season; 4 hours/day less in the dry season) and allowed energy (calorie) savings.Fair†
Asaba 201331Uganda: survey of 602 (~35%) households in Makondo Parish, and in-depth interviews, focus group discussions and participant observation in four villagesMixed methods2011–2012Over 70% of survey respondents highlighted ‘tiresome’ nature of water fetching. Many added that carrying water required ‘a lot of physical energy’. Among men (22.9%) and women (13.6%), male youths (18.1%), female youths (19.1%), male children (23.7%) and female children (23.1%) carrying water was perceived to cause fatigue.Poor*
Robson 201332Malawi: 1504 children aged 9–18 years from 12 field sites in each of 3 regionsMixed methods2006–2009Of children citing water carrying as their heaviest load, 5% more girls than boys reported experiencing tiredness in the last week. Supported by qualitative data from adults and children, indicating that children suffer from tiredness and inability to concentrate at school, particularly from being woken at night or very early morning to fetch water.Poor*†
Bisung 201552Kenya: convenience sample of 8 women living in Usoma, 15 km from KisumuQualitative2013Children need a lot of energy to push wheelbarrows and carts used for carrying water.Good†
Kenya: 52 semi-structured interviews to examine relationships among primary water gatherers and their families after receiving nearby access to water, in Kitui.QualitativeNRPrimary water gatherer ‘very tired and easily annoyed’ prior to the implementation of interventions providing nearby water supply.Good†
Ayoade 201758Nigeria: 800 girls aged 5–15 years in periurban areas of Abeokuta, Ogun StateQualitative2013–2014Respondents reported that they experienced fatigue due to water carriage, which negatively affected their ability to participate in school.Poor†
  • *Methodological quality rating of cohort study or cross-sectional survey.

  • †Methodological quality rating of qualitative study or reporting of qualitative findings as part of a mixed methods study.

  • ‡Index of total energy expenditure adjusted for basal metabolic rate (BMR).

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

  • HHs, households.