Abstract
BackgroundLack of access to safe water remains a significant risk factor for poor health in developing countries. There has been little research into the health effects of frequently carrying containers of water. The aims of this study were to better understand how domestic water carrying is performed, identify potential health risk factors and gain insight into the possible health effects of the task.MethodsMixed methods of data collection from six were used to explore water carrying performed by people in six rural villages of Limpopo Province, South Africa. Data was collected through semi-structured interviews and through observation and measurement. Linear regression modelling were used to identify significant correlations between potential risk factors and rating of perceived exertion (RPE) or self reported pain. Independent t-tests were used to compare the mean values of potential risk factors and RPE between sub-groups reporting pain and those not reporting pain.ResultsWater carrying was mainly performed by women or children carrying containers on their head (mean container weight 19.5 kg) over a mean distance of 337 m. The prevalence of spinal (neck or back) pain was 69% and back pain was 38%. Of participants who carried water by head loading, the distance walked by those who reported spinal pain was significantly less than those who did not (173 m 95%CI 2-343; p = 0.048). For head loaders reporting head or neck pain compared to those who did not, the differences in weight of water carried (4.6 kg 95%CI -9.7-0.5; p = 0.069) and RPE (2.5 95%CI -5.1-0.1; p = 0.051) were borderline statistically significant. For head loaders, RPE was significantly correlated with container weight (r = 0.52; p = 0.011) and incline (r = 0.459; p = 0.018)ConclusionsTypical water carrying methods impose physical loading with potential to produce musculoskeletal disorders and related disability. This exploratory study is limited by a small sample size and future research should aim to better understand the type and strength of association between water carrying and health, particularly musculoskeletal disorders. However, these preliminary findings suggest that efforts should be directed toward eliminating the need for water carrying, or where it must continue, identifying and reducing risk factors for musculoskeletal disorders and physical injury.
Highlights
Lack of access to safe water remains a significant risk factor for poor health in developing countries
Our study suggests that the volume of water carried and environmental factors, the incline or gradient of the path along which water is carried are likely to influence the physical work of water carrying as indicated by rating of perceived exertion (RPE)
This study has highlighted the potential association between spinal pain and water carrying in South Africa
Summary
Lack of access to safe water remains a significant risk factor for poor health in developing countries. Water filled containers are often carried on the head, transportation with wheel barrows, animal drawn carts or by rolling filled containers has been observed [7,8]. These methods obviously create physical demands on the body and the potential for adverse physical stress from regularly carrying loads of water has been recognised [6,9,10]. Physical loading of the body within an individual’s capacity for adaptive responses may lead to tissue strengthening, frequent loading beyond capacity for adaptation or repair may lead to injury through fatigue failure, accumulation of fatigue damage [11] or early degenerative changes in bone and soft tissues [12]
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