In pursuit of 'safe' water: the burden of personal injury from water fetching in 21 low-income and middle-income countries

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.

Keywords: cross-sectional survey; injury; maternal health; public health.

Figure 1

Characteristics of the 879 reported water-fetching injuries by (A) type of injury, (B) mechanism, (C) bodily location and (D) physical context across 24 HWISE sites in 21 low-income and middle-income countries. Note: sites are ordered within each geographical region by descending proportion of any reported injuries. Bars are stacked by descending proportion reported within each category across all sites. Colours represent different categories in each panel. Respondents in Honda, Colombia did not report any injuries and are not shown in this figure. HWISE, Household Water Insecurity Experiences.

Figure 2

Gender differences in reported water-fetching injuries by (A) type of injury, (B) mechanism, (C) bodily location and (D) physical context across 24 HWISE sites in 21 low-income and middle-income countries (n=716). HWISE, Household Water Insecurity Experiences.

Figure 3

Suggested survey module for assessing water-fetching injuries and related symptoms. Note: Illustrative ICD-11 codes are listed next to each option when possible. Each injury can have multiple ICD-11 codes for mechanism, body location and context. See online supplemental table 4 for an editable version of this suggested survey module. ICD, International Statistical Classification of Diseases.