Table 6.

Water carriage and energy expenditure or fatigue

First author and date	Population	Study type	Dates	Key finding	Quality
Gibson 200624	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 villages	Cohort study	2003	Odds 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 200726	South 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 Natal	Mixed methods	NR	17% 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* Fair†
Rao 200825	India: 22 rural women aged 18–45 years from villages about 30–40 km from Pune city, Maharashtra	Cross-sectional survey	NR	PAL‡ 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 201028	India: 30 rural women with normal blood pressure and temperature aged 21–40 years in Jorhat district of upper Brahmaputra Valley Zone of Assam	Observational study	NR	Compared 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 2010a46	South Africa: subgroup of 29 people interviewed, drawn from convenience sample of 39 adults and children fetching water in six rural villages of Limpopo Province	Mixed methods	2008	Rating 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 2010b46	South Africa: 39 adults and children observed to fetch water in six rural villages of Limpopo Province	Qualitative	2008	Children link water carriage to tiredness in qualitative interviews.	Good†
Domènech 201247	Nepal: 120 households equally distributed among 10 selected communities and with at least 2 years of experience with rainwater harvesting	Mixed methods§	2008–2009	Rainwater 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 201331	Uganda: survey of 602 (~35%) households in Makondo Parish, and in-depth interviews, focus group discussions and participant observation in four villages	Mixed methods	2011–2012	Over 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* Fair†
Robson 201332	Malawi: 1504 children aged 9–18 years from 12 field sites in each of 3 regions	Mixed methods	2006–2009	Of 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 201552	Kenya: convenience sample of 8 women living in Usoma, 15 km from Kisumu	Qualitative	2013	Children need a lot of energy to push wheelbarrows and carts used for carrying water.	Good†
Zolnikov 201657	Kenya: 52 semi-structured interviews to examine relationships among primary water gatherers and their families after receiving nearby access to water, in Kitui.	Qualitative	NR	Primary water gatherer ‘very tired and easily annoyed’ prior to the implementation of interventions providing nearby water supply.	Good†
Ayoade 201758	Nigeria: 800 girls aged 5–15 years in periurban areas of Abeokuta, Ogun State	Qualitative	2013–2014	Respondents 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.