Table 9.

Water carriage and social vulnerability

First author and date	Population	Study type	Dates	Key finding	Quality
Devoto 201230	Morocco: 845 households in Tangiers, not connected to a city water network, comparing subgroup of households reporting above median baseline time fetching water	Cohort study	2007–2008	Significant 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*
Domènech 201247	Nepal: 120 households distributed among ten selected communities, with at least 2 years experience of rainwater harvesting	Mixed methods‡	2008–2009	Perceived benefits from rainwater harvesting reported as being particularly helpful to vulnerable groups, described as older people, disabled people and children.	Fair†
Yallew 201235	Ethiopia: 296 home based care clients living with HIV/AIDS, drawn from two NGOs in Gondar city	Mixed methods	2009	Bivariate 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* Good†
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	Water 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* Fair†
Robson 201332	Malawi: 1504 children aged 9–18 years from 12 field sites in each of 3 regions	Mixed methods	2006–2009	Hazards of water fetching reported to be harassment, verbal abuse or attack from people, and ‘meeting criminals’.	Poor*†
House 201448	Various countries§	Qualitative	NR	Case studies indicate that gender-based violence occurs during water fetching in many countries. Violence may be sexual, psychological, physical or sociocultural.	Poor†
Isoke 201449	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 members	Mixed methods¶	NR	Reasons 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†
Mugambe 201437	Uganda: 450 respondents, with 222 from HIV/AIDS affected, 228 from HIV/AIDS non-affected households of rural districts Mpigi and Gomba	Cross-sectional survey	NR	Bivariate 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 201450	Zimbabwe: respondents from three suburbs in Bulawayo affected by water scarcity	Qualitative	NR	Sexual 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†
Schatz 201451	South Africa: 30 women aged 60–75 years and impacted by HIV in some way, from phase I of the ‘Gogo Project’, in rural subdistrict	Qualitative	NR	Fetching water is an activity associated with the respondents’ (older women) own health and level of family support.	Good†
Subbaraman 201554	India: 40 adults of Mumbai slum; 3 focus groups (FGs) 6–9 women; 3 FGs 6–9 men	Qualitative	2011	Reports of social conflict and extortion when bringing water containers home.	Good†
Ghosh 201655	India: 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 Bengal	Qualitative	NR	Mothers 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 201640	Kenya: 387 households near Kianjai, north-central Kenya	Cross-sectional survey	2013	Water 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 201641	Kenya: 323 women at 33 weeks gestation, of mixed HIV status, recruited from seven clinics in Nyanza province	Quantitative	2014–2015	Water 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*
Zolnikov 201657	Kenya: 52 semi-structured interviews among primary water gatherers and their families after receiving nearby water access	Qualitative	NR	Primary water gatherers report feeling ‘scared and fearful when gathering water, unhappy with water-gathering situation’	Good†
Ayoade 201758	Nigeria: 800 girls aged 5–15 years in periurban areas of Abeokuta, Ogun State	Qualitative	2013–2014	456 (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 201742	Ghana: 120 survey respondents in Ga-Mashie, Accra and 80 in Madina, Accra	Mixed methods**	NR	Incidence 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.