Studies were included in the review if they reported quantitatively measured variables or qualitative reports related to the work of fetching water from an off-plot or out of home source and carrying it back home and included some measurement or qualitative appraisal of the health of the person who performed the water carriage work. Retrieved titles and abstracts were evaluated against predefined inclusion criteria by two reviewers (JLG and PRH). One researcher (JLG) independently exported titles and abstracts of all retrieved citations into endnote (X7) and removed duplicates. Experts in the field of water access and health were also contacted to identify relevant literature and reference lists of included papers were checked for relevant papers. Seven electronic databases were accessed: Embase Medline Web of Science Social Sciences Citation Index selecting public, occupational and environmental health themes Web of Science Arts and Humanities Citation Index grey literature databases provided by the International Initiative for Impact Evaluation ( ), the WHO Virtual Health Sciences Library ( and the WHO African index medicus. Therefore, a systematic review of published literature was conducted with the aim of answering the review question: ‘Is the work of water carriage associated with the health of individuals who fetch and carry water for household use?’Ī search of electronic databases was conducted from inception to 8 November 2017 by one reviewer (JLG). With more attention focused on this issue in recent years, a review of the published literature to summarise what is currently known and identify gaps in the existing knowledge base is timely. 15 16 While concerns have been raised, what remains unclear, is how the work of water carriage is associated with the health of the water carrier. It is clear that women and children most commonly collect and carry water home for household use, 3 12 13 often by carrying 20–25 L containers on their head 14 or by other methods such as loading a number of containers into a wheelbarrow. What is absent from these studies of distance to water source and increased household water quantity, is investigation of how these factors affect the health of the person who brings water into the home. In low-income countries, incidence of trachoma and gastrointestinal-related disease improved with increased quantity of water in the home, and in high-income countries, higher levels of water consumption were associated with renal and bladder cancer, but not type II diabetes. 8–10 Stelmach and Clasen 11 reviewed the association between water quantity and health. Previous research has demonstrated an association between distance or time to water source and health of children in the home, as indicated by diarrhoeal disease, and child anthropometrics and mortality. 7 They would also make water access inequitable for those obtaining water off-plot compared with people with safe water piped into their homes, and directly create inequity in relation to SDG 3. 6 Adverse health impacts of water carriage are likely to have implications for SDGs 1 (end poverty in all its forms), 4 (quality education), 5 (gender equality), 8 (decent work and economic growth), 10 (reduced inequalities) and 16 (promote peaceful and inclusive societies). 4 Understanding how water carriage is associated with health is relevant to the United Nations Sustainable Development Goal (SDG) 6, target 1 ‘universal and equitable access to safe and affordable drinking water for all’, 5 and SDG 3, which aims to ensure ‘healthy lives and promote well-being for all at all ages’. 1 More recently, interest in the work of carrying water from sources located away from the home, or ‘off-plot’, has been raised by WHO, Unicef 2 3 and the International Labour Organisation. However, health is defined more broadly as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. Historically, the focus of water and health research has been on management of water quality and risk or prevalence of infectious disease.
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