Jo-Anne Geere

Domestic water carrying and its implications for health: a review and mixed methods pilot study in Limpopo Province, South Africa

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.

The diagnostic accuracy of MRI for the detection of partial- and full-thickness rotator cuff tears in adults

This study assessed the diagnostic test accuracy of magnetic resonance imaging (MRI) in the detection of partial- and full-thickness rotator cuff tears in the adult population. A systematic review was conducted of the following electronic databases: Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, AMED, ISI Web of Science, Current Controlled Trials, National Technical Information Service, the National Institute for Health Research Portfolio, the UK National Research Register Archive and WHO International Clinical Trials Registry Platform database and reference lists of articles. All studies assessing the sensitivity and/or specificity of MRI for adult patients with suspected rotator cuff tear where surgical procedures were the reference standard were included in the study. A meta-analysis was performed to calculate pooled sensitivity, specificity, likelihood and diagnostic odds ratio values, and summary receiver operating characteristic plots were constructed. Forty-four studies were included. These included 2751 shoulders in 2710 patients. For partial-thickness rotator cuff tears, the pooled sensitivity and specificity values were 0.80 [95% confidence interval (CI): 0.79-0.84] and 0.95 (95% CI: 0.94-0.97), respectively. For full-thickness tears, the sensitivity and specificity values were 0.91 (95% CI: 0.86-0.94) and 0.97 (95% CI: 0.96-0.98), respectively. While there was no substantial difference in diagnostic test accuracy between MRIs reviewed by general radiologists and those reviewed by musculoskeletal radiologists, higher-field-strength (3.0 T) MRI systems provided the greatest diagnostic test accuracy.

Survey of rehabilitation support for children 0-15 years in a rural part of Kenya.

Abstract Purpose: Information regarding the nature, availability and distribution of rehabilitation services for children with disabilities across developing countries is scarce, and data that do exist are of variable quality. If planning and development are to progress, information about service provision is vital. The aim was to establish the scope and nature of rehabilitation support available to children with disabilities (0–15 years) and their families in rural Kenya. Method: A comprehensive sample comprising service provision in the health and special education sectors was established. Non-governmental and community-based organisations were also included. A survey of rehabilitation services was conducted through examination of service-related documentation and key informant interviews with the heads of services. Results: Rehabilitation comprised hospital-based occupational therapy, physiotherapy and orthopaedic technology; and seven special education establishments plus an education assessment resource centre. There was one non-government organisation and one community-based organisation relevant to children with disabilities. Activities focused on assessment, diagnosis and raising community awareness. Provision was challenged by inadequate staffing, resources and transport. Government funding was supplemented variously by donations and self-sufficiency initiatives. Rehabilitation approaches appeared to be informed by professional background of practitioner, rather than the needs of child. Service documentation revealed use of inconsistent recording methods. Conclusions: The data highlight the challenges of rehabilitation, demanding greater investment in personnel and their training, more material resources, improved access to the community and better recording mechanisms. Implications for Rehabilitation There needs to be greater investment in rehabilitation provision in developing countries. Consideration of community-based initiatives is required to support better access for all. In order to argue the case for improved resources, better skills and mechanisms for recording, monitoring and evaluating practice are needed.

Meta-analysis identifies Back Pain Questionnaire reliability influenced more by instrument than study design or population

OBJECTIVE To assess if predefined variables in study design, instrument type, and patient characteristics account for variance in reported retest reliability for the Oswestry Disability Index (ODI) and Roland-Morris Questionnaire (RMQ). A second aim was a more precise estimate of instrument reliability. STUDY DESIGN AND SETTING A systematic literature search of MEDLINE, EMBASE, AMED, PsycINFO, and CINAHL was performed from inception to January 2011. Hand search, gray literature, and reference retrieval completed the search. Two blinded reviewers extracted the data. Original authors were contacted for the missing data. A meta-analysis was performed with the intraclass correlation coefficient as the outcome measure. RESULTS Fifty studies on 31 ODI and 28 RMQ cohorts were retrieved that met the inclusion criteria. Meta-analysis found the ODI more reliable than the RMQ (coefficient, -0.2840; P = 0.009) and lower reliability on increased days to retest (coefficient, -0.0089; P = 0.005) and in low back pain (LBP) with leg pain than LBP only cohorts (coefficient, -0.2194; P = 0.046). The use of a transition item to identify stable patients and percentage of cohort not included at retest were significant only on single variable analysis. CONCLUSION Study design and population influence the reliability of a given instrument, however, a greater difference in reliability exists between instruments.

Factors that impact on access to water and sanitation for older adults and people with disability in rural South Africa: An occupational justice perspective

ABSTRACT Limited access to water and sanitation is a risk to health, dignity, and ability to engage in occupations. This article aims to: 1) discuss the current and historical factors affecting access to water and sanitation in rural South Africa, and 2) explore the occupational implications of water access, particularly for older adults and people with disability in rural South Africa. A literature review was carried out through searching JSTOR, Scopus, and MEDLINE databases and using framework analysis to interpret the retrieved documents. This paper also reports a thematic analysis of semi-structured interviews, conducted in 2012 in a rural area of South Africa. Environmental, political, social-economic and attitudinal factors were identified as impacting water access and occupation, in both the documentary analysis and the semi-structured interviews. Due to South Africa’s history, injustice has occurred in the forms of occupational apartheid and occupational deprivation. We argue that supply systems must enable people to easily access more water than is essential for survival, so that people can participate in meaningful and productive occupations. Therefore, access to water should be considered part of an occupational right. Recognising this right will be an integral step in ensuring that water supplies are improved to support better livelihoods, and to achieve economic and social empowerment, and quality of life for all, in line with many of the United Nations’ new Sustainable Development Goals.

Carrying water may be a major contributor to disability from musculoskeletal disorders in low income countries: a cross-sectional survey in South Africa, Ghana and Vietnam

Background The Sustainable Development Goals include commitments to end poverty, and promote education for all, gender equality, the availability of water and decent work for all. An important constraint is the fact that each day, many millions of women and children, and much less frequently men, carry their household’s water home from off-plot sources. The burden of fetching water exacerbates gender inequality by keeping women out of education and paid employment. Despite speculation about the potential health impacts of fetching water, there is very little empirical evidence. We report the first large study of the health impacts of carrying water on women and children. Methods A cross-sectional survey was conducted in South Africa, Ghana and Vietnam during 2012. It investigated water carrying methods and health status. Because areas of self-reported pain were correlated we undertook factor analysis of sites of reported pain, to interpret patterns of pain reporting. Regression analysis using Generalised Estimating Equations (GEE) investigated water carrying as a risk factor for general health and self-reported pain. Results People who previously carried water had increased relative risk of reporting pain in the hands (risk ratio RR 3.62, 95% confidence interval CI 1.34 to 9.75) and upper back (RR 2.27, 95% CI 1.17 to 4.40), as did people who currently carry water (RR hand pain 3.11, 95% CI 1.34 to 7.23; RR upper back pain 2.16, 95% CI 1.25 to 3.73). The factor analysis results indicate that factor 1, ‘axial compression’, which is correlated with pain in the head and upper back, chest/ribs, hands, feet and abdomen/stomach, is associated with currently (0.30, 95% CI 0.17 to 0.43) or previously (0.21, 95% CI 0.01 to 0.42) carrying water. Factor 2, ‘soft tissue strain’, which is correlated with pain in the neck, shoulders/arms, lower back and hips/pelvis or legs, is marginally negatively associated with currently (-0.18, 95% CI -0.32 to -0.04) carrying water. The factor ‘axial compression’ was more strongly associated with carrying water containers on the head. Conclusions Participants who reported a history of current or past water carrying more frequently reported pain in locations most likely to be associated with sustained spinal axial compression in the cervical region. Given the fact that cervical spinal conditions are globally one of the more common causes of disability, our findings suggest that water carrying, especially by head loading is a major contributing factor in musculoskeletal disease burden in low income countries. Our findings support the proposed indicator for monitoring SDG6.1: “Percentage of population using safely managed drinking water services at home.”

Is water carriage associated with the water carrier’s health? A systematic review of quantitative and qualitative evidence

Introduction The work of carrying water falls mainly on women and children, particularly in sub-Saharan Africa and rural areas. While concerns have been raised, how water carriage is associated with health of the water carrier is not clear. The aim of this review is to summarise evidence on whether, and how, water carriage is associated with the water carrier’s health. Methods A systematic review of literature was conducted, searching Embase; Medline; Web of Science Social Sciences Citation Index; Web of Science Arts and Humanities Citation Index; International Initiative for Impact Evaluation website; WHO Virtual Health Sciences Library and WHO African index medicus, from inception to 8 November 2017. Results Forty-two studies were included. Their ability to demonstrate cause and effect relationships was limited by study design and fair or poor methodological quality. Overall, the studies suggest that water carriage is associated with negative aspects of the water carriers’ health. There is moderate quantitative and strong qualitative evidence that water carriage is associated with pain, fatigue, perinatal health problems and violence against vulnerable people, and inconclusive evidence of an association with stress or self-reported mental health and general health status. Conclusion In many circumstances, water carriage is a potential barrier to Sustainable Development Goal (SDG) 6 target ‘universal and equitable access to safe and affordable drinking water for all’ and SDG 3 ‘ensure healthy lives and promote well-being for all at all ages’. Efforts should focus on providing water on premises, and where this is not possible, providing water close to home and reducing risk of gender-based violence.