Who carries the weight of water? Fetching water in rural and urban areas and the implications for water security

The global burden of fetching water, particularly its effects on individuals and societies, is largely unknown because comparative analysis of the global data available is incomplete and scarce. To address this information gap, this article presents a synthesis of the data on water-fetching from households in 23 countries. In rural areas of the dataset almost 50% of the population still have to bring water from a source outside of their home or yard. Women generally carry the main responsibility for fetching water; however, in many countries and in particular in urban areas, men also take on a great share of this work. The mean single trip time to collect water ranges from 10 to 65 minutes in urban areas with an average increase or decrease of 2 to 13 minutes in rural areas. Further, up to 60% of children support the collection of wood and water, in some countries spending up to 11.3 hours per week. Water fetching continues to have the greatest impact on women and children in poorer rural areas and is likely to be a substantial barrier to household water security and sustainable development in regions most in need of sustainable development

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

Cardiac Specific Gene Expression Changes in Long Term Culture of Murine Mesenchymal Stem Cells

Murine MSCs are a readily available source of adult stem cells enabling extensive in vitro study of this cell population. MSCs have been described as multipotent, and have been proven capable of differentiation into several connective tissue types. Furthermore some studies have suggested an ability to differentiate into non-connective tissue cell types such as the cardiomyocyte. The aim of this study was to differentiate murine MSCs toward cardiac lineage with the commonly used method of culture with 5’ Azacytidine. Critically, baseline analysis of gene expression of passage four MSCs demonstrated expression of key cardiac markers including cardiac troponin T and I, and the ryanodine receptor. Furthermore, expression analysis of these genes changed with time in culture and passage number. However, there was no significant alteration when cells were subjected to a differentiation protocol. This study therefore highlights the importance of analyzing baseline cells extensively, and indicates the limitations in extrapolating data for comparison between species. Furthermore this data brings into question the efficacy of cardiac differentiation using MSCs

Feminist Ecclesiology: A Trinitarian Framework for Transforming the Church\u27s Institutional and Spiritual LIfe

In light of women’s marginal status in church governance and ministry through most of recorded history, feminist trinitarian ecclesiology is needed to transform the church’s institutional and spiritual life. While Vatican II provided the paradigm shift and promising anthropology essential for an egalitarian church, feminist ecclesiology prompts a radical transformation of its hierarchical and patriarchal structures and practices so that it may truly embody the Trinity. Trinitarian life provides practical and radical consequences for Christian life, and provides a model of church marked by relationships of equality, mutuality, unity and reciprocity. It also provides a strong ecclesiological argument for reform of the juridical Catholic nullity of marriage process, which may pave a pathway for the civilly remarried to receive the sacraments of Reconciliation and Holy Eucharist

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. Findings: People who previously carried water had increased relative risk of reporting pain in the hands (RR 3.62, 95%CI 1.34-9.75) and upper back (RR 2.27, 95%CI 1.17-4.40), as did people who currently carry water (RR hand pain 3.11, 95%CI 1.34-7.23; RR upper back pain 2.16, 95%CI 1.25-3.73). 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 0.17-0.43) or previously (0.21, 95%CI 0.01-0.42) 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 - -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“ (our emphasis)

Drawers of water for life, but not for health. How water carriage is associated with the health of water carriers.

Introduction For many people, water carriage is a regular chore which is essential for life. However, the relationship between water carriage and health of the water carriers is not clear. The aim of this thesis is to answer the research question ‘How is water carriage associated with the water carrier’s health?’ Methods A systematic review of literature, analysis of data from 49 Multiple Indicator Cluster Surveys, and a cross sectional survey conducted in South Africa, Ghana and Vietnam were used to investigate the relationship between water carriage and the health of water carriers. Water carriers are most often women and girls of child bearing age, therefore, maternal, early childhood and physical health outcomes were investigated. Results It was found that water carriage is associated with pain location and increased pain severity, but slightly better self-reported general health. Water carriage is also associated with reduced likelihood of a woman giving birth in a health care facility, reduced uptake of antenatal care, increased risk of child deaths, and increased risk of a child under five years of age having diarrhoea, and being left at home alone. The systematic review additionally highlights that water carriage is associated with fatigue and discrimination or abuse of vulnerable people and revealed plausible mechanisms by which water carriage may lead to psychological distress. Conclusion Water carriage is associated with a range of negative health outcomes and indicators, suggesting that it is not good for the water carrier’s health. Water carriage is a potential barrier to achieving targets of the United Nations Sustainable Development Goals 6 ‘Ensure availability and sustainable management of water and sanitation for all’ and 3 ‘Ensure healthy lives and promote well-being for all at all ages’. Overall the data support a conclusion that action should be taken now to reduce the need for water carriage, and to increase the number of people who can access water for household use in their own home or yard

'Maybe I will give some help ... maybe not to help the eyes but different help': an analysis of care and support of children with visual impairment in community settings in Malawi

Background: Visual impairment in children is common in low and middle‐income settings. Whilst visual impairment (VI) can impact on the development of children, many reach full potential with appropriate early intervention programmes. Although there is increased emphasis on early child development globally, it is not yet clear how to provide specific programmes for children with VI in low and middle‐income settings. This study aims to identify facilitators and barriers to the provision of a developmental stimulation programme for children with VI in rural and urban Malawi. Methods: We undertook 6 focus groups, 10 home observations and 20 in‐depth interviews with carers of children with VI under 6 years in urban and rural Southern Malawi. We utilised topic guides relating to care, play, communication and feeding. Qualitative data were subject to thematic analysis that included placing themes within Bronfenbrenner's ecological framework. We established authenticity of themes through feedback from participants. Results: We identified themes within Bronfenbrenner's framework at five levels: (1) blindness acting as a barrier to stimulation and communication, health and complex needs all affecting the individual child; (2) understanding of VI, ability to be responsive at the microsystem level of the carer; (3) support from other carers at microsystem level within a mesosystem; (4) support from other professionals (knowledge of, identification and management of children with VI, responsibilities and gender roles, environmental safety and prejudice, stigma and child protection all at the level of the exosystem. Discussion: This study has revealed the requirements needed in order to produce meaningful and appropriate programmes to support nutrition, care and early stimulation for children with VI in this and similar African settings. This includes supporting carers to understand their child's developmental needs, how to better communicate with, feed and stimulate their child; offering advice sensitive to carers' responsibilities and professional training to better support carers and challenge community stigma

“My Vocal Cords are Made of Tweed”: Style-Shifting as Speaker Design

Intraspeaker variation is evaluated in terms of speaker design in a number of studies (Coupland 1985, Schilling-Estes 1998, Podesva 2008). This study explores possible motives for variation from a speaker design perspective through the analysis of three phonetic variables with differing social status. The variables occur in the speech of Stephen Fry, an intellectual whose public identity is closely linked with his Received Pronunciation (RP) speech. Fry uses more non-standard forms in contexts where his identity is more directly relevant, suggesting his desire to “accentuate the positive and eliminate the negative” associations of the RP register (Meyerhoff 2011:28). However not all the data fit this pattern, demonstrating the need for a broad model of speaker design incorporating multiple motives for style-shifting. It is proposed that the use of linguistic variables with differing social evaluation can give insight into prioritisation of speaker motives in future speaker-centred studies