Women carrying water in rural Nepal: health implications and a strategy for improved water supply

Women in Nepal, especially in rural areas, are subjected every day to strenuous activities for household maintenance and children care, such as water fetching. The aim of this project was to find relevant risk factors (both water carrying-related and not) over the health of a statistically significant women sample. The project focused on the relationship between the risk factors and certain health outcomes, chosen on the basis of their medical and social relevance: pain at the ankles, head, neck, back, and uterine prolapse (UP). Once the water carrying related risk factors were identified, a strategy for the design of improved Water Supply System (WSS) in one hamlet of Bolde district was investigated. This project used data from a cross-sectional study conducted in 2019 during the dry season in some rural districts of Nepal. Regression model generations through Generalized Estimating Equation (GEE) adjusted for age and accounting for clusters were used to find relevant health risk factors. Three prevision models were generated on the basis of the GEEs results, including the relevant risk factors. The ankles have been found as the pain location where women involved in the past in water carrying have a higher Odd Ratio with respect to women who have never been submitted to this charge; the water load and the mean value of minutes to reach the source in the past have been found out as predictors of pain at the ankles. The dominant influencing factors that have been identified as affecting women currently practicing water carrying are: the help in water carrying for what concerns both back and head pain; the waist loading mode was detected as the prominent risk factor for UP. When including non-water-carrying-related factors, interesting results related to the social and medical status of the women are highlighted: the age of marriage, the number of births given, the employment in agriculture , help in water carrying, help in lifting heavy loads during pregnancy, number of pregnancies and the education level. It can be concluded that the major sufferers of health problems are those women who are more involved in water carrying and are socially or medically disadvantaged at the same time. For the WSS design, references to previous projects and hydraulic guidelines were used. The proposed scheme was divided into the following sections: catchment, transmission, water-tank, distribution, and pipe-to-house connection. The available data (e.g., water demand, morphology of the site and type of ground) were used to design system and estimate the overall cost. Finally, the sustainability of the system was evaluated. Specifically, diameters of 20 mm are estimated for both the transmission and the distribution pipelines, as well as a water tank storage of 22 m3 to cover the hamlet demand. The total estimated cost of the project is 359,2 Rs. On the basis of this number, the WSS design may be feasible when accompanied with on-site checks and refinement, and with the help of the Government and financial Institutions.