{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:10:35Z","timestamp":1792131035243,"version":"4.4.0"},"reference-count":67,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T00:00:00Z","timestamp":1655942400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>\n                    More than a third of women in Nepal have to carry water from source to home to satisfy their families\u2019 daily needs. A cross-sectional study was carried out in a hilly area in Nepal to assess water-carrying practices and their association with women\u2019s health. Quantitative interviews were conducted with 1001 women of reproductive age and were complemented with health surveys carried out by health professionals and structured observations of water carrying. Multivariate mixed logistic regression models were used to assess the associations between water-carrying-related risk factors and health issues for women. Around 46% of women faced considerably increased to excessive physical stress due to water carrying during the dry season. Women suffered from a disproportionately high prevalence of back pain (61%), with about 18% of this pain being horrible to excruciating; pain in the knees (34%); uterine prolapse (11.3%); and at least one spontaneous abortion (9%). The risk category of water carrying was significantly associated with uterine prolapse (OR = 1.44, 95%CI = 1.12\u20131.85,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.031) and pain in the hips (OR = 1.69, 95%CI = 1.27\u20132.26,\n                    <jats:italic>p<\/jats:italic>\n                    &lt;0.001). Receiving help with water carrying during pregnancy and during the first three months after delivery was associated with reduced odds ratios for uterine prolapse (OR = 0.10, 95% CI = 0.01\u20130.87,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.037), and strong back pain (OR = 0.32, 95% CI = 0.12\u20130.87,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.026). Improvements to water supply infrastructure and the promotion of social support for carrying water during pregnancy and after delivery are recommended to reduce water-carrying-related health risks.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0269926","type":"journal-article","created":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T13:39:53Z","timestamp":1655991593000},"page":"e0269926","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Water carrying in hills of Nepal\u2013associations with women\u2019s musculoskeletal disorders, uterine prolapse, and spontaneous abortions"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9691-9374","authenticated-orcid":true,"given":"Regula","family":"Meierhofer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vica Marie Jelena","family":"Tomberge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Inauen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akina","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,6,23]]},"reference":[{"key":"pone.0269926.ref001","volume-title":"Transforming our world: the 2030 Agenda for Sustainable Development.","author":"UN","year":"2015"},{"issue":"4","key":"pone.0269926.ref002","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.ijheh.2016.04.008","article-title":"On-plot drinking water supplies and health: A systematic review","volume":"219","author":"A Overbo","year":"2016","journal-title":"International Journal of Hygiene and Environmental Health"},{"issue":"7","key":"pone.0269926.ref003","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/j.ijheh.2019.06.011","article-title":"Drinking water accessibility and quantity in low and middle-income countries: A systematic review","volume":"222","author":"A Cassivi","year":"2019","journal-title":"International Journal of Hygiene and Environmental Health"},{"key":"pone.0269926.ref004","volume-title":"Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines","author":"WHO\/UNICEF","year":"2017"},{"key":"pone.0269926.ref005","volume-title":"Progress on household drinking water, sanitation and hygiene 2000\u20132017. Special focus on inequalities","author":"WHO. JMP","year":"2019"},{"key":"pone.0269926.ref006","volume-title":"Nepal Demographic and Health Survey","author":"DHS","year":"2016"},{"issue":"9","key":"pone.0269926.ref007","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1016\/j.socscimed.2011.03.010","article-title":"Safe access to safe water in low income countries: Water fetching in current times.","volume":"72","author":"SB Sorenson","year":"2011","journal-title":"Social Science & Medicine"},{"issue":"6","key":"pone.0269926.ref008","doi-asserted-by":"crossref","first-page":"e0155981","DOI":"10.1371\/journal.pone.0155981","article-title":"An Analysis of Water Collection Labor among Women and Children in 24 Sub-Saharan African Countries","volume":"11","author":"JP Graham","year":"2016","journal-title":"PLOS ONE"},{"issue":"3","key":"pone.0269926.ref009","doi-asserted-by":"crossref","first-page":"e000764","DOI":"10.1136\/bmjgh-2018-000764","article-title":"Is water carriage associated with the water carrier\u2019s health? A systematic review of quantitative and qualitative evidence","volume":"3","author":"J-AL Geere","year":"2018","journal-title":"BMJ Global Health"},{"issue":"15","key":"pone.0269926.ref010","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18157908","article-title":"The Physical Burden of Water Carrying and Women\u2019s Psychosocial Well-Being: Evidence from Rural Nepal","volume":"18","author":"VM Tomberge","year":"2021","journal-title":"International Journal of Environmental Research and Public Health"},{"issue":"9","key":"pone.0269926.ref011","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1016\/j.socscimed.2004.02.033","article-title":"An issue of culture: the effects of daily activities on prenatal care utilization patterns in rural South Africa","volume":"59","author":"TM McCray","year":"2004","journal-title":"Social Science & Medicine"},{"issue":"7","key":"pone.0269926.ref012","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1186\/s12913-016-1866-8","article-title":"Expressing collective voices on children\u2019s health: photovoice exploration with mothers of young children from the Indian Sundarbans","volume":"16","author":"U Ghosh","year":"2016","journal-title":"BMC Health Services Research"},{"issue":"2","key":"pone.0269926.ref013","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/BF00889713","article-title":"Motherhood and subsistence work: The Tamang of rural Nepal.","volume":"17","author":"C Panter-Brick","year":"1989","journal-title":"Human Ecology"},{"key":"pone.0269926.ref014","article-title":"Water for life: ceaseless routine efforts for collecting drinking water in remote mountainous villages of Nepal. Environment","author":"S Komatsu","year":"2019","journal-title":"Development and Sustainability"},{"issue":"3","key":"pone.0269926.ref015","doi-asserted-by":"crossref","first-page":"153","DOI":"10.5271\/sjweh.1414","article-title":"Work load and musculoskeletal complaints during pregnancy","volume":"20","author":"JA Paul","year":"1994","journal-title":"Scandinavian Journal of Work, Environment & Health"},{"issue":"2","key":"pone.0269926.ref016","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.ajog.2013.02.047","article-title":"Clinical guidelines for occupational lifting in pregnancy: evidence summary and provisional recommendations.","volume":"209","author":"LA MacDonald","year":"2013","journal-title":"American Journal of Obstetrics & Gynecology"},{"issue":"4","key":"pone.0269926.ref017","doi-asserted-by":"crossref","first-page":"335","DOI":"10.5271\/sjweh.3335","article-title":"Occupational lifting during pregnancy and risk of fetal death in a large national cohort study","author":"M Juhl","year":"2013","journal-title":"Scandinavian Journal of Work, Environment & Health"},{"issue":"2","key":"pone.0269926.ref018","doi-asserted-by":"crossref","first-page":"115","DOI":"10.3109\/01443615.2012.721408","article-title":"The impact of strenuous physical activity on the development of pelvic organ prolapse","volume":"33","author":"A Majumdar","year":"2013","journal-title":"Journal of Obstetrics and Gynaecology"},{"issue":"3","key":"pone.0269926.ref019","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1080\/13691050110090248","article-title":"Uterine prolapse in rural Nepal: Gender and human rights implications. A mandate for development","volume":"4","author":"B Earth","year":"2002","journal-title":"Culture, Health & Sexuality"},{"key":"pone.0269926.ref020","volume-title":"Study on selected reproductive health morbidities among women attending reproductive health camps in NepalUnited Nations Population Fund, Government of Nepal, Ministry of Health","author":"UNFPA","year":"2016"},{"issue":"9575","key":"pone.0269926.ref021","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(07)60814-9","article-title":"Pelvic organ prolapse: don\u2019t forget developing countries","volume":"369","author":"P Gunasekera","year":"2007","journal-title":"The Lancet"},{"issue":"2","key":"pone.0269926.ref022","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3126\/njog.v2i2.1453","article-title":"Pelvic organ prolapse in rural Nepalese women of reproductive age groups: What makes it so common?","volume":"2","author":"G Gurung","year":"2007","journal-title":"Nepal Journal of Obstetrics and Gynaecology"},{"issue":"11","key":"pone.0269926.ref023","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1007\/s00192-013-2169-9","article-title":"Epidemiology and outcome assessment of pelvic organ prolapse","volume":"24","author":"MD Barber","year":"2013","journal-title":"International Urogynecology Journal"},{"issue":"11","key":"pone.0269926.ref024","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1007\/s00192-007-0331-y","article-title":"Risk factors for uterine prolapse in Nepal","volume":"18","author":"B Bodner-Adler","year":"2007","journal-title":"International Urogynecology Journal"},{"issue":"2","key":"pone.0269926.ref025","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.ijgo.2012.05.031","article-title":"Prevalence of and risk factors for pelvic organ prolapse and lower urinary tract symptoms among women in rural Nepal","volume":"119","author":"Y-S Lien","year":"2012","journal-title":"International Journal of Gynecology & Obstetrics"},{"issue":"1","key":"pone.0269926.ref026","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/1472-6874-14-20","article-title":"s experiences and health care-seeking practices in relation to uterine prolapse in a hill district of Nepal.","volume":"14","author":"B Shrestha","year":"2014","journal-title":"BMC Women\u2019s Health"},{"issue":"2","key":"pone.0269926.ref027","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s00192-010-1215-0","article-title":"Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors","volume":"22","author":"GJA Walker","year":"2011","journal-title":"International Urogynecology Journal"},{"issue":"4","key":"pone.0269926.ref028","doi-asserted-by":"crossref","first-page":"e0195910","DOI":"10.1371\/journal.pone.0195910","article-title":"Prevalence and risk factors for pelvic organ prolapse in Kilimanjaro, Tanzania: A population based study in Tanzanian rural community","volume":"13","author":"GG Masenga","year":"2018","journal-title":"PLOS ONE"},{"issue":"3","key":"pone.0269926.ref029","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s00192-016-3077-6","article-title":"Living with pelvic organ prolapse: voices of women from Amhara region, Ethiopia","volume":"28","author":"JL Gjerde","year":"2017","journal-title":"International Urogynecology Journal"},{"issue":"9566","key":"pone.0269926.ref030","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/S0140-6736(07)60462-0","article-title":"Pelvic organ prolapse","volume":"369","author":"JE Jelovsek","year":"2007","journal-title":"The Lancet"},{"issue":"3","key":"pone.0269926.ref031","doi-asserted-by":"crossref","first-page":"e90550","DOI":"10.1371\/journal.pone.0090550","article-title":"Occupational Lifting, Fetal Death and Preterm Birth: Findings from the Danish National Birth Cohort Using a Job Exposure Matrix","volume":"9","author":"E Mocevic","year":"2014","journal-title":"PLOS ONE"},{"key":"pone.0269926.ref032","first-page":"205","volume-title":"Developments in Applied Statistics","author":"JH Hoffmeyer-Zlotnik","year":"2003"},{"issue":"4","key":"pone.0269926.ref033","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.3758\/BRM.41.4.1149","article-title":"Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses","volume":"41","author":"F Faul","year":"2009","journal-title":"Behavior Research Methods"},{"issue":"2","key":"pone.0269926.ref034","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"F Faul","year":"2007","journal-title":"Behavior Research Methods"},{"issue":"7","key":"pone.0269926.ref035","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1111\/j.1365-2702.2005.01121.x","article-title":"Pain: a review of three commonly used pain rating scales","volume":"14","author":"A Williamson","year":"2005","journal-title":"Journal of Clinical Nursing"},{"issue":"2","key":"pone.0269926.ref036","first-page":"133","article-title":"Pain measurement tools for clinical practice and research","volume":"64","author":"S. Flaherty","year":"1996","journal-title":"AANA journal"},{"issue":"3","key":"pone.0269926.ref037","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/S0003-6870(02)00014-5","article-title":"The nature of work-related neck and upper limb musculoskeletal disorders","volume":"33","author":"PW Buckle","year":"2002","journal-title":"Applied Ergonomics"},{"issue":"1","key":"pone.0269926.ref038","doi-asserted-by":"crossref","first-page":"010406","DOI":"10.7189\/jogh.08.010406","article-title":"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","volume":"8","author":"J-A Geere","year":"2018","journal-title":"Journal of global health"},{"key":"pone.0269926.ref039","volume-title":"Megaphys. Mehrstufige Gef\u00e4hrdungsanalyse physischer Belastungen am Arbeitsplatz","author":"DGVU","year":"2020"},{"key":"pone.0269926.ref040","volume-title":"Applications Manual for the Revised NIOSH Lifting Equation","author":"TR Waters","year":"1994"},{"key":"pone.0269926.ref041","volume-title":"Suva-Publikation 1903d","author":"SUVA","year":"2019"},{"key":"pone.0269926.ref042","volume-title":"ISO 11228\u20131 Ergonomics\u2014Manual handling. Part 1: Lifting and carrying.","author":"ISO","year":"2003"},{"key":"pone.0269926.ref043","volume-title":"Beurteilung der k\u00f6rperlichen Belastung: Heben und Tragen von Lasten (Document ID 88190.D)","author":"SUVA","year":"2019"},{"key":"pone.0269926.ref044","volume-title":"Obesity; Preventing and Managing the Global Epidemic: report of a WHO consultation","author":"WHO","year":"2000"},{"key":"pone.0269926.ref045","volume-title":"Report of a WHO Expert Consultation","author":"WHO","year":"1995"},{"issue":"60","key":"pone.0269926.ref046","article-title":"The DHS Wealth Index: Approaches for Rural and Urban Areas","author":"SO Rutstein","year":"2008","journal-title":"Demographic and Health Research Division"},{"key":"pone.0269926.ref047","author":"V. Krishnan","year":"2010","journal-title":"Constructing an Area-based Socioeconomic Index: A Principal Components Analysis Approach"},{"issue":"7624","key":"pone.0269926.ref048","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1136\/bmj.39356.604074.BE","article-title":"Uterine prolapse","volume":"335","author":"A Doshani","year":"2007","journal-title":"BMJ (Clinical research ed)"},{"issue":"1","key":"pone.0269926.ref049","article-title":"Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women","volume":"17","author":"A Tinelli","year":"2010","journal-title":"Menopause"},{"issue":"3","key":"pone.0269926.ref050","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.berh.2014.07.006","article-title":"A time for action: Opportunities for preventing the growing burden and disability from musculoskeletal conditions in low- and middle-income countries","volume":"28","author":"D Hoy","year":"2014","journal-title":"Best Practice & Research Clinical Rheumatology"},{"key":"pone.0269926.ref051","article-title":"Understanding safe water-carrying practices during pregnancy and postpartum: A mixed-methods study in Nepal","author":"VMJ Tomberge","year":"2021","journal-title":"Applied Psychology: Health and Well-Being"},{"issue":"1","key":"pone.0269926.ref052","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/1476-069X-9-52","article-title":"Domestic water carrying and its implications for health: a review and mixed methods pilot study in Limpopo Province, South Africa","volume":"9","author":"J-AL Geere","year":"2010","journal-title":"Environmental Health"},{"issue":"1","key":"pone.0269926.ref053","doi-asserted-by":"crossref","DOI":"10.3362\/1756-3488.2013.003","article-title":"Heavy loads: children\u2019s burdens of water carrying in Malawi","volume":"32","author":"E Robson","year":"2013","journal-title":"Waterlines"},{"issue":"9","key":"pone.0269926.ref054","article-title":"Assessment of Water Provision and Associated Risks Among Children in Abeokuta Peri-Urban, Ogun State, Southwestern Nigeria: The Gender Implications.","volume":"4","author":"AA Ayoade","year":"2015","journal-title":"wH2O: The Journal of Gender and Water"},{"key":"pone.0269926.ref055","doi-asserted-by":"crossref","first-page":"100587","DOI":"10.1016\/j.eclinm.2020.100587","article-title":"Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies","volume":"29\u201330","author":"A Cui","year":"2020","journal-title":"EClinicalMedicine"},{"key":"pone.0269926.ref056","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/bmb\/lds012","article-title":"Occupational activities and osteoarthritis of the knee","volume":"102","author":"KT Palmer","year":"2012","journal-title":"Br Med Bull"},{"issue":"2","key":"pone.0269926.ref057","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1136\/oem.2007.032466","article-title":"Knee osteoarthritis: influence of work involving heavy lifting, kneeling, climbing stairs or ladders, or kneeling\/squatting combined with heavy lifting","volume":"65","author":"LK Jensen","year":"2008","journal-title":"Occupational and Environmental Medicine"},{"key":"pone.0269926.ref058","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/978-1-4471-1918-0_2","volume-title":"Spontaneous Abortion: Diagnosis and Treatment","author":"E. Alberman","year":"1992"},{"issue":"5","key":"pone.0269926.ref059","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1053\/beog.2000.0123","article-title":"Epidemiology and the medical causes of miscarriage","volume":"14","author":"L Regan","year":"2000","journal-title":"Best Practice & Research Clinical Obstetrics & Gynaecology"},{"issue":"1","key":"pone.0269926.ref060","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12978-017-0297-2","article-title":"Factors associated with spontaneous abortion: a cross-sectional study of Chinese populations","volume":"14","author":"D Zheng","year":"2017","journal-title":"Reproductive Health"},{"issue":"06","key":"pone.0269926.ref061","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1055\/s-0031-1293204","article-title":"Does Obesity Increase the Risk of Miscarriage in Spontaneous Conception: A Systematic Review","volume":"29","author":"C Boots","year":"2011","journal-title":"Semin Reprod Med."},{"issue":"1","key":"pone.0269926.ref062","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/jog.13799","article-title":"Obesity and recurrent miscarriage: A systematic review and meta-analysis","volume":"45","author":"MB Cavalcante","year":"2019","journal-title":"Journal of Obstetrics and Gynaecology Research"},{"issue":"8","key":"pone.0269926.ref063","doi-asserted-by":"crossref","first-page":"e0236435","DOI":"10.1371\/journal.pone.0236435","article-title":"Association between obesity and miscarriage among women of reproductive age in Nepal","volume":"15","author":"PR Ghimire","year":"2020","journal-title":"PLOS ONE"},{"issue":"15","key":"pone.0269926.ref064","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1001\/jama.1984.03340390049028","article-title":"Effects of Pregnancy on Work Performance","volume":"251","author":"ericanMedicalAssociation","year":"1984","journal-title":"JAMA"},{"issue":"1","key":"pone.0269926.ref065","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1177\/0018720813502223","article-title":"Provisional Recommended Weight Limits for Manual Lifting During Pregnancy","volume":"56","author":"TR Waters","year":"2013","journal-title":"Human Factors"},{"key":"pone.0269926.ref066","volume-title":"Nepal Sustainable Development Goals Status and Road Map","author":"NPC","year":"2018"},{"issue":"11","key":"pone.0269926.ref067","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1007\/s00192-016-3038-0","article-title":"Prevalence of, and risk factors for, symptomatic pelvic organ prolapse in Rural Bangladesh: a cross-sectional survey study","volume":"27","author":"F Akter","year":"2016","journal-title":"International Urogynecology Journal"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0269926","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T13:40:40Z","timestamp":1655991640000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0269926"}},"subtitle":[],"editor":[{"given":"Pathiyil Ravi","family":"Shankar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,6,23]]},"references-count":67,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0269926","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,23]]}}}