Background: Back pain (BP) is among the most common musculoskeletal problems globally and is a leading contributor to disability among adults. Millions of women especially those in low-income settings, engage in strenuous domestic activities that may increase their risk of BP. The purpose of this meta-analysis was to estimate the association between physically demanding domestic labor (PDDL) which is characterized as intensity, frequency, duration of work and biomechanical risk factors of work and BP among women. Methods: Five databases were searched for records published from January 1991 to March 2020; and results from 11studies were included in the meta-analysis. A random effects model and the generic inverse-variance method was used to estimate the pooled odds ratio (OR), 95% confidence interval (CI), and the degree of heterogeneity among studies (I²). Stratified and sensitivity analyses were conducted to identify the influence of outliers and identify the sources of heterogeneity. Results: Exposure to high PDDL was significantly associated with BP (OR = 1.63; 95% CI 1.30, 2.04; I² = 70%). The odds of back pain were highest among the following groups: women performing domestic labor in non-neutral postures (OR = 2.30; 95% CI = 1.75–3.04; I² = 0%; N = 4 studies) and among women from low- and middle-income countries (OR = 1.98; 95% CI = 1.58–2.49; I² = 29%; N = 5 studies). We found no evidence of publication bias (Egger’s test p-value = 0.15). Conclusions: PDDL may significantly increase a woman’s risk of experiencing BP, but larger prospective studies are needed to further investigate the association. Presenting data on how domestic work affects the musculoskeletal health of women will be important in designing future interventions (behavioral, infrastructural, and ergonomic) that can reduce the burdens from domestic labor.

Gender norms prescribe domestic labor as primarily a female’s responsibility in developing countries. Many domestic tasks depend on access to water, so the physical, emotional, and time demands of domestic labor may be exacerbated for women living in water-insecure environments. We developed a set of domestic work experience (DWE) measures tailored to work in rural areas in developing countries, assessed rural Nigerian women’s DWE, and examined relationships among the measures. Interviewer-administered survey data were collected between August and September from 256 women in four rural Nigerian communities. Latent factors of DWE were identified by analyzing survey items using confirmatory factor analysis. Pearson’s correlation was used to examine relationships among latent factor scores, and multivariate linear regression models were used to determine if factor scores significantly differed across socio-demographic characteristics. The DWE measures consisted of latent factors of the physical domain (frequency of common domestic tasks, water sourcing and carriage, experience of water scarcity), the psychosocial domain (stress appraisal and demand–control), and the social domain (social support). Significant correlations were observed among the latent factors within and across domains. Results revealed the importance of measuring rural Nigerian women’s DWE using multiple and contextual approaches rather than relying solely on one exposure measure. Multiple inter-related factors contributed to women’s DWE. Water insecurity exacerbated the physical and emotional demands of domestic labor DWE varied across age categories and pregnancy status among rural Nigerian women.

Background: Women performing strenuous domestic tasks (especially those in developing countries) are at risk of experiencing musculoskeletal pain (MSP). Physical, psychosocial, and social conditions of work in rural environments contribute to women’s domestic work experiences (DWEs) and the risk of MSP. The impact of DWEs on women’s health is especially severe in water-insecure countries like Nigeria. This study examines the relationship between a recently developed measure of DWEs and self-reported pain in the lower back (LBP), neck/shoulder (NSP), and elbow/hand/wrist regions (EHWP) among rural Nigerian women. Methods: Interviewer-administered survey data were collected from 356 women in four rural communities of Ibadan, Nigeria. Binary and ordinal logistic regression models were used to examine the relationship between DWE factor scores, sociodemographic characteristics, and musculoskeletal pain symptoms and severity after controlling for sociodemographic covariates. Effect estimates of association were presented using the odds ratio (OR), and the corresponding 95% confidence interval (CI) at p-value of 0.05. Findings: Among 356 participants, the 2-month prevalence of LBP was 58%, NSP was 30%, and EWHP 30%. High DWE scores were significantly associated with higher odds of experiencing and having more severe LBP, NSP, and EHWP. Specifically, the odds of LBP [(OR = 2.88; 95% CI = 1.64–5.11), NSP (OR = 4.58; 95% CI = 2.29–9.40) and EHWP (OR = 1.88; 95% CI = 1.26–3.77)] were significantly higher among women who perceived their domestic work responsibilities as very stressful (i.e., ‘high stress appraisal’) compared to those with lower stress appraisal scores. Those who were time-pressured and had less autonomy over familial duties (i.e., ‘high demand/low control’) had significantly higher odds of LBP [(OR = 2.58; 95% CI = 1.64–4.09) and NSP (OR = 1.49; 95% CI = 1.24–2.58)]. Frequently fetching and carrying water over long distances and time (i.e., ‘high water sourcing and carriage’) was also associated with higher odds of LBP [(OR = 1.31; 95% CI = 1.09–1.79) and NSP (OR = 1.20; 95% CI = 1.08–1.76). Conclusion: Strenuous and stressful DWEs were associated with MSP among rural Nigerian women. This study provides new evidence on how the physical, social, and psychosocial factors of domestic work can increase women’s risk of MSP.

Introduction Global morbidity from enteric infections and diarrhea remains high in children in low- and middle-income countries (LMICs), despite significant investment over recent decades in health systems and global water and sanitation infrastructure. Other types of societal changes may be required to reduce disease burden. Ecological research on the influence of household and neighborhood societal development on pathogen transmission dynamics between humans, animals, and the environment could identify more effective strategies for preventing enteric infections. Methods and analysis The “enteric pathome” - i.e., the communities of viral, bacterial, and parasitic pathogens transmitted from human and animal feces through the environment is taxonomically complex in high burden settings. This integrated cohort-exposure assessment study leverages natural socio-economic spectrums of development to study how pathome complexity is influenced by household and neighborhood development. We are enrolling under 12-month-old children in low- and middle-income neighborhoods of two Kenyan cities (Nairobi and Kisumu) into a “short-cohort” study involving repeat testing of child feces for enteric pathogens. A mid-study exposure assessment documenting infrastructural, behavioral, spatial, climate, environmental, and zoonotic factors characterizes pathogen exposure pathways in household and neighborhood settings. These data will be used to inform and validate statistical and agent-based models that identify individual or combined intervention strategies for reducing multi-pathogen transmission between humans, animals, and environment in urban Kenya. Ethics and dissemination The protocols for human subjects’ research were approved by Institutional Review Boards at the University of Iowa (ID - 202004606) and AMREF Health Africa (ID - ESRC P887/2020), and a national permit was obtained from the Kenya National Commission for Science Technology and Innovation (NACOSTI) (ID# P/21/8441). The study was registered on Clinicaltrials.gov (Identifier: NCT05322655). Protocols for research on animals were approved by the University of Iowa Animal Care and Use Committee (ID 0042302). STRENGTHS AND LIMITATIONS OF THE STUDY This cohort-exposure assessment study will provide new evidence on the nature of household and neighborhood developmental strategies that are most effective at preventing critical multi-pathogen transmission pathways among humans, animals, and environment in cities of low- and middle-income countries. We study middle class households and neighborhoods to test counterfactual theories about meeting basic developmental standards to reduce pathogen transmission. Our data collection uses objective methods to comprehensively document socioeconomic, weather, infrastructural, spatial, behavioral, environmental, zoonotic, and human data, including use of both selective culture and molecular methods to characterize pathogen community patterns. The observational study design is vulnerable to unmeasured confounders. The living conditions in middle-class households and neighborhoods may not offset hygiene conditions in the overall urban environment enough to alter enteric pathogen transmission patterns.

Background: Back pain (BP) is among the most common musculoskeletal problems globally and is a leading contributor to disability among adults. Millions of women especially those in low-income settings, engage in strenuous domestic activities that may increase their risk of BP. The purpose of this meta-analysis was to estimate the association between physically demanding domestic work (PDDW) which is characterized as intensity, frequency, duration of work and biomechanical risk factors of work and BP among women. Methods: Five databases were searched for records published from January 1991 to March 2020; and results from 11studies were included in the meta-analysis. A random effects model and the generic inverse-variance method was used to estimate the pooled odds ratio (OR), 95% confidence interval (CI), and the degree of heterogeneity among studies (I²). Stratified and sensitivity analyses were conducted to identify the influence of outliers and identify the sources of heterogeneity. Results: Exposure to high physically demanding domestic work was significantly associated with BP (OR = 1.63; 95% CI 1.30, 2.04; I² =70%). The odds of back pain were highest among the following groups: women performing domestic work in non-neutral postures (OR=2.30; 95% CI= 1.75 – 3.04; I² = 0%; N= 4 studies) and among women from low and middle income countries (OR= 1.98; 95% CI = 1.58-2.49; I²=29%; N = 5 studies). We found no evidence of publication bias (Egger’s test p-value = 0.15).Discussion: PDDW may significantly increase a woman’s risk of experiencing BP, but larger prospective studies are needed to further investigate the association. Presenting data on how domestic work affects the musculoskeletal health of women will be important in designing future interventions (behavioral, infrastructural and ergonomic) that can reduce domestic work burden

The National Institutes of Health (NIH) supported the Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) program, which aims to ensure that all Americans have access to COVID-19 testing and promotes health equity, especially in underserved communities. Under RADx-UP, there are two pilot programs – Community Collaboration Grants (C2G) and Rapid Research Pilot Program (RP2) – that fund projects to conduct community-engaged outreach and research to address COVID-19 testing disparities. As such, we sought to assess projects’ health equity impacts within their priority populations. Our evaluation team used cognitive interviews with C2G and RP2 project representatives to revise health equity metrics within an existing Health Impact Assessment (HIA) tool to measure health equity impacts within these community-engaged research projects. During interviews, participants indicated that we needed to improve the clarity and readability of key terms and phrases related to health equity, and they provided suggestions for how to tailor metrics to community partners. In this paper, we highlight our process of adapting the original metrics and share lessons learned that other evaluators may apply to their work. Our project highlights the importance of cognitive interviewing as a critical methodology to tailor an existing pilot-tested HIA to a community-based audience; however, it also sheds light on the difficulties of measuring health equity within community-engaged research initiatives and future recommendations.