Inequalities in Access to Safe Water and Nursing Care
Keywords:
water; care; inequality; nursing; gender; Africa; AngolaAbstract
Access to safe water constitutes an essential key determinant of health and social well-being. Inequalities in water availability and quality disproportionately affect women and girls, who assume most of the work related to water supply and management. Therefore, to analyze, through a literature review, how inequalities in access to safe water, the gender approach, and Nursing care disproportionately affect water availability and management, based on a narrative synthesis of studies published on between 2019 and 2024. Databases such as PubMed, Scopus, and Web of Science were consulted. Observational, cross-sectional studies, and controlled trials that evaluated health indicators, unpaid workload, and psychosocial aspects associated with water access and gender were included. Limited access and poor water quality are associated with infectious diseases, physical burden, and stress in women. In Cuito Bie, women and children transport water from wells or rivers, which increases health and physical risks. Strengthening Nursing action in health education, prevention, and hygiene promotion is required. Inequality in water access constitutes a structural health problem with gender-differentiated effects. Guaranteeing equitable availability and quality of water and considering the gender perspective allow for improving health and care.
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References
1.World Health Organization. Drinking-water. Geneva: WHO; 2023 [citado 10/03/2026]. Disponible en: https://www.who.int/news-room/fact-sheets/detail/drinking-water
2.United Nations Children’s Fund (UNICEF). Progress on household drinking water, sanitation and hygiene 2000–2022. New York: UNICEF; 2023 [citado 10/03/2026]. Disponible en: https://www.unicef.org/reports/progress-on-household-drinking-water-sanitation-and-hygiene-2000-2022
3.World Bank. Water supply, sanitation, and hygiene in Sub-Saharan Africa. Washington DC: World Bank; 2022 [citado 10/03/2026]. Disponible en: https://www.worldbank.org/en/topic/water
4. Prüss-Ustün A, Wolf J, Bartram J, Clasen T, Cumming O, Freeman MC et al. Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries. International Journal of Hygiene and Environmental Health. 2019[citado 10/03/2026];222(5):765-7. Disponible en: https://www.sciencedirect.com/science/article/pii/S1438463918310484?via%3Dihub
5.Brewis A, Wutich A. Gendered dimensions of water insecurity. Am J Hum Biol. 2021 [citado 10/03/2026];33(3):e23485. Disponible en: https://doi.org/10.1002/ajhb.23485
6.World Health Organization, United Nations Children's Fund (UNICEF). Progress on household drinking water, sanitation and hygiene 2000-2022: Special focus on gender. Geneva: WHO; 2023 [citado 10/03/2026]. Disponible en: https://www.who.int/publications/i/item/9789240075085
7.United Nations. The United Nations World Water Development Report 2023: Partnerships and cooperation for water. Paris: UNESCO; 2023 [citado 10/03/2026]. Disponible en: https://unesdoc.unesco.org/ark:/48223/pf0000384661
8.Sorenson SB, Morssink C, Campos PA. Safe access to safe water in low-income countries. Soc Sci Med. 2021 [citado 10/03/2026];283:114161. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0277953611001572?via%3Dihub
9.Stevenson EGJ, Ambelu A, Caruso BA, Tesfaye Y, Freeman MC. Community water improvement and women’s psychological distress. Soc Sci Med. 2022 [citado 10/03/2026];292:114620. Disponible en: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0153432
10.Geere JL, Hunter PR, Jagals P. Domestic water carrying and its implications for health: a review and mixed methods pilot study in Limpopo Province, South Africa. Environmental health : a global access science source. 2010 [citado 10/03/2026]; 9(52). Disponible en: https://doi.org/10.1186/1476-069X-9-52
11.Caruso BA, Clasen T, Hadley C, Yount KM, Haardörfer R, Rout M, et al. Understanding gender disparities in water access. Environ Res. 2022 [citado 10/03/2026];204:112145. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S1462901124001874
12.Pickering AJ, Null C, Winch PJ, Mangwadu G, Arnold BF, Prendergast AJ, et al. The WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrhoea. Lancet Glob Health. 2019 [citado 10 /03/2026];7(8):e1139-46. Disponible en: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30268-2/fulltext
13.Collins SM, Mbullo P, Boateng GO, Young SL. Water insecurity and mental health in low-income settings. BMJ Glob Health. 2023 [citado 10/03/2026];8(5):e013754. Disponible en: https://doi.org/10.1136/bmjgh-2023-013754
14. Sommer M, Ferron S. Gender, water and health: new perspectives. J Water Health. 2014 [citado 10/03/2026];19(5):765-77. Disponible en: https://om.ciheam.org/om/pdf/a64/06002387.pdf
15. Prüss-Ustün A, Wolf J, Bartram J, Clasen T, Cumming O, Freeman MC, et al. Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries. Int J Hyg Environ Health. 2019[citado 10/03/2026];222(5):765-7. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC6593152/
16.Bain R, Johnston R, Mitis F, Chatterley C, Slaymaker T. Establishing sustainable development goal baselines for drinking water. Sci Total Environ. 2018 [citado 10/03/2026] ;10(12):1711. Disponible en: https://www.mdpi.com/2073-4441/10/12/1711
17.Shields KF, Bain RE, Cronk R, Wright JA, Bartram J. Association of water supply interruptions with illness. Water Res. 2022 [citado 10 mar 2026] Disponible en:
18.Cumming O, Arnold BF, Ban R, Clasen T, Esteves Mills J, Freeman MC, et al. The implications of water and sanitation interventions. Lancet. 2026 [citado 10/03/2026];60(4):2917–29 . Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC12874536/
19.Freeman MC, Garn JV, Sclar GD, Boisson S, Medlicott K, Alexander KT, et al. The impact of sanitation on infectious disease outcomes. PLoS Med. 2017 [citado 10/03/2026];220:928-49. Disponible en: https://www.sciencedirect.com/science/article/pii/S1438463917301529
20.Yearwood EL. Lessons learned from the 2023 International Council of Nurses Congress. Archives of Psychiatric Nursing. 2023 [citado 10/03/2026];45:192. Disponible en: https://www.psychiatricnursing.org/action/showPdf?pii=S0883-9417%2823%2900105-X
21.World Health Organization. Infection prevention and control global report 2023 Geneva: WHO; 2023 [citado 10/03/2026]. Disponible en: https://www.who.int/publications/i/item/9789240051164
22.Luby SP, Rahman M, Arnold BF, Unicomb L, Ashraf S, Winch PJ, et al. Effects of water quality, sanitation, and hygiene interventions on child health outcomes: a cluster randomized trial. N Engl J Med. 2018 [citado 10/03/2026];386:234-245. Disponible en: https://doi.org/10.1056/NEJMoa2104120
23. Sinazo Sixolisiwe T, Lungisa S, Mgweba L. Thirsting for solutions: Unpacking inadequate water provision in rural communities. Africa’s Public Service Delivery and Performance. 2025 [citado 10/03/2026];13(1):e873. Disponible en: https://apsdpr-org.translate.goog/index.php/apsdpr/article/view/873/1727?_x_tr_sl=en&_x_tr_tl=es&_x_tr_hl=es&_x_tr_pto=tc
24. Akpabio EM, Ozoh SI. Household access to water, sanitation, and hygiene services in Cross River State, Nigeria: patterns, challenges, and community participation. Water Policy. 2026 [citado 10/03/2026];28(4):651-74. Disponible en: https://iwaponline.com/wp/article/28/4/651/111413/Household-access-to-water-sanitation-and-hygiene
25.Bose D, Bhattacharya R, Wright J, Kaur T, Banerjee R, Bhatia T. Overcoming water, sanitation, and hygiene challenges in critical regions of the global community. Water-Energy Nexus. 2024 [citado 10/03/2026];7:277-96. Disponible en: https://www.sciencedirect.com/science/article/pii/S2588912524000171
26.World Health Organization (WHO)/UNICEF. Progress on drinking water, sanitation and higiene in schools 20215-2025: 2026 update Geneva: WHO; 2021 [citado 10/03/2026]. Disponible en: https://www.who.int/publications/m/item/progress-on-drinking-water--sanitation-and-hygiene-in-schools---2015-2025
27.Alamanos A, Xenarios S, Assubayeva A, Michel Landis CF, Dellis K, Koundouri P. Systems-thinking innovations for water security. Frontiers. 2025 [citado 10/03/2026];6. Disponible en: https://www.frontiersin.org/journals/water/articles/10.3389/frwa.2024.1492698/full
28.Howard G, Bartram J. Domestic water quantity, service level and health . 2ª ed. Geneva: WHO; 2020 [citado 10/03/2026]. Disponible en: https://www.who.int/publications/i/item/9789241515917
29.United Nations. World Water Development Report 2022: Groundwater: Making the invisible visible Paris: UNESCO; 2022 [citado 10/03/2026]. Disponible en: https://unesdoc.unesco.org/ark:/48223/pf0000380753
30. Lo S, Kojok R, Kirkpatrick CR, Del Pozo AG, Le TT, DePledge L, et al. Drinking water and the implications for gender equity and empowerment: A systematic review of qualitative and quantitative evidence. International journal of hygiene and environmental health, 2023 [citado 17/05/2026];247;114044. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC12834121/
31.Mutanda GW, Nhamo G. Gendered perspective on water security, rights and conflicts in sub-Saharan Africa: a systematic review. Front Water 2024 [citado 17 ago 2026];6:1399415. Disponible en: https://www.researchgate.net/publication/382349589_Gendered_perspective_on_water_security_rights_and_conflicts_in_sub-Saharan_Africa_a_systematic_review
32.Macura B, Foggitt E, Liera C, Soto A, Orlando A, Del Duca L, et al. Systematic mapping of gender equality and social inclusion in WASH interventions: knowledge clusters and gaps. BMJ Glob Health. 2023 [citado 17/05/2026];8(1):e010850. Disponible en: https://gh.bmj.com/content/8/1/e010850
33.Caruso BA, Conrad A, Patrick M, Owens A, Kviten K, Zarella O, et al. Water, sanitation, and women's empowerment: a systematic review and qualitative metasynthesis. PLOS Water. 2022 [citado 17/05/2026];1(6):e0000026. Disponible en: https://journals.plos.org/water/article?id=10.1371/journal.pwat.0000026
34.Pouramin P, Nagabhatla N, Miletto M. A systematic review of water and gender interlinkages: assessing the intersection with health. Front Water. 2020 [citado 17/05/2026];2:6. Disponible en: https://www.researchgate.net/publication/340654705_A_Systematic_Review_of_Water_and_Gender_Interlinkages_Assessing_the_Intersection_With_Health
35.Sultana A, Wilson J, Martin-Hill D, Davis-Hill L, Homer J. Assessing the impact of water insecurity on maternal mental health at Six Nations of the Grand River. Front Water 2022 [citado 17/05/2026];4:834080. Disponible en: https://www.frontiersin.org/journals/water/articles/10.3389/frwa.2022.834080/full
36.Tallman PS, Collins SM, Chaparro MP, Salmon-Mulanovich G. Water insecurity, self-reported physical health, and objective measures of biological health in the Peruvian Amazon. Am J Hum Biol. 2022 [citado 17/05/2026];34(12):e23805. Disponible en: https://onlinelibrary.wiley.com/doi/10.1002/ajhb.23805
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