Health impacts of pedestrian head-loading: A review of the evidence with particular reference to women and children in sub-Saharan Africa

Across sub-Saharan Africa, women and children play major roles as pedestrian load-transporters, in the widespread absence of basic sanitation services, electricity and affordable/reliable motorised transport. The majority of loads, including water and firewood for domestic purposes, are carried on the head. Load-carrying has implications not only for school attendance and performance, women's time budgets and gender relations, but arguably also for health and well-being. We report findings from a comprehensive review of relevant literature, undertaken June–September 2012, focussing particularly on biomechanics, maternal health, and the psycho-social impacts of load-carrying; we also draw from our own research. Key knowledge gaps and areas for future research are highlighted. •Across Africa, women and children play major roles as head-loaders.•Head-loading may have serious detrimental health impacts, but research is limited and inconclusive.•Head-loading represents a potentially huge, hitherto unrecognised, public health issue in Africa.