Research Paper Access to groundwater and link to the impact on quality of life: A look at the past, present and future public health needs in Mzimba District, Malawi Kerstin Rieger a , Rochelle H. Holm b,n , Helen Sheridan c,n a Masters in Development Practice, Trinity College Dublin, School of Natural Science, Geography Department, College Green, Dublin 2, Ireland b Centre of Excellence in Water and Sanitation, Mzuzu University, P/Bag 201, Mzuzu 2, Malawi c Natural Product Chemistry, Trinity College Dublin, School of Pharmacy and Pharmaceutical Sciences, Panoz Institute, East End 3, Dublin 2, Ireland article info Article history: Received 10 August 2015 Received in revised form 10 June 2016 Accepted 22 July 2016 Available online 26 July 2016 Keywords: Quality of life Water quality Public health Sanitation and hygiene Malawi abstract Imagine a world where you have to get up at 4am to walk for two hours in the dark to fetch water. This remains true in Malawi, where it is said that the Millennium Development Goals have been met. This research aimed at understanding the impact access to groundwater has on people's ‘Being’, ‘Belonging’ and ‘Becoming,’ as well as on people's capabilities and on their quality of life in Mzimba District, Malawi. Being, Belonging and Becoming define three life domains. Being reveals ‘who one is,’ Belonging reflects ‘connections with one's environments’ and Becoming relates to ‘achieving personal goals, hopes and aspirations.’ The study comprised of 210 households, four treatment groups based on communities consisting of households with access to a hand pump and compared to four control group communities, where households had no access to a hand pump. Results showed current awareness of environmental issues is linked to recognising future (5 years in advance) environmental challenges. There is a need to create awareness of water quality within the communities and point-of-use household water treatment. Both the treatment- and control group had a gap in sanitation facilities, with up to 27 people (5–6 households) sharing a single pit latrine. Polygamous marriages had implications on self-respect and led to neglect on the first wives. Focus group discussions revealed HIV, disabilities and mental health issues, including the use of drugs and alcohol, affect freedom, and created a burden, not only for affected in- dividuals, but also for their extended families. Focus groups highlighted safe and clean drinking water, improved sanitation facilities, better hygiene, and accessible public health services as pressing needs. The implications of this study demonstrate, rural individuals ‘Being’, ‘Belonging’ and ‘Becoming’ need to be considered when addressing pressing public health needs, as Malawi works toward the Sustainable Development Goals for water supply. & 2016 Published by Elsevier B.V. 1. Introduction Improved drinking water sources became a reality for 2.3 bil- lion people between 1990 and 2012 (United Nations, 2014). In 2015, 663 million people worldwide, mostly rural, still relied on unimproved water sources such as surface water from lakes or dams for drinking, cooking and hygiene purposes. In addition, globally 2.4 billion people still have no access to improved sani- tation facilities and only half of the rural population uses improved sanitation facilities (UNICEF and World Health Organization, 2015). In September 2015, the United Nations announced the new 17 Sustainable Development Goals (SDGs) replacing the MDGs. Goal 6 demands ‘Clean Water and Sanitation’ to “Ensure availability and sustainable management of water and sanitation for all” (UN De- partment of Economic and Social Affairs, 2015). Although economic and social development in Sub-Saharan Africa is fundamentally reliant on the role groundwater plays, this resource-base and its use, are not sufficiently understood (Pavelic et al., 2012). There is a lack of reliable data in Sub-Saharan Africa and the records, when available, have been gathered in an un- systematic manner. The reasons are complex and numerous, in- cluding the absence of clear institutional responsibilities and protocols, lack of technical expertise, inadequate resources and the non-existence of database management systems (Adelana et al., 2008). Malawi is a land-locked country in Sub-Saharan Africa with a Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/gsd Groundwater for Sustainable Development http://dx.doi.org/10.1016/j.gsd.2016.07.002 2352-801X/& 2016 Published by Elsevier B.V. n Corresponding authors. E-mail addresses: riegerk@tcd.ie (K. Rieger), rochelle@rochelledholm.com (R.H. Holm), hsheridn@tcd.ie (H. Sheridan). Groundwater for Sustainable Development 2-3 (2016) 117–129