Abstract
Primary-school children in low- and middle-income countries are often deprived of microbiologically safe water and sanitation, often resulting in a high prevalence of gastrointestinal diseases and poor school performance. We used Quantitative Microbial Risk Assessment (QMRA) to predict the probability of infection in schoolchildren due to consumption of unsafe school water. A multistage random-sampling technique was used to randomly select 425 primary schools from ten districts of Sindh, Pakistan, to produce a representative sample of the province. We characterized water supplies in selected schools. Microbiological testing of water resulted in inputs for the QMRA model, to estimate the risks of infections to schoolchildren. Groundwater (62%) and surface water (38%) were identified as two major sources of drinking water in the selected schools, presenting varying degrees of health risks. Around half of the drinking-water samples were contaminated with Escherichia coli (49%), Shigella spp. (63%), Salmonella spp. (53%), and Vibrio cholerae (49%). Southern Sindh was found to have the highest risk of infection and illness from Campylobacter and Rotavirus. Central and Northern Sindh had a comparatively lower risk of waterborne diseases. Schoolchildren of Karachi were estimated to have the highest probability of illness per year, due to Campylobacter (70%) and Rotavirus (22.6%). Pearson correlation was run to assess the relationship between selected pathogens. V. cholerae was correlated with Salmonella spp., Campylobacter, Rotavirus, and Salmonella spp. Overall, the risk of illness due to the bacterial infection (E. coli, Salmonella spp., V. cholerae, Shigella, and Campylobacter) was high. There is a dire need for management plans in the schools of Sindh, to halt the progression of waterborne diseases in school-going children.
Highlights
The United Nations has estimated that at least 2.5 billion people in low- and middle-income countries lack access to improved sanitation, and over 884 million lack access to improved drinkingInt
Across all schools, 49% of the drinking-water samples were contaminated with E. coli, 54% with Salmonella spp., 49% with V. cholerae, and 63% were contaminated with Shigella (Table 3)
The latest Pakistan demographic and health survey in the community settings of the study area reported a high prevalence of waterborne diseases, such as diarrhea, dysentery, cholera, and typhoid [36], which aligns with the high-risk pathogens we found in our study
Summary
The United Nations has estimated that at least 2.5 billion people in low- and middle-income countries lack access to improved sanitation, and over 884 million lack access to improved drinkingInt. The United Nations has estimated that at least 2.5 billion people in low- and middle-income countries lack access to improved sanitation, and over 884 million lack access to improved drinking. Res. Public Health 2020, 17, 2774; doi:10.3390/ijerph17082774 www.mdpi.com/journal/ijerph. Res. Public Health 2020, 17, 2774 water [1]. An estimated 2.3 billion people across the world are suffering from water-related diseases [2]. Consumption of pathogenic microorganisms in drinking water may pose serious health risks due to waterborne diseases [3,4]. Drinking water is considered one of the important reservoirs of microbes in developing countries. Four Billion cases of diarrhea are reported each year, of which 2.2 million result in death, and children under five years are the main victims.
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