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Abstract
Objective:
This study investigated the relationship between microbial contamination of drinking water sources and the burden of gastrointestinal illnesses among communities affected by the 2022 floods in Pakistan. The research aimed to quantify contamination levels, document disease prevalence, and evaluate the extent to which flood-related disruption of water systems contributed to increased cases of diarrhea and dysentery.
Methods:
A cross-sectional environmental health field study with retrospective epidemiological analysis was conducted across four flood-impacted districts in Sindh and Punjab Provinces between October and December 2022. Water samples were collected from hand pumps, wells, surface water points, and temporary storage containers. These samples were analyzed for Escherichia coli, total coliforms, turbidity, and residual chlorine using standard WHO-recommended microbial assessment protocols. Household surveys (n=1,240) and medical records from primary health centers (n=17,892 patient entries) were reviewed to document gastrointestinal symptoms and verified diagnoses. Multivariate logistic regression was applied to evaluate associations between contamination levels and reported illnesses.
Results:
Microbial contamination exceeded WHO drinking water safety limits in 78.4% of sampled sources. E. coli concentrations were significantly higher in surface water points and temporary storage vessels compared with groundwater sources. Districts exhibiting the highest contamination—particularly those where floodwaters remained stagnant for prolonged periods—also recorded markedly higher gastrointestinal illness prevalence. Regression analysis demonstrated that households consuming water with elevated E. coli counts were more likely to report diarrhea (adjusted OR 3.41, 95% CI 2.62–4.38) and dysentery (adjusted OR 2.97, 95% CI 2.16–3.89). Medical center records showed a 2.6-fold increase in diarrhea cases during the post-flood period compared with baseline seasonal trends.
Conclusion:
The 2022 Pakistan floods led to widespread deterioration of drinking water quality, and microbial contamination played a substantial role in elevating the gastrointestinal illness burden. The findings underscore the urgent need for flood-resilient water infrastructure, emergency water treatment interventions, and sustained monitoring in disaster-prone regions. Future policy directions must prioritize integrated water, sanitation, and hygiene (WASH) strategies capable of protecting public health during climate-induced disasters.