The World Health Organization (WHO) advocates universal access to safe drinking water (DW) by 2030 in order to mitigate waterborne diseases (WBDs). Mitigating WBDs necessitates access to clean water devoid of pathogens such as Escherichia coli. Despite advancements, urban areas such as Jalandhar continue to grapple with recurrent outbreaks of diarrhoea, cholera, hepatitis A, and hepatitis E. Zero E. coli presence in water samples is considered safe DW. This study aims to find out whether DW supplied and available in Bist Doab region is free from faecal contamination and safe to drink per the WHO Standards. A total of 32 samples were collected from six distinct villages, alongside 23 samples from three urban wards of Jalandhar and tested using spreading techniques, involving bacterial screening and quantification of colony-forming units to ascertain E. coli contamination levels. The results reveal that 56.5% of urban DW samples exhibited potential health risks attributable to contamination, while rural counterparts demonstrated significantly lower E. coli levels. An area-specific approach and a three-tier policy are proposed through this research work to combat WBDs effectively and efficiently in our developing nation.

  • Approximately 56% of drinking water (DW) samples tested from urban areas were found contaminated with Escherichia coli.

  • Approximately 21.9% of rural DW samples were unsuitable to drink directly.

  • Challenges in urban areas are unauthorised connections of water supply, sewerage congestion, and garbage accumulation.

Ensuring universal access to clean water and sustainable management of water, sanitation, and hygiene (WASH) by 2030 stands as a pivotal objective within the Sustainable Development Goals 2017 framework (Bhaduri et al. 2016; Bain et al. 2018). However, recent assessments by the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF) highlight the urgent need for significantly accelerated progress to fulfil over 99% of WASH criteria (Girmay et al. 2023). Presently, a staggering 780 million individuals worldwide grapple with the absence of clean water access (Kumar et al. 2022), a predicament that engenders myriad health challenges, particularly waterborne diseases (WBD). Indeed, inadequate sanitation and contaminated water precipitate a plethora of health issues, with waterborne infections exacting a notable toll. According to a 2015 WHO report, these factors contributed to 6.5% of global mortality; moreover, WHO estimates that bolstering sanitation, hygiene, and water supply efforts could avert 4% of the world's disease burden.

In India alone, UNICEF approximates that waterborne illnesses account for 37.7 million infections annually, leading to 1.5 million child fatalities attributed solely to diarrhoea, along with 73 million lost productivity days due to such illnesses (UNICEF 2024). Additionally, projections suggest that the substantial disease burden induced by waterborne illnesses significantly impedes the nation's economic advancement (Pathak 2015). A cornerstone in ameliorating this situation lies in furnishing the populace with access to safe and adequate drinking water (DW) services. According to WHO, this approach is paramount for enhancing health and well-being and curbing waterborne illnesses (WHO 2024). WHO delineates improved DW sources as those located within structures, readily accessible, and devoid of harmful or faecal matter (WHO 2024).

The assessment of bacterial quality serves to elucidate the potential for faecal contamination within potable water sources (Khan & Gupta 2020). Ingesting bacteria in DW presents significant health risks, including gastrointestinal infections (Jang et al. 2017). Hence, it is imperative to vigilantly monitor and maintain bacteriological standards to safeguard community health (Shah et al. 2023). DW reservoirs are susceptible to contamination by diverse bacterial strains, including pathogenic entities such as Salmonella, Campylobacter, and Escherichia coli (E. coli), stemming from various sources such as sewage discharge, agricultural runoff, and inadequate sanitation practices (Kass et al. 2005; Arya et al. 2019). Particularly in locales with deficient water treatment or inadequate disinfection protocols, these bacteria can proliferate within water reservoirs (Khan et al. 2022). Coliform bacteria serve as commonly utilized indicators of faecal contamination, as their presence indicates the potential for faecal pathogen infiltration (Edberg et al. 2000). The detection and quantification of coliform bacteria and E. coli serve as pivotal markers of water quality, with the absence of E. coli per 100 mL of water deemed safe for human consumption (Mara & Horan 2003).

According to routine reports from the Office of Integrated Disease Surveillance Programme (IDSP 2005–2023), instances of diarrheal outbreaks persist in Punjab and India. Within the Doaba region, which comprises four districts and 29 health blocks, diarrheal outbreaks are recurrent, particularly during hot and humid seasons (IDSP 2024). While typhoid remains under control, cases of cholera have been reported by the IDSP, along with an outbreak of hepatitis A and E. Despite the Ministry of Jal Sakti, the Government of India's assurance of the public provision of DW in all villages, the recurring outbreaks of cholera, viral hepatitis, and diarrheal illnesses suggest potential faecal contamination of DW (Haumba 2023). Indeed, an IDSP study revealed that the consumption of contaminated water resulting from the intermingling of sewage water with DW supplies was the predominant cause of waterborne illness outbreaks. Thus, this study aims to assess the microbial quality of DW supplied to and utilized by residents of the Bist Doab region, encompassing both urban and rural areas and to identify which reasons prevail in urban and rural areas that lead to such pollution.

The universe of study

Bist Doab is a geographical unit located between two rivers namely River Beas and River Sutluj. Total coliform level in lower courses of both rivers are found much higher than upper courses. In addition, sites where samples were tested were classified as B, C, D, E water class of designated best use (Statistical Abstract 2021), making Bist Doab region vulnerable to WBDs such as diarrhoea, typhoid, cholera, and hepatitis A and E. Bist Doab has 29 health blocks and areas located near the lower river courses and its tributaries recorded higher number of diarrhoea and typhoid cases per annum than the upper courses of the river (IDSP, Punjab). Therefore, this study aims to test faecal contamination in DW sources present in Bist Doab. Water sources used for drinking purpose in the urban areas are public supply only. People are not allowed to bore their own submersible in the houses or in their premises. In urban areas, public supply water is distributed twice a day, 2–3 h in the morning shift generally from 6 to 9 a.m., but timings vary a little from area to area. During the evening time, water supply timing is also for 3 h mainly from 5 to 8 p.m. Conversely, water sources used in rural areas are public supply, submersibles, hand pumps, and common submersibles. Public water is supplied from 6 to 8 a.m. in the morning and during evening public water is supplied generally for 1–1:5 h. Each village has different timings during the evening; however, the general time is 3 p.m. onwards upto 7 p.m. People using submersibles (private bore inside premises) have water for 24/7. Hand pumps are used by few labourers and migrant families only. During the survey, it was found in one village that people were using a common submersible in which 15–20 houses were getting DW supply from a single bore and the bore is owned by the community.

Primary survey

Sample collection followed a multistage systematic and random sampling methodology. Initially, 29 health blocks were prioritized based on household count and categorized into high, medium, and low categories. One health block from each category was randomly selected as a sample. Subsequently, villages were similarly categorized by household count, and the first village from each category was chosen as a sample. Similarly, wards were categorized, and the first ward from each category was selected as a sample. In total, five enumeration block clusters and six villages were chosen for the survey Figure 1.

Sampling points were further categorized to include water sources used by the households, ensuring diverse and representative data. Measures to prevent cross-contamination were strictly adhered to, including sterilized equipment, aseptic techniques, and immediate storage in ice-cooled conditions for laboratory analysis

Water sample details

DW samples were collected from households of selected villages and wards using the discrete grab sampling method. Water samples were collected from the DW sources only, which were identified by a pilot survey of sampled villages and wards (Tables 1 and 2). This study aims to determine DW quality supplied in sampled villages and wards, hence, a cross-sectional study was conducted. People in rural areas utilize public supply, direct submersibles, and hand pumps for drinking purposes and only public supply was the source of DW in urban areas. It was ensured to collect samples from each source in the rural areas. In urban areas, the only source of DW was public supply, so it was ensured to collect sufficient samples from the areas to assess quality of DW supplied. WHO recommends to collect one sample for every 5,000 people in normal conditions from every source so the same was taken into consideration for this study (WHO 2011). Sterile 70 mL plastic bottles were utilized for sample collection from various DW sources, adhering strictly to standard procedures and safety protocols. To ensure the decontamination of the samples, running water samples were collected after allowing the taps to run for a brief period. Prior to sampling, the initial portion of water was discarded, and the midstream was collected to minimize potential contamination from atmospheric air and ensure sample integrity. Each sample was carefully labelled with the location name and source and stored in sealed envelopes. Furthermore, the survey documented the temperature of the running water and the latitude and longitude of the sampling site. Samples were stored in an ice box until they could be transported to the laboratory for analysis.

The procedure of the water sample test

The detection of E. coli in water samples was conducted using eosin methylene blue (EMB) agar plates following a standardized protocol. Prior to use, the plates were verified for proper storage conditions and expiration dates and allowed to reach room temperature to prevent condensation. A sterilized cotton swab was used to spread water samples onto the agar under aseptic conditions. Plates were labelled with sample-specific details and incubated upside down at 37 °C for 24 h. Post-incubation, the plates were inspected for bacterial growth, with particular attention to colonies exhibiting a metallic green sheen, a hallmark of E. coli. A representative colony was selected for confirmatory testing, where Gram staining revealed the characteristic morphology of Gram-negative bacilli. The findings were evaluated based on WHO guidelines to assess the health risks associated with water contamination. This protocol ensured a systematic, reliable approach to identifying E. coli in environmental water samples (Table 3).

In addition to the identification of pathogens, the assessment of water quality involves measuring key physicochemical parameters, including pH, temperature, and total dissolved solids (TDS).

pH determination

pH is crucial as it influences the solubility and speciation of chemical compounds in water. To measure pH, a calibrated pH meter is employed, and readings are taken directly from the water sample. Normal pH levels for DW typically range between 6.5 and 8.5, with variations indicating potential contamination or changes in water chemistry.

Temperature determination

Temperature is another vital parameter, as it impacts the rate of chemical reactions and biological processes. A calibrated thermometer is used to measure the water temperature, with the standard being around 25 °C. Significant deviations may suggest abnormal environmental conditions or potential contamination sources.

Total dissolved solids

TDS represent the total concentration of inorganic and organic substances dissolved in water. This includes minerals, salts, and other compounds. TDS determination is often performed using a handheld TDS meter or by gravimetric analysis. Elevated TDS levels may indicate the presence of contaminants and affect the water's taste and safety. The acceptable range for TDS in DW varies based on regional and international guidelines. However, a general guideline for acceptable TDS range for DW is as follows: good quality water = 0–300 mg/L (or ppm), fair quality water = 300–600 mg/L (or ppm), and poor quality water = 600 mg/L and above.

Table 1

Water sample area, sample date, and geographical coordinates and elevation

WardSNArea nameSample dateLatitudeLongitudeElevation
Ward 1 Ashok Vihar 18/02/2024 31°22′13.49″N 75°33′37.53″E 259 m 
Indra Colony 18/02/2024 31°22′03.43″N 75°33′32.82″E 263 m 
Ward 17 Bashirpura 9/01/2024 31°19′45.66″N 75°35′56.37″E 260 m 
Kamal Vihar 9/01/2024 31°19′31.34″N 75°36′12.21″E 255 m 
Ward 35 Bhargo Camp 25/12/2023 31°18′53.35″N 75°33′56.88″E 258 m 
WardSNArea nameSample dateLatitudeLongitudeElevation
Ward 1 Ashok Vihar 18/02/2024 31°22′13.49″N 75°33′37.53″E 259 m 
Indra Colony 18/02/2024 31°22′03.43″N 75°33′32.82″E 263 m 
Ward 17 Bashirpura 9/01/2024 31°19′45.66″N 75°35′56.37″E 260 m 
Kamal Vihar 9/01/2024 31°19′31.34″N 75°36′12.21″E 255 m 
Ward 35 Bhargo Camp 25/12/2023 31°18′53.35″N 75°33′56.88″E 258 m 

Source: Primary survey, Mobile global positioning system (GPS), and Google Earth Pro.

Table 2

Rural water sample area, sample date, and geographical coordinates and elevation

Health blocksSNVillageSample dateLatitudeLongitudeElevation
Mehatpur Shankar 29/02/2024 31°08′51.83″N 75°32′03.12″E 247 
Chak Kalan 1/03/2024 31°10′37.35″N 75°31′44.85″E 245 
Nawanpind Jattan 29/02/2024 31°06′10.45″ 75°25′11.63″E 256 
Phagwara Panchhat 11/03/2024 31°20′16.09″N 75°52′20.20″E 269 
10 Khera 11/03/2024 31°13′38.77″N 75°43′08.32″E 254 
11 Athouli 12/03/2024 31°11′55.69″N 75°45′31.84″E 252 
Health blocksSNVillageSample dateLatitudeLongitudeElevation
Mehatpur Shankar 29/02/2024 31°08′51.83″N 75°32′03.12″E 247 
Chak Kalan 1/03/2024 31°10′37.35″N 75°31′44.85″E 245 
Nawanpind Jattan 29/02/2024 31°06′10.45″ 75°25′11.63″E 256 
Phagwara Panchhat 11/03/2024 31°20′16.09″N 75°52′20.20″E 269 
10 Khera 11/03/2024 31°13′38.77″N 75°43′08.32″E 254 
11 Athouli 12/03/2024 31°11′55.69″N 75°45′31.84″E 252 

Source: Primary survey, Google Earth Pro.

Table 3

Risk categories of contamination and colour code (Mahmud et al. 2019; WHO 2020)

Risk categoryE. coli ¹cfu/100 mLColour code
Safe Blue 
Low 1– < 10 Green 
Intermediate 10– < 100 Yellow 
High 100– < 1,000 Orange 
Very high >1,000 Red 
Risk categoryE. coli ¹cfu/100 mLColour code
Safe Blue 
Low 1– < 10 Green 
Intermediate 10– < 100 Yellow 
High 100– < 1,000 Orange 
Very high >1,000 Red 

Urban DW samples are far more contaminated than rural DW samples

In the study, 55 samples of DW were subjected to analysis for E. coli contamination, revealing that 20 samples (36.4%) were indeed contaminated. Notably, urban DW samples exhibited heightened pollution levels. Table 4 presents the characteristics of the samples from the urban areas.
Table 4

Bacteriological quality of urban drinking water samples

AreaSampleE. coli presenceNumber of colonies(CFU*100)/10Disease risk category
Boota Mandi Present 60 Intermediate 
Present 357 3570 Very high 
Present 58 580 High 
Bhargo Camp Present 244 2440 Very high 
No 10 Low 
present 20 200 High 
Bashirpura No Safe 
No Safe 
No Safe 
Kamal Vihar 10 Present 45 450 Intermediate 
11 Present 24 240 Intermediate 
12 No Safe 
13 No Safe 
Indra colony 14 Present 20 Intermediate 
15 Present 40 Intermediate 
16 Present 80 Intermediate 
17 Present 10 Low 
18 No  Safe 
Ashok Vihar 19 No Safe 
20 Present 10 Low 
21 No Safe 
22 No Safe 
23 No Safe 
AreaSampleE. coli presenceNumber of colonies(CFU*100)/10Disease risk category
Boota Mandi Present 60 Intermediate 
Present 357 3570 Very high 
Present 58 580 High 
Bhargo Camp Present 244 2440 Very high 
No 10 Low 
present 20 200 High 
Bashirpura No Safe 
No Safe 
No Safe 
Kamal Vihar 10 Present 45 450 Intermediate 
11 Present 24 240 Intermediate 
12 No Safe 
13 No Safe 
Indra colony 14 Present 20 Intermediate 
15 Present 40 Intermediate 
16 Present 80 Intermediate 
17 Present 10 Low 
18 No  Safe 
Ashok Vihar 19 No Safe 
20 Present 10 Low 
21 No Safe 
22 No Safe 
23 No Safe 
Figure 1

Primary survey areas. Source: Primary survey.

Figure 1

Primary survey areas. Source: Primary survey.

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Figure 2 displays 23 household DW samples from distinct areas of urban Jalandhar health block. Water sample examination revealed that 13 samples (56.5%) were infected with the E. coli strain, as illustrated in Figure 3(a). Among these 23 samples, 10 (43.48%) were deemed uncontaminated, displaying a bacterial count of 0 colony-forming units (CFU) per 100 mL, aligning with the safety standards outlined by the WHO for consumption and domestic use (Table 3).
Figure 2

Presence of E. coli in urban water samples. Source: Water sample test results.

Figure 2

Presence of E. coli in urban water samples. Source: Water sample test results.

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Figure 4

Presence of E. coli in rural water samples. Source: Water sample test results.

Figure 4

Presence of E. coli in rural water samples. Source: Water sample test results.

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Figure 3

Water samples contaminated with E. coli and risk categories of contamination. Source: Primary survey and water test results.

Figure 3

Water samples contaminated with E. coli and risk categories of contamination. Source: Primary survey and water test results.

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Table 5 presents the characteristics of the samples from the rural areas. In this study, a total of 32 water samples were collected from six villages situated in rural areas, where inhabitants accessed water from three distinct sources: hand pumps, submersibles, and public supplies. The predominant source, utilized by 67.65% of households, was public water. However, 24.51% of residences had submersibles installed on their premises, 3.92% relied on hand pumps in conjunction with public water, and some residences utilized communal submersible facilities. Consequently, samples were also taken from hand pumps and common submersibles for analysis.

Table 5

Bacteriological quality of rural water samples

VillageSampleSourceE. coliNumber of coloniesCFU*100/10Disease risk category
Panchatt Sub No Safe 
Sub No Safe 
Public supply No Safe 
Public supply No Safe 
Public supply No Safe 
Khera Public supply No Safe 
Public supply No Safe 
Public supply No Safe 
Submersible No Safe 
10 Submersible No Safe 
Athouli 11 Public supply No Safe 
12 Public supply No Safe 
13 Public supply No Safe 
14 Submersible No Safe 
15 Submersible No Safe 
    Safe 
Shankar 16 Public supply No Safe 
17 Public supply No Safe 
18 Hand pump No Safe 
19 Submersible Yes 20 Intermediate 
20 Public supply No Safe 
Chak Kalan 21 Public supply No Safe 
22 Public supply No Safe 
23 Submersible Yes 10 Low 
24 Submersible No Safe 
25 Public supply No Safe 
Nawan Pind Jattan 26 Submersible Yes 90 Intermediate 
27 Common submersible Yes 20 Intermediate 
28 Public supply No Safe 
29 Public supply Yes 80 Intermediate 
30 Common submersible Yes 24 240 High 
31 Submersible Yes 30 300 High 
32 Public supply No Safe 
VillageSampleSourceE. coliNumber of coloniesCFU*100/10Disease risk category
Panchatt Sub No Safe 
Sub No Safe 
Public supply No Safe 
Public supply No Safe 
Public supply No Safe 
Khera Public supply No Safe 
Public supply No Safe 
Public supply No Safe 
Submersible No Safe 
10 Submersible No Safe 
Athouli 11 Public supply No Safe 
12 Public supply No Safe 
13 Public supply No Safe 
14 Submersible No Safe 
15 Submersible No Safe 
    Safe 
Shankar 16 Public supply No Safe 
17 Public supply No Safe 
18 Hand pump No Safe 
19 Submersible Yes 20 Intermediate 
20 Public supply No Safe 
Chak Kalan 21 Public supply No Safe 
22 Public supply No Safe 
23 Submersible Yes 10 Low 
24 Submersible No Safe 
25 Public supply No Safe 
Nawan Pind Jattan 26 Submersible Yes 90 Intermediate 
27 Common submersible Yes 20 Intermediate 
28 Public supply No Safe 
29 Public supply Yes 80 Intermediate 
30 Common submersible Yes 24 240 High 
31 Submersible Yes 30 300 High 
32 Public supply No Safe 

Source: Water sample test result.

The contamination differences between rural and urban areas are influenced by factors such as population density, sanitation infrastructure, and water storage practices, as illustrated in the findings from the study on E. coli contamination in DW samples. Urban areas, such as Jalandhar, exhibited heightened levels of contamination. High population density increases the likelihood of faecal–oral contamination, particularly in overcrowded areas. Urban environments often face challenges with sanitation infrastructure; the development of slums and informal settlements without adequate waste management exacerbates contamination risks. For instance, open sewage lines in proximity to water sources can lead to severe pollution, as seen in other global studies of urban areas. Water storage practices further complicate the issue. In resource-limited urban settings, improper storage techniques, such as using uncovered containers or scooping water with unclean hands, significantly raise contamination levels, as highlighted in studies from similar urban contexts.

Conversely, rural areas, despite lower population densities, encounter contamination issues largely stemming from open defecation and direct exposure to unprotected water sources. Without centralized water systems, these areas rely on wells or rivers, which are prone to contamination from agricultural runoff or animal waste. These findings emphasize the necessity of tailored solutions to address contamination issues, focusing on enhancing sanitation infrastructure and improving water storage practices in urban and rural areas alike.

Further categorization of the contaminated samples indicated that among the 56.5% from metropolitan regions, 13.04% fell within the low-risk bracket, with a CFU/100 mL count. The remaining 26.09% were classified as intermediate, signifying a CFU/100 mL range between 10 and less than 100. A proportionate distribution of contaminated water samples, accounting for 8.7% (two out of 13) in each group, was observed in the high and very high-risk categories, corresponding to CFU counts of 100 to less than 1,000 and greater than 1,000, respectively. Figure 3(b) visually represents the distribution of contaminated DW samples across different risk categories through a distinct colour code.

Of the 32 samples analysed from rural areas, 78.1% were suitable for direct consumption (Figure 4 and Tables 5). Seven samples were found to be contaminated with E. coli; among these, one exhibited a contamination level of less than 10 CFU/100 mL, four samples (12.5%) fell within the range of 10 to 100 CFU/100 mL, and two samples (6.3%) contained between 100 and 1,000 CFU/100 mL. Notably, no sample exhibited a contamination level exceeding 1,000 CFU/100 mL. Overall, 3.1% of rural water samples showed a low risk of contamination, 12.5% presented an intermediate risk, and 6.3% posed a high risk of contamination.

Physical quality of DW samples tested

Figures 5(a) and 5(b) present the physical attributes of DW samples collected from urban areas. The optimal pH range falls between 6.5 and 8.5, a criterion met by all samples regardless of their origin. The TDS in the water samples were quantified using TDS meters. The majority of samples exhibited good TDS quality, with 95.65% of those from metropolitan areas registering below 300, signifying high-quality water. The TDS readings for the remaining 4.35% fell between 300 and 600, considered fair quality and safe for consumption. Notably, no sample exceeded a TDS value of 600.

Figure 6(a) and 6(b) demonstrated physical properties of DW samples collected from villages. Rural samples exhibited a different pattern, with 18.75% displaying TDS values between 300 and 600 and 81.25% recording TDS levels below 300. Consequently, urban Jalandhar's DW samples demonstrated superior TDS quality compared to their rural counterparts. The study concludes that the physical characteristics of the region's DW, as evidenced by optimal TDS and pH levels, reflect good quality.
Figure 5

pH and TDS level in urban DW samples. Source: Water sample test results.

Figure 5

pH and TDS level in urban DW samples. Source: Water sample test results.

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Figure 6

pH and TDS in Rural DW samples. Source: Water sample test results.

Figure 6

pH and TDS in Rural DW samples. Source: Water sample test results.

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Public water supply is safer in rural areas than in urban

Given the prevalence of public water distribution in both rural and urban contexts, a comparative analysis was undertaken. Out of 23 DW samples obtained from public distribution systems, 13 tested positive for E. coli. By contrast, only one out of 18 samples from rural areas showed E. coli contamination. The contamination rate was 56.52% in urban samples, whereas it stood at 5.56% in rural samples. Therefore, this study reveals that urban areas are more susceptible to WBDs than rural areas in the study region due to high chances of microbial contamination in DW. Indeed, urban Jalandhar health block records the highest number of diarrhoea and typhoid cases each year in comparison to other health blocks of Bist Doab region per IDSP records.

The analysis of physicochemical parameters and their correlation with E. coli contamination highlights significant disparities between urban and rural water quality. In urban Jalandhar, 56.52% of DW samples from public distribution systems tested positive for E. coli, indicating a high contamination rate. This contrasts sharply with rural areas, where only 5.56% of samples showed contamination. Despite 95.65% of urban samples having TDS below 300 mg/L, indicative of high-quality water by WHO standards, microbial contamination persisted, reflecting vulnerabilities in water distribution and storage practices. In rural areas, the predominant use of submersibles and public water supplies (67.65%) ensured better control over water quality, with 81.25% of samples showing TDS levels below 300 mg/L. Both regions met the optimal pH range of 6.5–8.5, which supports bacterial survival but does not directly influence contamination levels. The findings underscore that while physicochemical parameters such as TDS and pH suggest good water quality, microbial safety is compromised in urban areas due to inadequate sanitation infrastructure, higher population density, and poor water handling practices. These factors contribute to the higher prevalence of E. coli in urban water, correlating with the elevated cases of diarrheal diseases and typhoid recorded in Jalandhar (Kristanti et al. 2022).

Challenges in urban areas

Residents of the urban health block of Jalandhar reported congestion in the sewage systems, as evidenced by a survey conducted in the area. The resultant waterlogging, particularly prevalent during the monsoon season, engenders a conducive milieu for the proliferation of E. coli bacteria and faecal contamination within potable water reservoirs. Consequently, this situation poses a significant risk of WBD outbreaks, as highlighted by Ninama (2023). The Integrated Disease Surveillance Programme (IDSP 2024) has consistently disseminated weekly updates regarding WBD outbreaks, attributing the root cause in urban Jalandhar to the intermingling of sewage and DW supplies (Gupta & Gupta 2020). Compounded by Jalandhar's high population density, certain individuals have resorted to unauthorized connections between DW sources and sewage systems, thereby compromising the integrity of DW pipelines. This unlawful practice has resulted in breaks and fissures in the pipelines, elevating the probability of cross-contamination between the two systems, as elucidated by Manetu & Karanja (2024).

The city of Jalandhar generates approximately 400 tonnes of solid waste on a daily basis (Sethi et al. 2013). To manage this waste, the municipal authorities have instituted a collection system spanning various locations within the city, with subsequent disposal in neighbouring villages (Sharma et al. 2019). However, an assessment of this waste management system indicates significant deficiencies. Numerous heaps of garbage are evident in every administrative ward, with 75 collection points scattered across Jalandhar city. These collection points, lacking enclosures or metal containers, are highly susceptible to waterborne and vectorborne diseases such as malaria, typhoid, and diarrhoea. While the municipality assures daily waste collection from these points, they remain perpetually crowded, emit foul odours, and reduce the aesthetic appeal of the cityscape (Singh & Kumar 2023). Furthermore, during periods of heightened temperatures and heavy rainfall, these sites serve as breeding grounds for contamination (Odonkor & Mahami 2020).

It was discovered during the survey that while public faucets were built inside homes, some homes did not have public taps located in the kitchen. These taps were situated in open areas, next to bathrooms, or within bathrooms. People store DW from these taps, which are within or close to the bathroom, for later use, increasing the risk of E. coli contamination. Second, they utilize the water they store in roof-mounted tanks for cooking and drinking. When tanks are not cleaned on a regular basis, E. coli can pollute the water, leading to diarrhoea and other waterborne illnesses (Schafer & Mihelcic 2012).

Challenges in rural areas

The primary survey encompassed six villages, of which only two possessed operational piped sewerage systems. During the survey, open sewers were observed in four of these villages. Testimonies indicated that these drains frequently overflowed during rainy seasons, occasionally resulting in the seepage of contaminated water into the vicinity and residential areas (Bindra et al. 2021). Maintenance of these drains, undertaken either by individuals or external contractors, transpires biweekly, yet the accumulation of refuse and debris remains a prevalent issue.

Moreover, a lack of organized waste disposal systems in these rural settings fosters indiscriminate littering, exacerbating the proliferation of diseases such as malaria, typhoid, and diarrhoea. Wastewater management poses an additional challenge, as untreated effluents stagnate in open areas, emitting foul odours and attracting a multitude of insects, including flies and mosquitoes. Although some villages implement rudimentary wastewater treatment methods, such as drainage into ponds and subsequent irrigation onto fields, such practices are not uniformly adopted. Addressing these concerns necessitates thorough cleaning, disinfection, and proper covering of stagnant water bodies to effectively mitigate the risks associated with waterborne illnesses.

This research paper recommends an area-specific approach to deal with WBD outbreaks effectively. Due to the high population of urban Jalandhar, this study suggests that in order to maintain sufficient city hygiene, the sewerage pipeline should be cleaned on a regular basis, and an effective waste disposal system should be developed. Weekly reporting of cleaning should be applied to ensure regular cleaning in the municipality. In rural areas, proper waste disposal systems, water treatment facilities, and closed drainage systems must be created. Waste disposal system should include dumping of garbage at particular sites and regular collection/disposal of that garbage, which can be ensured through leadership of the village, i.e. Sarpanch and Pradhan. Furthermore, individuals must be instructed not to use tank water for drinking or cooking but rather to store direct water in a clean container for immediate consumption. There should be a tap in the kitchen to collect direct supply water for drinking and cooking purposes rather than using the one in the bathroom. Finally, this study proposes policy implementation at national, state/district, and community level to mitigate WBDs from the developing region.

National level: Awareness campaign about personal hygiene along similar lines of COVID-19 will be effective in controlling WBDs infection. Introducing advisory guidelines on daily routine hygienic practices should be made part of schools and higher educational institution curriculum.

District level: Local administration in cities and Panchayats in villages should be made responsible and financially strong enough to maintain sanitation levels in cities and villages, respectively. Incentives can be also given to concerned authorities and persons working to make their areas clean.

Community level: Community participation in developing drainage systems and waste disposal mechanism should be encouraged, particularly in highly populated areas. Local level representatives of government in cities and villages such as Mayor and Sarpanch, respectively, in India should be trained, strengthened, and made responsible to enhance community participation in cleanliness of their area of service.

This study found a high level of microbial contamination in DW making urban Jalandhar health blocks highly susceptible to WBDs, particularly in the study region. The prevalence of sporadic sewage treatment and illicit connections has resulted in breaches within water supply networks, thereby fostering E. coli contamination within potable water sources. Additionally, deficiencies in waste disposal infrastructure exacerbate the proliferation of E. coli in DW within Jalandhar. Conversely, while rural water testing indicates relatively lower contamination levels, various factors such as inadequate waste management, open drainage systems, and stagnant water bodies pose significant risks of waterborne and water-related diseases. Notably, a substantial portion of rural households lacks direct kitchen tap connections to a safe water supply, resorting instead to stored tank water for domestic consumption. In mitigating the burden of WBDs, it is imperative to foster awareness regarding the hazards associated with consuming tank-stored water directly. Ultimately, effective combat against WBDs necessitates concerted efforts to address infrastructural deficiencies alongside advocating for the adoption of fundamental hygiene practices. Community participation at the grassroots level should be encouraged and streamlined to bring sanitation revolution in any developing nation. Local level administration should be trained, empowered, and made responsible for enhancing community participation.

We are obliged to Lovely Professional University, Phagwara, for helping us conduct our research.

Funding received from the UGC under the JRF Scheme

All relevant data are included in the paper or its Supplementary Information.

The authors declare there is no conflict.

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