Assessment of microbial risks by characterization of Escherichia coli presence to analyze the public health risks from poor water quality in Nepal.

The combination of natural disasters and inadequate infrastructure introduce unique challenges in providing safe drinking water in low-income countries. For example, Nepal faces several challenges in managing sporadic diarrheal outbreaks across the country, given its complex geographic terrain, and its susceptibility to extreme natural events like earthquakes, floods, and landslides. To assess the risks of diarrheal diseases caused by fecal contamination in several water sources in different geographical regions of Nepal, we conducted a two months cross-sectional study throughout 37 out of 75 districts in Nepal, including the ones affected by Nepal 2015 earthquake. Quantitative Microbial Risk Assessment (QMRA) was applied to estimate the human health risk based on Escherichia coli (E. coli) count for 2,822 water samples collected at source and households. Disease burden calculations suggested that Hilly and Terai (low-land) regions are at the highest risk with 0.27 and 0.16 DALYs per person per year (DALYpppy), respectively, whereas mountain region disease burden was 0.02 DALYpppy. The risk comparison among exposure pathways indicated that the water used in households, including drinking water and water for washing, posed higher risks than from source water, reservoir water or tap water, suggesting deteriorated sanitation conditions in households. These findings suggest that the combination of QMRA and spatial analysis can help to prioritize intervention activities after a major natural disaster.