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Estimating infection risks and the global burden of diarrheal disease attributable to intermittent water supply using QMRA

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)7542-7551
Number of pages10
JournalEnvironmental Science and Technology
Issue number13
Early online date20 Jun 2017
DateAccepted/In press - 5 Jun 2017
DateE-pub ahead of print - 20 Jun 2017
DatePublished (current) - 5 Jul 2017


Intermittent water supply (IWS) is prevalent throughout low and middle-income countries. IWS is associated with increased microbial contamination and potentially elevated risk of waterborne illness. We used existing data sets to estimate the population exposed to IWS, assess the probability of infection using quantitative microbial risk assessment, and calculate the subsequent burden of diarrheal disease attributable to consuming fecally contaminated tap water from an IWS. We used reference pathogens Campylobacter, Cryptosporidium, and rotavirus as conservative risk proxies for infections via bacteria, protozoa, and viruses, respectively. Results indicate that the median daily risk of infection is an estimated 1 in 23 500 for Campylobacter, 1 in 5 050 000 for Cryptosporidium, and 1 in 118 000 for rotavirus. Based on these risks, IWS may account for 17.2 million infections causing 4.52 million cases of diarrhea, 109 000 diarrheal DALYs, and 1560 deaths each year. The burden of diarrheal disease associated with IWS likely exceeds the WHO health-based normative guideline for drinking water of 10–6 DALYs per person per year. Our results underscore the importance water safety management in water supplies and the potential benefits of point-of-use treatment to mitigate risks.

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via ACS at 10.1021/acs.est.7b01014 . Please refer to any applicable terms of use of the publisher.

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