Behavioural lapses and microbial pollution compromise the public health outcomes of safe sanitation in sustainable cities  

Behavioural lapses and microbial pollution compromise the public health outcomes of safe sanitation in sustainable cities | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Behavioural lapses and microbial pollution compromise the public health outcomes of safe sanitation in sustainable cities Rahmathunnisa Edayakkal, Anas Abdulaziz, Jibin James, Nizam Ashraf, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8670523/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The persistence of diarrheal diseases in urban areas, even those with ostensibly safe water and sanitation systems, indicates significant underlying microbial and infrastructural vulnerabilities that pose challenges to sustainable urban development. Kavaratti Island in India serves as a pertinent example: despite achieving universal access to desalinated water and sanitation facilities, the island reports between 250 and 500 cases of acute diarrheal disease annually. This study employs a combination of household surveys and environmental monitoring to investigate the behavioural determinants of exposure and microbial contamination across various water sources, including groundwater, ponds, and adjacent coastal waters. The findings reveal that only a quarter of households depend solely on desalinated water, while the majority continue to utilize untreated groundwater, thereby reflecting a limited understanding of the associated microbial risks. Quantitative real-time PCR analysis indicates widespread fecal contamination, with concentrations of Escherichia coli surpassing 1,000 gene copies per milliliter in all surveyed ponds and in most groundwater sources during the dry season. Furthermore, Vibrio cholerae was detected in 85% of pond samples and in 20% of groundwater samples during the rainy season. Notably, more than half of the E. coli isolates, along with all Vibrio isolates, displayed resistance to ampicillin, which is a commonly prescribed antibiotic in the region. These results illustrate that infrastructure alone is insufficient to guarantee microbial safety in vulnerable coastal urban settings. The high incidence of diarrheal disease, combined with microbial pollution and antibiotic resistance, highlights the urgent need for integrated surveillance systems, enhanced public awareness, and participatory water management strategies. Community-based initiatives, such as citizen science programs and water clinics, have the potential to strengthen public health resilience in these contexts. Diarrhoea Vibrio faecal pollution antimicrobial resistance citizen science water clinic Full Text Additional Declarations No competing interests reported. Supplementary Files supplementaryfiles.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8670523","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":580291134,"identity":"fc9d61e1-e296-4a97-8138-365df2b22c2d","order_by":0,"name":"Rahmathunnisa Edayakkal","email":"","orcid":"","institution":"CSIR-National Institute of Oceanography","correspondingAuthor":false,"prefix":"","firstName":"Rahmathunnisa","middleName":"","lastName":"Edayakkal","suffix":""},{"id":580291136,"identity":"edbe2b88-ec20-4e74-a03b-09395a0f8c64","order_by":1,"name":"Anas 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Kavaratti Island in India serves as a pertinent example: despite achieving universal access to desalinated water and sanitation facilities, the island reports between 250 and 500 cases of acute diarrheal disease annually. This study employs a combination of household surveys and environmental monitoring to investigate the behavioural determinants of exposure and microbial contamination across various water sources, including groundwater, ponds, and adjacent coastal waters. The findings reveal that only a quarter of households depend solely on desalinated water, while the majority continue to utilize untreated groundwater, thereby reflecting a limited understanding of the associated microbial risks. Quantitative real-time PCR analysis indicates widespread fecal contamination, with concentrations of Escherichia coli surpassing 1,000 gene copies per milliliter in all surveyed ponds and in most groundwater sources during the dry season. 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