least 20–30 s, especially before eating food and after using restrooms. Limitations We followed a comprehensive approach to finding the most relevant articles, yet we might have overlooked some of the published scien- tific literature because it was not available via public databases. For example, reports pub- lished in the national language Urdu or local languages such as Punjabi, Pashto, Sindhi, Saraiki, Balochi, Hindko, Pahari-Pothwari, or Brahui were not accessible to us. Likewise, we were not able to access unpublished data mentioned in handwritten reports or internal/ external registries at hospitals. Furthermore, there was substantial varia- tion in reporting, as some researchers could not associate specific outbreaks to water sources by laboratory testing. Considering the limitations, potential researchers may opt to trace back outbreaks to their pathogens
and reviewers may consider covering the data present in local languages. Conclusion Pakistan is a developing country with the 5th largest population (>233 million) in the world. The increasing population; decreasing surface, ground, and river water; and limited resources to access clean water have led to the increasing consumption of unsafe water. Therefore, the likelihood of the occurrence of waterborne diseases is increasing. Based on recent studies at the provincial and city levels, rusted pipes and ineective disposal of wastewater are commonly associated with infections of Salmonella Typhi and rotavi- rus. Furthermore, contamination of drink- ing water with feces leads to E. coli infection, while well water contamination in flood sea- sons is associated with cholera. There is a dire need to address the issue of waterborne diseases at national and inter-
national scientific and policymaking levels to lead to the formulation and implementa- tion of sustainable policies for improving the quality of drinking water in Pakistan. Com- munication, coordination, and collaboration among government authorities, communi- ties, and individuals will help keep the bur- den of waterborne diseases in check. Imple- menting regulations for Pakistan’s wastewater treatment plants is warranted. Furthermore, there is a pressing need to improve the outbreak reporting and investigation sys- tem. Lastly, the monitoring of water quality through the detection of these waterborne pathogens could help identify the limitations of the water supply system. Corresponding Author: Shahan Azeem, Fac- ulty of Veterinary Science, Institute of Micro- biology, University of Veterinary Animal Sci- ences, Lahore, Pakistan. Email: sazeem@uvas.edu.pk.
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