Water Contamination,Households’ Risk Perceptions,and Averting Behavior: Evidence from the Nullah Lai,Rawalpindi,Pakistan

Abstract

This study examined the households’ risk perceptions of water contamination available in the surroundings of the Lai sewer in Rawalpindi city of Pakistan. Through purposefully structured questionnaire, 134 households were interviewed from three randomly selected areas adjacent to the main sewer bed of the Lai sewer. The data were collected from both the ethnography of three neighborhoods named Mohinpura, Dhok Ratta, and Dhok Naju adjacent to the Lai sewer and questionnaire survey to assess the households’ perceptions of groundwater and supplied water contamination as principal sources of drinking water. Supplementing ethnographic research, the data collected through the questionnaire was analyzed using the ordered probit model. The findings showed that households’ education level, income, health effects, proximity to the Lai sewer, knowledge, and awareness of water contamination, and attitude toward health risks had significant effects on households’ risk perceptions. This study will be an important addition to the existing water pollution–related research and will particularly help to sensitize the households and communities about water contamination and health-related risks. The recommendations of the study will further guide the relevant state institutions based on the perspectives of the research participants and neighboring residents of the Lai sewer of Rawalpindi city.

Keywords

Health effects knowledge safe water sustainable development Punjab

Introduction

Equitable access to safe drinking water is a fundamental human right and undoubtedly important for a healthy life (UN, 2002). The Sustainable Development Goals (SDGs) emphasize the importance of having access to safe and clean drinking water (World Health Organization (WHO), 2018). Goal sixth of the SDGs reads, “Ensure availability and sustainable management of water and sanitation for all.” According to the WHO, one-third of the global population don’t have access to safe drinking water (WHO, 2019). Moreover, around 0.8 million children (<5 years old) worldwide die of diarrhea annually, with an average of about 2200 dying every day because of contaminated drinking water (Liu et al., 2012). Such incidences and issues are usually underreported by the governments in the global south (Beard and Mitlin, 2021). The situation, however, is not improving, as shown in recent studies (Felter and Robinson, 2021; Ferreira et al., 2021; Richards et al., 2021; Schimpf and Cude, 2020).

Like other low- and middle-income countries, Pakistan suffers from chronic shortages of clean water. Its water resources are contaminated with heavy metals, pathogens, and other pollutants (Adelodun et al., 2021; Ali et al., 2021; Khan et al., 2013; Raza et al., 2017). The Water Aid Organization (2018) documented that Pakistan ranked ninth among the list of countries with the poorest access to safe drinking water. It was reported that 21 million people in Pakistan did not have adequate access to safe water. Similarly, the United States Agency for International Development (USAID) reported that approximately 250,000 children in Pakistan were dying each year due to waterborne diseases (Daily Times, 2016). Evidence provided by Saeed et al. (2020) and Hansen et al. (2020) posited that the infant mortality rate due to diarrhea was highest in Pakistan than in other Asian countries. One possible reason for this high infant mortality rate was the high percentage of bacteria-contaminated water (around 70%) in the country (Ali et al., 2021; Daud et al., 2017).

The groundwater contamination mostly originates from industrial and municipal wastewater that slowly absorbs in natural rocks and pollutes the groundwater aquifer (Peng et al., 2018; Meng et al., 2019; Zhang et al., 2019; Zheng et al., 2021). In the case of the Lai sewer in Rawalpindi city of Pakistan, the wastewater flowing on the ground level easily absorbs into fissured bedrock and carries toxic pollutants into a deep aquifer (DAWN, 2008) and among these pollutants, the most common are pathogens, inorganic pollutants, anions and cations, and other radioactive substances (Azizullah et al., 2011; Raza et al., 2017). Moreover, a poor sewerage system throughout the country is another reason of water contamination. Leakages from the sewerage pipes running parallel to the water pipes supplied by the Water and Sanitation Authority (WASA) contaminate the supplied water with human fecal, microbes, and other germs (Daud et al., 2017). The old-fashioned, rusty, and ragged sewer system has worsened the living conditions, especially for households living in the slums of Rawalpindi city (Muhammad, 2017). There is overwhelming evidence indicating that heavy metals, chromium, cadmium, arsenic, mercury, led, and zinc are the main health-related pollutants (Amadi et al., 2017; Khan et al., 2013; Qu et al., 2012; Rehman et al., 2018) and identified to cause both acute and chronic issues (Tchounwou et al., 2012) such as cancer (Khan et al., 2013; Muhammad et al., 2011) kidney failure (Babich et al., 2020; Xu et al., 2018) lungs damage (Madhav et al., 2020), and hepatitis (Adelodun et al., 2021).

Undoubtedly, the utilization of contaminated toxic water with municipal and industrial waste is causing a multitude of water-related health problems (Díaz-Vázquez et al., 2021; Sarker et al., 2021). Participants of this study comprise people who live in physical spaces considered as hazardous and a threat to healthy life. This kind of association between disease and place implies that the population living there possesses inherent traits that make it more susceptible to disease (Jerrett et al., 2010). Thus, a vigilant assessment and information on this environmental problem are recognized as necessary for reducing the health risks and their perceptive logic among the communities that are more vulnerable to the structural risks. Depending upon structural environmental problems, people develop the ability to perceive environmental hazards in their surroundings, based on their experience, awareness, and knowledge (Ali et al., 2021; Mehmood et al., 2020).

Realizing the need to know the ground realities, the authors explored the households’ risk perceptions of contaminated drinking water and the way it places the households in a hazardous environment increasing risks to health. Thus, this study addressed two main questions: (1) What constitutes clean water, and how do people talk about its supply and its situated position in one of the most hazardous urban environment? (2) What are the determinants of households’ risk perceptions of water contamination? To the best of the authors’ knowledge, there are very limited studies available to analyze the determinants of households’ risk perceptions in Pakistan. Existing studies by Ahmed and Shafique (2019) and Ali et al. (2021) analyzed the effects of sociodemographic variables on households’ risk perceptions but ignored key variables such as water color, smell, and taste that may affect households risk perceptions. This study included all these variables in the empirical analysis and highlighted all shortcomings that had been overlooked in existing studies using qualitative and quantitative approaches. Moreover, the main reasons for the selection of Rawalpindi city are two; first, because most of the drinking water sources (approximately 87%) in Rawalpindi are unfit for drinking purposes (Islam-ul-Haq et al., 2008) and second, the main source of bacterial and viral contamination in the groundwater is occurring because of the Lai sewer (Muhammad, 2017). This issue requires serious attention to understand the perspectives of the people and how it connects with the responsiveness from the government and civil society to create awareness in the surrounding areas of the Lai sewer. Findings and recommendations are expected to empower the households residing near the Lai sewer about water contamination and how to avoid or reduce exposure to contaminated water by selecting alternative options. Recommendations are further expected to provide information to the government departments and nongovernmental organizations (NGOs) about the installation of drinking water filtration plants in Rawalpindi city, particularly in the surrounding of the Lai sewer.

Averting behavior model and theoretical framework

The conventional averting behavior model proposed by Grossman (1972) was used to understand households’ drinking water choices. This evaluation method is particularly applicable when households consider the negative effects of environmental pollution on their well-being and try to choose some alternative option(s) along with investing in averting the negative effects. Therefore, information on what individuals do to protect themselves against environmental risks can be used to infer their preference for reducing these risks. It can be shown that the optimal choice of averting measures (A*) depends on averting costs (PA), the perceived quality of tap water (QÞ), and the optimal choice of purified water (W*).

A * = g [P_{A}, Q, W^{*} (P_{A}, P_{X,} I, Q)]

(1)

where W* is considered as a function of the price of the composite good $P_{X}$ , $P_{A}$ is considered as the vector of opportunity costs of averting measures, while (I) is household income. A* describes the combination of household averting behaviors that is, averting measures from every possible source (e.g. purchasing bottled water, boiling, filtering, and chlorination of tap water) to ensure the maximum utility for the household (Um et al., 2002). Whereas W and Q are based on the household’s perceptions about how the quality of the available water is and how much purification is required by the household? The household production function and the averting behavior model have been enormously applied to various environmental-related studies (Amoah et al., 2021; Cropper and Freeman, 1991; Mehmood et al., 2021; Olmstead, 2010).

There are several paths from socioeconomic (age, education, family size, and income), sociopsychological (knowledge, awareness, and attitude), and demographic (area, proximity to the pollutant source) that are directly associated to explain households’ risk perceptions and averting behavior (Figure 1). Households’ knowledge of water pollution can help understand the health issues and take preventive decisions (Gray, 2018). Awareness is the attention, concern, and sensitivity toward environmental issues perceived from friends, relatives, society, or media (Alsulaili et al., 2020; Kazama and Takizawa, 2021), for example, water contamination can create serious health issues. Hence, when households observe water contamination they may take preventive action. Attitude toward environmental issues is a set of indicators and feelings for the safe environment, and the motivation of an individual for active participation for environmental improvement (Odimayomi et al., 2021), for example, water contamination in the surrounding of the Lai sewer requires attention. Figure 1 presents the theoretical framework explaining the relationship between households’ risk perception and averting behavior.

Figure 1.

Theoretical framework to explain factors affecting households’ risk perceptions and averting behavior.

Material and methods

Study region

Rawalpindi is a metropolitan city having more than 2 million populations living in the area of 259 km². Primary data were collected from the households residing near the Lai sewer in Rawalpindi city of Pakistan. The Lai sewer is a natural rain-fed stream flowing through the twin cities of Rawalpindi and Islamabad locally known as the Nullah Lai. The sewer is heavily polluted with industrial, agricultural, and municipal waste causing a serious environmental problem, more particularly water pollution (Muhammad, 2017). Historically, the sewer consists of six major tributaries: three tributaries originate from the foothills of the Himalayas near Islamabad flowing down toward the lower-lying areas of Rawalpindi city, where the main sewer is further joined by three tributaries. The Lai sewer basin has a catchment area of nearly 234.8 km². Municipal discharge of 0.545 million m³/day flowing in the Lai sewer absorbs into fissured bedrock and seeps contaminants into a deep aquifer. The localities near the Lai sewer use bore water pumps installed beside the Lai sewer bed and this usage of bore water pumps places the households in risk. In addition, in some areas of Rawalpindi city, particularly in the surroundings of the Lai sewer, broken sewage pipes lead to seepages, thus contaminating the water supply pipes with sanitation pipes. Figure 2 shows the geographical location of the area surveyed.

Figure 2.

Geographical location of the area surveyed.

Survey design and data collection

The primary data were collected through the field survey conducted in the communities located on the proximity of the Lai sewer in Rawalpindi city of Pakistan. The fieldwork duration for the survey and community-based research stretches from March 2018 to November 2019. A mixed-method approach was used and information from the respondents were collected based on a combination of field observations and in-depth interviews. The qualitative method was used to understand how people talk about water contamination, its supply, and its situated position and risk involved with the contaminated drinking water. Complementing the ethnographic research, the authors have launched a survey to find out the determinants of the households’ risk perceptions of water contamination in Rawalpindi city through a questionnaire survey. For quantitative assessment, a questionnaire was designed and, in total, 134 households were interviewed from three randomly selected areas in the surrounding of the Lai sewer in Rawalpindi city. Primary information about households’ socioeconomic characteristics, drinking water sources, water contamination, illness status associated with water pollution, households’ water choices, and so on were gathered through a pre-tested and well-structured questionnaire.

Ordered probit model and its specification

Households are assumed to use available water for drinking, cooking, and bath purposes. Following the empirical method of Greene (2008) and Owusu et al. (2012), the Ordered probit model could be specified to determine the households’ responses which influence risk perceptions on using water for consumption

T_{i}^{*} = β^{'} X_{i} + ε_{i}

(2)

where $T_{i}^{*}$ is considered as an unobserved and continuous measure on risk perception of health-related issues of households, particularly for drinking purposes, $X_{i}$ is a vector of explanatory variables that influence a household’s risk perception, $β^{'}$ is a vector of parameters to be estimated, and $ε_{i}$ is a random error term assumed to be standard normal distributed. Since $T_{i}^{*}$ is unobserved, the authors observe coded discrete responses of the variable $T_{i}$ as follows

T = {\begin{matrix} 0 i f - \infty \leq T_{i}^{*} \leq μ_{1} (s t r o n g l y d i s a g r e e) \\ 1 i f μ_{1} \leq T_{i}^{*} \leq μ_{2} (d i s a g r e e) \\ 2 i f μ_{2} \leq T_{i}^{*} \leq μ_{3} (n e t u r a l) \\ 3 i f μ_{3} \leq T_{i}^{*} \leq μ_{4} (a g r e e) \\ 4 i f μ_{4} \leq T_{i}^{*} \leq μ_{5} (s t r o n g l y a g r e e) \end{matrix}}

(3)

The study by Greene (2008) highlights that the vector of parameters $β^{'}$ and the thresholds $μ^{'} s$ can be measured jointly using the maximum likelihood procedure which yields consistent and asymptotic estimators. Through the use estimated coefficient of the ordered probit model, the marginal effects of the independent variables are estimated. The associated probabilities with the coded household’s risk perception responses of the ordered probit model are given as

\begin{array}{l} P_{1} (0) = P r (T_{i} = 0) = P r (T_{i}^{*} \leq μ_{1}) = P r (β^{'} X_{i} + ε_{i} \leq μ_{1}) = P r (ε_{i} \leq μ_{1} - β^{'} X_{i}) \\ = ϕ (μ_{1} - β^{'} X_{i}) \\ P_{i} (1) = P r (T_{i} = 1) = P r (μ_{1} \leq T_{i}^{*} \leq μ_{2}) = P r (ε_{i} \leq μ_{2} - β^{'} X_{i}) - P r (ε_{i} \leq μ_{1} - β^{'} X_{i}) \\ = ϕ (μ_{2} - β^{'} X_{i}) - ϕ (μ_{1} - β^{'} X_{i}) \\ P_{i} (k) = P r (T_{i} = k) = P r (μ_{k} \leq T_{i}^{*} \leq μ_{k + 1}) = P r (ε_{i} \leq μ_{k + 1} - β^{'} X_{i}) - P r (ε_{i} \leq μ_{i} - β^{'} X_{n}) \\ = ϕ (μ_{k + 1} - β^{'} X_{i}) - ϕ (μ_{k} - β^{'} X_{i}) \\ P_{i} (K) = P r (T_{i} = K) = P r (μ_{K} \leq T_{i}^{*}) = 1 - ϕ (μ_{K} - β^{'} X_{i}) \end{array}

(4)

where k is an alternative response, $P (T_{i} = k)$ is the probability that a household residing near the Lai sewer, $i$ responds in manner k, and $ϕ (.)$ is the standard normal cumulative distribution function. Perceived risk is likely to depend on the quality of groundwater used by the household living in the neighborhood of Lai sewer. Household’s risk perception is latent in nature since households had to select one option among a set of five possible options as mentioned earlier. The positive signs of the estimated parameters $β$ indicate higher health-related risks associated with the use of groundwater for drinking purposes as the value of the associated variables increase, while negative signs suggest the converse (Greene, 2008).

The dependent variable in the ordered probit model is considered as the households’ risk perceptions of water contamination; measured on a 5-point Likert-type scale (strongly disagree = 1 to strongly agree = 5) with an assertion of health-related risks to households from contaminated water used for drinking purposes. Independent variables included in the model were the age of the respondent measured in years; family size measured in numbers, education level measured in years; monthly income measured in US$. Distance from the Lai sewer bed measured in meters; residence period indicates the period of residence near the Lai sewer estimated in years; health effects, a dummy variable (Yes = 1, otherwise 0). The aesthetic characteristics in the model were the taste of water measured on a 4-point Likert-type scale (very good = 1 to bad = 4); the color of water also measured on a 4-point Likert-type scale (very clean = 1 to very dirty = 4); and the smell of water measured on a 3-point Likert-type scale (no smell = 1 to serious smell = 3). The sociopsychological characteristics included in the model were the attitude of the respondents toward water contamination measured on a 5-point Likert-type scale (strongly disagree = 1 to strongly agree = 5); knowledge measured on a 5-point Likert-type scale (strongly disagree = 1 to strongly agree = 5); and awareness measured on a 5-point Likert-type scale (strongly disagree = 1 to strongly agree = 5).

Results

Qualitative assessment

While engaging in qualitative research methods, the authors tried to explore people’s perceptions of risk in their situated socioeconomic position as individuals, households, and communities. This part of our research framework has been very important for the people to talk about their subjective experiences in the hazardous environment in its physicality, water management, and formulation of their rights. People of all three communities of our research were unanimous in their articulation of political rights, which they find selectively missed or failed by the state due to chronic irresponsiveness. One of the male respondents in his 60s opined pessimistically that even this study is doomed to failure because, like all other studies, “it would fall on deaf ears who are not concerned at all.” This one account summarizes the concerns expressed by the larger community vis-à-vis state institutions. Furthermore, the widespread presence of heaps of dirt, sewerage in Lai, and unpaved channels from toilets to the sewer are common reference points used by the people to navigate their neighborhoods. The authors argued that this constitutes the operative logic of risk perception in the communities around Lai sewer.

Quantitative assessment

Socioeconomic characteristics of the respondents

In the area surveyed, both women and men were involved in fetching water but female respondents were a few in numbers; thus, in the analysis only male respondents were considered. Table 1 shows that the mean age of the respondents was around 40 years, while the mean family size was 7.88. The mean of education level was 4.97 and the majority of the respondents around 44.77% were uneducated. The average monthly income of the respondents was US$198. The mean of residence period was 23.91 years, while the mean of the proximity from the Lai Sewer was 60.42 meters. Out of total 134 respondents, 55% reported adverse health effects by the use of the water such as diarrhea, hepatitis, and abdominal pain.

Table 1.

Socioeconomic characteristics of the respondents.

Characteristics	Unit	Descriptive statistics
Age of the respondent	Years	M = 40.02, SD = 13.7
Family size	Numbers of family members	M = 7.88, SD = 4.16
⩾5		N = 41
6–10		N = 62
11⩽		N = 31
Education level	Years	M = 4.97, SD = 4.94
Uneducated		N = 60
Middle or below		N = 41
Matriculation		N = 16
Intermediate or above		N = 17
Income	US dollars^a	M = 198, SD = 125
Below 100		N = 34
100–199		N = 48
200–299		N = 22
300⩽		N = 30
Proximity to the Lai sewer	Meters	M = 60.42, SD = 78.11
Residence period	Years	M = 23.91, SD = 16.14
⩾15 years		N = 61
Above 15 years		N = 73
Health effects	1 Yes; 0 otherwise	N = 74 (55.22%)

M: mean; SD: standard deviation; N: number.

1 US dollars = 155.07 Pak Rupee.

Figure 3 presents the households’ risk perceptions of water contamination in the area surveyed. Out of 134 respondents, around 35% of the households reported that available water in the area is highly risky for health, and 27.61% claimed that water is a little risky for health. Around 12% of the households were neutral about water contamination. On the contrary, 18.65% stated no risk of water contamination on health, while 5.22% strongly argued that water available in the area surveyed is not contaminated.

Figure 3.

Households’ risk perceptions of water contamination (%).

The association between the dependent and all the independent variables are validated by the coefficients of the ordered probit model (Table 2). The households’ risk perceptions of water contamination is significantly and positively associated with education level (β = 0.042), income (β = 0.001), health effects (β = 0.591), water color (β = 0.277), knowledge (β = 0.222), awareness (β = 0.158), and attitude (β = 0.163). The coefficient of proximity to the Lai Sewer had a significant negative effect on households’ risk perceptions. The overall goodness and fitness of the model can also be observed from the values of pseudo $R^{2}$ measures (0.173) the log-likelihood statistics (–160), and $L R χ^{2}$ (67.57).

Table 2.

Estimated results of the households’ risk perceptions of water contamination.

	Coefficient	Std. Error	P value	Lower bound	Upper bound
Age of the respondent	0.011	0.007	0.156	0.004	0.026
Family size	−0.017	0.025	0.483	−0.068	0.032
Education level	0.042	0.022	0.055*	0.000	0.085
Income	0.001	0.000	0.059*	−0.000	0.003
Proximity to the Lai	−0.003	0.001	0.014**	−0.005	−0.000
Residence period	0.003	0.007	0.638	−0.011	0.019
Health effects	0.519	0.210	0.014 **	0.106	0.932
Taste	0.080	0.096	0.408	−0.109	0.270
Color	0.277	0.119	0.020**	0.042	0.511
Smell	0.077	0.136	0.568	−0.189	0.330
Knowledge	0.222	0.086	0.010**	0.053	0.391
Awareness	0.158	0.076	0.038**	0.084	0.308
Attitude	0.163	0.085	0.055*	−0.003	0.330

Note: *P < 0.05, **P < 0.01, ***P < 0.001.

Source: Analyzed from primary data collected in 2019.

Diseases reported by the households and choices of purified water

The major health issues in the area surveyed were abdominal pain, vomiting, and tiredness stated by 46.30%, 44.11%, and 43.65% of the respondents, respectively (see Table 3). In addition, hepatitis, poor appetite, and sleeping disorder were reported by 33.37%, 23.88%, and 21.87% of the households, respectively. Similarly, other health problems including cancer, anemia, constipation, and kidney problems were also reported by a few percentages of the respondents.

Table 3.

Health issues reported by households (%).

Parameters	Total
Diarrhea	39.86
Hepatitis	33.37
Tiredness	43.65
Sleeping disorder	21.88
Poor appetite	23.88
Constipation	15.67
Vomiting	44.11
Kidney problems	16.41
Abdominal pain	46.30
Others (skin irritation, eye irritation cancer, anemia, dengue, etc.)	13.87

Note: Some households reported more than one disease.

The results showed that the households choose different methods for water purification, among them were (1) using an electric private or government filter; (2) boiling; and (3) using an ordinary filter at home. Around 31% of the households were taking water from the filtration plants installed by the government or some private sources. Around 18% households were using bottled (often claimed as mineral water) water of some private companies, 11.79% were using an osmosis water filter system installed at home, 12.58% were boiling the available water before the use. A significant percentage (almost 26.06%) of the households were using available water without any purification. Table 4 presents the households’ water consumption choices.

Table 4.

Households water consumption choices (%).

Choices	Total
Taking water from the filtration plants	31.21
Using bottled water	18.36
Using osmosis water filter system installed at home	11.79
Boiling water before the use	12.58
Using water without purification	26.06

Discussion

Understanding the factors affecting households’ risk perceptions of water contamination is significantly important for designing policy in the adoption of safety practices and devising alternative or purified sources of water collection. The results of the ordered probit model show the determinants of the households’ risk perceptions of water contamination. Findings indicate that the coefficient of education level was significant and positively associated with households’ risk perceptions. Education as a component of human capital creates a better understanding of the water contamination issue and helps in making well-informed choices in order to avoid any health problem (Odimayomi et al., 2021). The coefficient of income also had a significant positive effect on households’ risk perceptions as expected. The income of the households indicates the welfare status and purchasing power that help them make a better decision at the time of need (de Bruijn and Antonides, 2021).

The coefficient of the proximity to the Lai sewer had a significant negative effect on risk perceptions. This indicates that 1% decrease in the distance from the Lai sewer will increase the households’ risk perceptions by 0.003%. The location of the home from the pollution source is another most crucial factor that may place the households in more danger. Installing a pump near the Lai Sewer could lead to micro-organisms and pathogens contamination in the drinking water. The study by Su (2007) noted that toxic chemicals, pathogens, and bacterial contaminants are easily transmitted into drinking water sources, especially in the areas that are nearest to dump sites. Therefore, one should install the pump far away from the source of the potential hazard, and if it is already established, then any hazardous activity should be kept away from the pump. The variable of the residence period was found positive but non-significant. Apparently, and as stated by Li et al. (2014), the long period of staying in the area has led to better knowledge about the surrounding. Most importantly, the coefficient of health effects due to water contamination had a positive and significant effect on households’ risk perceptions. Javidi and Pierce (2018) recently analyzed the significant and positive impact of health effect due to water contamination on the households’ risk perceptions. The aesthetic characteristics (taste, color, and smell) of water available in the area may induce households to get aware of whether water is contaminated or not. Among these aesthetic determinants, the authors found that the color of water significantly affects households’ risk perception. However, neither the water taste nor the water smell had significant effects on households’ risk perceptions.

The positive and significant effect of households’ knowledge with perceived risk due to the hazards of water contamination was found in the analysis. Francis et al. (2015) stated that in Southern India lack of knowledge about health hazards is associated with households’ risk perceptions and drinking unsafe water. This finding is in line with the studies by Anthonj et al. (2019), Li and Hu (2018), Munene and Hall (2019), and McLeod et al. (2014). The coefficient of awareness was also significant at a 5% level of significance. The significant effect on risk perception of awareness is important because most of the households spend a substantial proportion of their time with friends, neighbors, and in social gatherings that make them aware of the potential health risks due to the Lai sewer. On the contrary, lack of awareness may fail to improve households’ risk perceptions and related health risks. They need to be made aware of the health effects due to the Lai sewer via their social networks and media campaigns. From the facts, it is clear that individuals acquire knowledge and awareness to better understand the nature of environmental issues and health risks as reported by Li et al. (2014). The authors found that in line with households’ knowledge and awareness, attitude is another most influential factor of risk perception with the coefficient value of 0.163 as this variable was positive but significant at a 10% level. Our findings are supported by the earlier studies by Bitew et al. (2017), Odimayomi et al. (2021), and Yan et al. (2018).

The study also focused on the diseases reported by the households using groundwater and supplied water in the area surveyed. Reported waterborne diseases by the households include diarrhea, tiredness, hepatitis, abdominal pain, sleeping disorder, poor appetite, vomiting, irritation, and kidney problems. Based on the previous studies by Katz et al. (2013), Pinon and Vialette (2018), Rosa et al. (2020), and Magana-Arachchi and Wanigatunge (2021), it has been reported that waterborne diseases caused by micro-organisms (virus and bacteria) and pathogens are transmitted through water. Such a scenario demands the need to create awareness among the general masses residing near the Lai sewer.

Overall, in the area surveyed, drinking water causes health issues, but a significant percentage of the households (around 38%) continue to consume water without using any purification method. Due to an increase in health issues and health costs, households are likely to adopt alternative options to fetch water. However, the present price of purified water or bottled water is much higher and consumers had to pay several times each month. The costs of bottled water are rather high in the context of households residing in the vicinity of the Lai sewer, where the average daily labor income is around US$4.50, and the average cost of living is US$3 per individual per day. Although a few drinking water treatment plants were also installed in the area surveyed, they could not fulfill the local demand. In such a situation, households had to depend on the water supplied by the WASA or groundwater that could be more alarming. The study’s findings and other interventions, such as seminars and households awareness programs in the surrounding of the Lai sewer could also be complemented in order to enhance households’ risk perceptions and to avoid or reduce health-related risks associated with contaminated water.

Conclusion and recommendations

This study investigated the households’ risk perceptions of groundwater and supplied water pollution. The primary data employed are collected in 2018–2019 from 134 households in the surroundings of the Lai sewer of Rawalpindi city of Pakistan. The mixed-method approach was used and households’ risk perceptions of water contamination were analyzed both qualitatively and quantitatively. The socioeconomic, demographic, and psychological factors which could influence households’ risk perceptions of health-related risks of groundwater and supplied water used for drinking purposes were analyzed with the ordered probit model. Understanding households’ perception of water pollution use for drinking and other households’ consumption purposes is critical for health safety and significant for recommending policies for poverty alleviation in Pakistan and other developing countries as well. The main sources of drinking water in the surveyed areas of Rawalpindi city include groundwater and supplied water, but these water bodies are heavily polluted due to contamination near the Lai sewer.

The econometric estimates using the ordered probit model show that households’ income, health effects, proximity, knowledge, awareness, and attitude may influence households’ perception of health-related risks due to water contamination. Moreover, the collected data indicated that households in the surveyed areas faced numerous waterborne diseases. Improper disposal of industrial and municipal waste in the Lai sewer containing heavy metals, pathogens, and other bacterial contamination absorbed into fissured bedrock and seeping contaminants into a deep aquifer. Due to the growing urban population and increasing demand for safe drinking water in Pakistan in general and in Rawalpindi city in particular, informed policy initiatives are direly required to ensure the reduction of health-related risks associated with water pollution. It is therefore significantly important that households’ perceptions should be built to guide them to use contaminated water. Households residing near the Lai sewer should be facilitated and encouraged to use safe drinking water and adopt better ways for fetching. Other policy recommendations vis-à-vis health risks reduction from the government side include replacement of old-fashion and rusty sewerage pipelines running parallel to supplied water pipes, installation of water filtration plants near Lai sewer, and enhancing the role of local media to create awareness among masses about water contamination pollution.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Arslan Waheed

Author biographies

Dr. Yasir Mehmood has done Ph.D. in Agricultural Economics from Northwest A&F University, China. He served in the public and private organizations of Pakistan for about nine years. Since 2019, he is serving as Assistant Professor of Economics at the Department of Social and Behavioral Sciences, National University of Medical Sciences, Pakistan.

Dr. Abdul Qadar is an Assistant Professor (Anthropology) in the Department of Social and Behavioral Sciences, NUMS, Pakistan. Dr. Qadar did his Ph.D. in Social Anthropology and Ethnology from EHESS, Paris. His research focuses on broader questions of social change, vulnerabilities, and exchanges.

Arslan Waheed is an Assistant Professor in the School of Social Sciences and Humanities, National University of Sciences and Technology, Islamabad, Pakistan. His research interests comprise urban planning, developmentalism, distressed neighborhoods, and socio-spatial hierarchies.

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