Access to clean and safe drinking water is a fundamental human right, essential for sustaining life and ensuring public health. However, in many parts of the world, including Shimla, a captivating hill station nestled in the Himalayan foothills of Himachal Pradesh, India, this basic necessity faces considerable challenges. Shimla, renowned for its picturesque landscapes and pleasant climate, draws tourists and adventurers from far and wide. Yet, beneath its scenic beauty lies a lurking threat - waterborne diseases. These diseases, often caused by the contamination of water sources with pathogenic microorganisms, pose a significant risk to the well-being of Shimla's residents [1-3].

Waterborne diseases encompass a spectrum of illnesses, including cholera, typhoid, gastroenteritis, and hepatitis, among others. They result from the consumption of water contaminated with bacteria, viruses, or parasites and can lead to severe health consequences, especially in vulnerable populations. Despite the importance of clean water and the efforts made by local authorities, the specter of waterborne diseases continues to cast a shadow over Shimla [4,5].

The importance of this assessment is underscored by the potential health consequences of waterborne diseases. Cholera, for instance, can lead to severe dehydration and death if not treated promptly. Typhoid fever can result in prolonged illness and, in some cases, complications affecting multiple organ systems. Gastroenteritis can cause significant discomfort and inconvenience, while hepatitis poses a risk of chronic liver disease. These diseases not only affect individuals but also place a burden on healthcare systems and communities [4-6].

Given the crucial role of awareness and knowledge in preventing waterborne diseases, it is imperative to assess the level of understanding among the general public of Shimla. Recognizing the sources of contamination, understanding proper water treatment, and practicing good hygiene are key steps in safeguarding public health. This study aims to bridge the existing gap in understanding the awareness and knowledge levels of Shimla's residents and visitors regarding waterborne diseases.

Therefore, this study seeks to evaluate the level of awareness and knowledge among Shimla's residents about waterborne diseases. The findings will serve as a foundation for designing targeted public health campaigns and educational programs aimed at promoting safe water practices, hygiene, and disease prevention. Ultimately, this endeavor aims to empower the community to take proactive measures in preventing waterborne diseases, ensuring that Shimla's water remains a source of life and not a cause of illness.

Objectives of the Study

To evaluate the level of awareness and knowledge among Shimla's residents about waterborne diseases

Research Approach

This study employs a descriptive research approach to assess the level of knowledge regarding waterborne diseases among the general public of Shimla. A descriptive approach is chosen as it allows for the systematic collection and analysis of data to describe and understand the current awareness and knowledge of the study participants on the specific topic of interest.

Research Design

A cross-sectional survey design is utilized for this study, enabling data collection at a single point in time from a diverse sample of individuals. This design ensures that information about the awareness of waterborne diseases can be obtained from a representative sample of the target population, thereby providing a snapshot of the prevailing knowledge at the time of the study.

Study Area and Duration

 The research is conducted in Shimla, renowned for its diverse population and urban lifestyle. The study duration spans from April 2023 to July 2023, during which data collection and analysis are performed.

Study Population and Sample Size

The study's target population comprises all adults above 18 years of age who have resided in Shimla for a minimum of 12 months. A sample size of 400 adults is determined, considering a 50% estimated knowledge level about waterborne diseases, a 5% absolute error, a 95% confidence level, and a 5% non-response rate. This sample size ensures adequate representation and generalizability of findings to the larger population.

Data Collection Tool

To gather information on waterborne diseases awareness, a well-structured and validated Google Form questionnaire is developed. The questionnaire consists of two sections: the first section captures socio-demographic data, including age, gender, marital status, religion, employment, and education, while the second section comprises 20 carefully crafted questions related to knowledge about waterborne diseases.

Description of the Questionnaire

The questionnaire is designed to evaluate participants' knowledge on waterborne diseases, with each correct response receiving one mark and incorrect answers receiving zero marks. Based on their scores, participants' knowledge levels are categorized into four groups: very good (>80%), good (60-79%), fair (41-59%), and poor (<40%). This scoring system allows for a clear understanding of the overall awareness levels among respondents.

Data Collection and Analysis

Data collection is conducted under the supervision of experienced supervisors, and the Google Form questionnaire is disseminated through various online platforms, such as email, WhatsApp groups, Facebook, Instagram, and LinkedIn, to reach both rural and urban areas of Shimla. Collected data is then meticulously entered into a Microsoft Excel spreadsheet and thoroughly checked for accuracy and completeness. Epi Info V7 software is employed for data analysis, and appropriate statistical tests, such as frequencies and percentages, are used to present the findings in a clear and concise manner.

Ethical Considerations

Throughout the study, utmost care is taken to adhere to ethical guidelines to ensure the privacy and confidentiality of participants. Informed consent is obtained from all respondents before their inclusion in the study, and their personal information is kept confidential. The research team ensures that all data is anonymized, safeguarding the participants' identities at all times.

The goal of the current study was to assess the knowledge regarding waterborne diseases among general public of Shimla through a non-experimental descriptive survey. A total of 400 respondents including 259 (64.75%) were from urban area and 141(35.25%) were from rural area were participated in the study.

In the present study 31.5% (126)  participants had very good knowledge (16-20 marks) towards waterborne diseases , 36.75% (147) had good knowledge (12-15 marks), 21.0% (84) had fair knowledge  (8-11 marks) and 10.75% (43) having poor knowledge (<8 marks).

Table1: Knowledge Regarding Waterborne Diseases among Study Participant

Table 2: Knowledge Scores towards Waterborne Diseases among Study Participants

Waterborne diseases, stemming from the contamination of water sources with pathogenic microorganisms, pose a significant public health risk in Shimla, a picturesque hill station in Himachal Pradesh, India. This discussion delves into the findings of the study, highlighting the awareness and knowledge levels of the public in Shimla regarding waterborne diseases. These findings are further compared to existing studies conducted in different regions to assess the overall understanding and awareness of waterborne diseases in Shimla.

The study evaluated the knowledge levels of 400 respondents in Shimla, with 64.75% residing in urban areas and 35.25% in rural areas. The results reveal a wide spectrum of knowledge among participants concerning waterborne diseases. An impressive 81.5% of respondents correctly identified waterborne diseases and their causes, reflecting a strong foundational understanding of the topic. Approximately 58.75% of participants were able to name at least three common types of waterborne diseases, indicating familiarity with specific illnesses within this category.

About 75.25% of respondents demonstrated an understanding of how waterborne diseases spread to humans, highlighting their awareness of the modes of transmission. A notable 78% recognized common risk factors associated with contracting waterborne diseases, emphasizing the importance of awareness in taking preventive measures. While 71.75% understood that waterborne diseases are not spread from person to person, a significant portion still held misconceptions about their transmission.

An encouraging 79.75% correctly identified the typical clinical features or symptoms of waterborne diseases, which is crucial for early recognition and appropriate action. Approximately 54.5% were aware of how healthcare professionals typically diagnose waterborne diseases, indicating a reasonable understanding of this aspect. 65.5% recognized the significance of promptly addressing waterborne diseases, reinforcing the importance of early intervention.

While 45.25% were aware of potential complications arising from untreated waterborne diseases, there is room for improvement in understanding the severity of these diseases. 57.25% correctly identified measures to ensure safe drinking water, indicating a significant level of awareness regarding preventive actions. 53.5% recognized the existence of specific preventive measures for travelers to regions with a high risk of waterborne diseases, contributing to the safety of travelers. An encouraging 62.75% understood the importance of proper sanitation and hygiene in preventing waterborne diseases, highlighting the significance of these practices. 55% could identify steps that communities can take to ensure access to safe drinking water, demonstrating an awareness of community-based approaches to water safety. While 24.5% were aware of the availability of vaccines for specific waterborne diseases, a larger portion remained uninformed about vaccination options.

Approximately 49.5% had knowledge of common treatment options for individuals affected by waterborne diseases, indicating room for improvement in understanding this critical aspect. 31.25% understood the role of water treatment facilities in preventing waterborne diseases, suggesting a need for increased awareness of water treatment processes. While 25.75% were aware of specific regulations or guidelines in their region for water quality and safety, a substantial portion remained uninformed about regulatory frameworks. Only 24.5% could name any public health campaigns or initiatives related to waterborne disease prevention, indicating a potential gap in public health communication. 33.5% recognized the role of individuals and communities in raising awareness about safe water practices, reflecting a willingness to engage in educational initiatives. Around 30.5% were aware of the existence of misconceptions or myths about waterborne diseases, signaling a level of critical thinking about the topic.

Comparing these findings with studies conducted in various regions, residents of Shimla exhibit a commendable level of awareness and knowledge regarding waterborne diseases [7-10]. While some aspects align with findings from other studies, such as the recognition of symptoms and the importance of hygiene, there are notable knowledge gaps in areas like vaccination awareness and the role of water treatment facilities. This underscores the need for targeted education and awareness campaigns in Shimla to enhance understanding further.

Assessing the awareness and knowledge levels of Shimla's residents regarding waterborne diseases has revealed a substantial understanding of many aspects of the topic. However, there are opportunities for improvement in specific areas, particularly in vaccination awareness, understanding treatment options, and awareness of water treatment processes. Addressing these knowledge gaps through tailored public health campaigns and educational initiatives is essential to mitigate the risks posed by waterborne diseases effectively. This collective effort will contribute to ensuring that Shimla's water remains a source of life and not a cause of illness.

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