Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Windy Tanner

Second Advisor

Elsio A. Wunder


Background: Pakistan ranks among the countries most vulnerable to climate change. In 2022, extreme flooding ravaged the country as a result of unprecedented monsoon rains, resulting in widespread environmental and health devastation. As flooding events damage water, sanitation and health (WASH) infrastructure, contribute to disaster conditions, and strain healthcare systems, heavy rains can impact waterborne disease transmission and outbreak events. Extreme flooding events are expected to increase in prevalence, severity, and scope as the climate continues to change in the future. This study aims to assess the impact of monsoon seasons and flooding events on waterborne disease burden in Pakistan from 2021 to 2023. Methods: Epidemiological case data from Pakistan’s National Institutes of Health was analyzed to explore the effect of monsoon seasonality and known flooding events (KFEs) on the prevalence of common water-sensitive diseases in Pakistan: acute diarrhea, bloody diarrhea, suspected cholera, and typhoid. Case data was statistically analyzed to assess important differences: between pre-monsoon, monsoon, and post-monsoon seasons, between years 2021 and 2023, and between four-week pre-flood and post-flood periods for all KFEs. Analysis was performed on national and administrative unit scales. Results: The analysis demonstrated statistically significant differences in case prevalence across pre-monsoon, monsoon, and post-monsoon seasons for most disease types and assessment levels (p<0.05). Yearly comparisons of adjusted case estimates (adjusted for reporting scope) demonstrated statistically significant differences between 2021 and 2023 for most disease types and assessment levels (p<0.05). Unadjusted comparison of population-adjusted case estimates for all KFEs between 2021 and 2023 demonstrated no significant difference between pre-flood and post-flood four-week periods. Conclusion: Our analysis indicated that heavy rains and flood conditions significantly impacted the burden of infectious waterborne diseases in Pakistan. The effects of climate change, especially on countries experiencing disproportionate impacts, are imminent. More robust analysis is imperative for strengthening healthcare systems and building resilience against environmental threats, including heavy rains and extreme flooding. Current public data reserves lack important breadth and detail necessary for comprehensive environmental health analysis. Research of this nature may influence political and public health action, protecting communities, promoting resilience, and ensuring health and well-being in the future.


This is an Open Access Thesis.

Open Access

This Article is Open Access