In the Kathmandu Valley of Nepal, locals depend on multiple water sources due to the limited access to safe water, which is a great global concern regarding its impact on human health. This study aimed to compare the infection risk of diarrhoea from multiple water sources with different concentrations of Escherichia coli among water supply areas and evaluate the impact of changing water sources due to the Gorkha earthquake on the infection risk. The concentration of enteropathogenic E. coli was estimated in samples of piped water, jar water, groundwater, and tanker water, which were collected in the Valley. The volume of each water ingestion was determined based on a questionnaire survey and considering drinking and bathing sources. The highest estimated risk was observed for households drinking groundwater from shallow dug wells, followed by tanker water. The estimated risk implied the regional disparity due to various water sources with different quality. After the earthquake, the ratio of households drinking only jar water increased, and the estimated risk decreased. The damage on piped water supply, the decrease of tanker water availability and the decrease of residents’ trust in groundwater quality presumably enhanced the consumption of jar water despite its high price.

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In Nepal, the number of diarrhoea hospitalizations in all ages is seriously high. According to the World Health Organization, diarrheal diseases can be substantially prevented through safe drinking water sources. In the Kathmandu Valley, because of the shortage of piped water, local residents use alternative water sources, such as groundwater, jars and tanker water. However, these alternative water sources can be contaminated. This study aimed to clarify the relationship between diarrhoea risk and the combinations of drinking water sources. A survey using multiple questionnaires on diarrhoea occurrence, water sources and water treatment was conducted three time between 2015 and 2016. The odds ratios (ORs) of developing diarrhoea were significantly high for drinking jar (OR 6.1) and tanker water (OR 8.4) compared with not drinking. The combined drinking of jar and tanker water obtained the 1 log higher OR compared with drinking only piped water. Conversely, drinking groundwater had a low OR, implying that the residents refrained from drinking polluted groundwater. In conclusion, diarrhoea occurrence was related not only to the level of water contamination, but also to a behavioural factor, i.e. people's careful management of the choice of multiple water sources.

Polymyalgia rheumatica (PMR) is frequently reported in the outpatient setting and presents with pain, morning stiffness, mild fever, and fatigue. However, the clinical course of PMR during hospitalization is unknown. We report a case of PMR that developed during hospitalization. PMR diagnosis should begin with an evaluation of core inclusion and exclusion criteria. However, when examining elderly patients, retrieving symptom information from the patient or their family is often difficult, especially during prolonged hospitalization. History taking by physical and occupational therapists or by other health care professionals is paramount in the symptomatic diagnoses of inpatients.