**Hypothesis 3 (H3).** *Family size has a positive relationship with waterborne diseases.*

(3) Life Choices

The model in Figure 1 indicates that experience establishes the basis for life choices, as illustrated in box no. 3. As described earlier, Weber introduced the term "life choices", which means "the self-direction of one's behavior". In this study, "life choice" refers to plant or tap water for drinking.

(4) Life Chances

As reflected in box no. 1, class circumstances and additional variables led to life chances (referring to structure) as revealed in box no. 4. Dahrendorf [60] dictated that Weber's work-life chances refer to "glazed chances of finding satisfaction for wants, needs, and interests, hence the possibility of manifestation of the events which ultimately carry out such satisfaction". In the context of this study, life chances mean fewer occurrences of waterborne illness by using plant water.

(5) Dispositions to Act (Habitus)

The interface of life choices and life chances takes the individual dispositions towards action, as shown in box 5 of Figure 1—such dispositions are instituted as habits. Habitus refers to the cognitive/mental map or the perceptions that usually help evaluate and guide the person's options and choices. Here, in this study, when households realized drinking plant water prevents them from waterborne illness, as the local government installed these plants to provide clean drinking water, they showed the disposition of the act by using plant water more for drinking purposes. Hence, we propose the following hypothesis:

**Hypothesis 4 (H4).** *Households using local government filtration plant water are healthier than households not using local government filtration plant water.*

**Hypothesis 5 (H5).** *Infants and children using local government filtration plant water have fewer waterborne diseases than families not using local government filtration plant water.*

(6) Practices (actions)

The disposition of an act (the preference to use clean drinking water) indulges households in practices. Practices refer to an action, as illustrated in Figure 1. These actions involve either bringing water from plants or incurring expenditures to bring water from plants. These practices ultimately lead to health improvement by decreasing the occurrence of waterborne illnesses. In this regard, the hypothesis is framed as follows:

**Hypothesis 6 (H6).** *More expenditure on drinking water reduces the incidence of waterborne illness.*

#### **3. Study Area**

The city of Lahore was chosen as the target site for this study. Lahore is the capital of Punjab province and one of the most populous cities in Pakistan, considered the secondlargest city in Pakistan, comprising 12,642,000 inhabitants (Figure 2) [3].

**Figure 2.** Study area.

In the city, 40 percent of the population is under the age of 15, with an average expected lifetime of no more than 60 years. Besides, the literacy rate is lower than 41% [61]. The public of Lahore city is also suffering from problems associated with the quality of drinking water [11]. To ensure the delivery of hygienic and pristine drinking water to residents of Lahore, the local government fixed several water purification plants at numerous locations around the city, including Shalamar Garden, Mishri Shah, Sabzazar, Lahore Zoo, Walled City, Gulshan-i-Iqbal, Shahdara, Aik Moria Pul, Pani Wala Tabla, Mughalpura, Data Darbar, Harbanspura, City Railway Station, at Blind School, outside Lohari Gate, Lorry Adda, and inside New Anarkali. These sites were selected based on the level of impurities, arsenic, residents' income, and ease of accessibility for citizens [62].

#### **4. Methods and Materials**

This study is cross-sectional, meaning that the study's population comprises households residing in four different areas of Lahore. These four areas were chosen using a multistage random sampling technique, where two areas constitute local government water purification plants, while two areas lack these plants [63]. The sites with local government purification plants were Shahdara and Harbanspura, and the sites missing these plants included the Nishatar colony and Zia Colony Township. These four sites were either semi-slums or slums. The income level of the households residing in these areas is low, with a high illiteracy rate. In addition, another purpose for selecting these areas was the level of arsenic, which is a life-threatening chemical. Contamination of drinking water with arsenic causes several chronic pulmonary and skin infections. According to WHO [4], the safe arsenic level in drinking water is up to 50 ppb. The level of arsenic in Shahdara is 76.8 ppb; in Harbanspura, it is 74.0 ppb; in the Nishatar colony, it is 82.0 ppb; and in Zia Colony Township, it is 66.9 ppb [16].

Potential respondents/households were carefully chosen through a simple random sampling technique. Seventy-five households were selected from every selected area. Hence, a total of 300 households were selected as a sample size. Primary data needed to be gathered to evaluate waterborne sickness's influence and determine the association's strength among variables. Data were collected from households in the studied localities using a structured questionnaire. The questionnaire covers all the pertinent information such as demographics (age, level of education, number of family members, average family income), drinking water sources, drinking water expenditures, waterborne associated incidences, and extent. A post-questionnaire development pilot study was conducted by administering 50 questionnaires with and without filtration plant areas to ensure that the questionnaire has valid measures for data collection. Furthermore, face-to-face interviews were conducted with the household head or another family member in their absence to learn their perspectives on the adulteration of drinking water, the underperformance of the water purification plant, the waterborne sickness they experienced, and the impact of this sickness on infants and children. Before starting the interview, the purpose of the

study was explained to the participants, and informed consent was obtained for inclusion in the final manuscript. The identity information of the participants was removed from the shared data.
