Linking water quality, health risks, and community responses in urban drinking water systems of a lower-middle-income city: Evidence from Bangladesh

Access to safe drinking water remains a public health concern in urban Bangladesh. This study assessed the quality, risks, and public perception of public water points (PWPs) in Kushtia Municipality. Seven water samples were analyzed for 13 physicochemical and 5 microbiological parameters. Six parameters (alkalinity, hardness, dissolved oxygen, BOD₅, temperature, and iron) exceeded national standards. Water Quality Index values (195.03–228.68) classified all sources as unfit for drinking, while Pollution Index and Nemerow Pollution Index identified BOD₅, hardness, and alkalinity as dominant pollutants. Fecal coliforms were detected in 71.4% and Pseudomonas spp. in 57.1% of samples. Chemical health risks from iron and arsenic were negligible, but the Quantitative Microbial Risk Assessment indicated a 100% annual infection risk in five of seven PWPs for both adults and children. A cross-sectional Knowledge, Attitude, and Practice (KAP) survey of 305 users revealed high knowledge (0.57), high attitudes (0.58), and borderline high but comparatively lower safe practices (0.50). Regression analysis showed education, occupation, and duration of water use influenced KAP scores, though associations were weak. Respondents emphasized regular maintenance, water testing, and treatment upgrades. The study emphasizes the need for integrated environmental management strategies, including routine microbial monitoring, infrastructure upgrades, and community-engaged interventions, to advance safe and equitable urban water access in low- and middle-income settings in line with SDG 6, SDG 3, and SDG 11.