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

Linking water quality, health risks, and community responses in urban drinking water systems of a lower-middle-income city: Evidence from Bangladesh | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Linking water quality, health risks, and community responses in urban drinking water systems of a lower-middle-income city: Evidence from Bangladesh Md. Inzamul Haque, Md. Anik Hossain, Abu Reza, Md. Asikur Rahman, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8980608/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract 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. KAP survey Microbial contamination Municipal water Physicochemical quality Quantitative microbial risk assessment Water Quality Index Water safety Full Text Additional Declarations No competing interests reported. Supplementary Files Supplementaryfilesv1.1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 11 Mar, 2026 Editor assigned by journal 06 Mar, 2026 Submission checks completed at journal 06 Mar, 2026 First submitted to journal 26 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8980608","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":597723340,"identity":"c4e1e5a9-10a3-45c4-bf27-ae0ab2ca26db","order_by":0,"name":"Md. 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