Perceptions of drinking water cleanliness and health-seeking behaviours: A qualitative assessment of household water safety in Lesotho, Africa.

Despite the increased availability of improved water sources globally, enteric illnesses remain a source of significant morbidity and mortality. While the MDGs goal for safe water, i.e. improved sources, was met, substantial numbers of people still rely on unimproved sources for at least some of their water needs and contamination can occur between the source and consumption. Reviews and meta-analyses point to the need for better understanding of the cultural context for (HWT) technologies. Qualitative interviews (n = 56) conducted in the Maseru District of Lesotho (2011) addressed how people decided if their water was safe, their understanding of the linkage between water and enteric illness, and health-seeking behaviour. Respondents overwhelmingly relied on visual inspections to determine if their water was clean and not all participants linked consuming unsafe water with diarrheal disease. More than half of all respondents did not boil their water, despite believing that their primary source was not clean. People often have the knowledge necessary to ensure safe water but do not for myriad reasons, including financial constraints or habit. Data such as these are critical as the literature reveals often conflicting findings about the effectiveness of HWT and water safety takes on increasing importance in syndemic settings.