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Background  Bacterial contamination of drinking water is a major public health problem in rural areas of sub-Saharan Africa. Unimproved water sources are a major reservoir of  Escherichia coli  ( E. coli ) causing severe diarrhoea in humans. This study assessed  E. coli  counts in drinking water from different sources and their relationship with water source protection status and neighbourhood sanitation and hygiene practices in rural villages of Mohale Basin in Lesotho.    Methods  Thirty drinking water sources were purposively sampled and their water analysed for  E. coli  counts. The types of water sources, their protection status and neighbourhood sanitation and hygiene practices in their proximity were also assessed.  E. coli  counts in water samples were compared to water source protection status, neighbourhood sanitation, hygiene practices, livestock faeces and latrine proximity to water sources.    Results   E. coli  counts were found in all water samples and ranged from less than 30 colony-forming units (cfu)/100 ml to 4800 cfu/100 ml in protected sources to 43,500,000 cfu/100 ml in unprotected sources. A significant association between  E. coli  counts in drinking water samples and lack of water source protection, high prevalence of open defecation (59%,  n  = 100), unhygienic practices, livestock faeces and latrine detections in proximity to water sources was found in the study ( P  < 0.05).    Conclusion  Water sources in studied villages were contaminated with faeces and posed a health risk to consumers of that water. Community-led sanitation and hygiene education and better water source protection are urgently needed.

environmental health and preventive medicine

Bacterial contamination of drinking water sources in rural villages of Mohale Basin, Lesotho: exposures through neighbourhood sanitation and hygiene practices