Submitted in fulfilment of the requirements for the Master of Technology Degree: Environmental Health, Durban University of Technology, 2012. / Waterborne diseases represent substantial global burden of disease and children under the age of five are more susceptible to these diseases compared to adults. The aim of this study was to determine the microbiological quality of Nyabarongo River water used for domestic purposes, women’s knowledge, attitudes and practices (KAP) on water usage and waterborne diseases and its link to the diarrhoea outbreaks experienced in two rural communities: Rusheshe and Ayabaraya of Masaka in Rwanda. A total of 35water samples were collected from Nyabarongo River and from study households which used slow sand filtration (SSF) or Sûr’Eau as treatment methods and analyzed for total coliform and faecal coliform indicators. For household samples turbidity was also analyzed. Retrospective records from Masaka Health Centre were reviewed to determine the prevalence of waterborne diseases from the study areas during 2010. Further, a structured questionnaire was administered to 324 women residents of the study areas to elicit information on their KAP on water handling and waterborne diseases. SPSS Predictive Analytic Software (PASW) Statistics version 18.0 (IBM, Somers, NY) and STATA Release (Version 11.0, College Station, Texas USA) were used for data analysis. Results showed that the mean values of total and faecal coliforms of river and household water samples were above the WHO and Rwandan recommended guidelines. The mean values of total coliform and faecal coliform were significantly lower (p ≤ 0.05) in both filtered and Sûr’Eau treated water than in river water. No statistical differences of means were observed for both total coliform and faecal coliform counts between samples taken from filtered and Sûr’Eau treated water containers (p=0.80 (TC) and p = 0.56 (FC). However, turbidity values were significantly lower in filtered water using SSF than in Sûr’Eau treated water samples (p =0.002). Out of 2814 records form Masaka Health Centre during 2010, 160 cases were identified as having diarrhoeal diseases. Furthermore, respondents who used Nyabarongo River as source of water were more likely to have symptoms of diarrhoea (OR =5.35; CI: 2.12 - 14.46; p <0.05). The frequency of diarrhoea were significantly higher among people who did not wash hands before food preparation (p = 002) and after using a toilet (p = 0.007) than among those who did. There was a statistically significant association of level of education levels and drinking water treatment practices at the household level (p < 0.05). Respondents with primary school education only and those with high school education were more likely to wash their hands after using a toilet (OR= 5.24, CI 1.42-19.38, p =0.01 and OR = 7.15, CI = 1.79 -28.62, p=0.01, respectively) than those who did not attend school. No significant associations were identified between educational levels and washing hands before food preparation. The findings of this study points to the facts that water sourced from Nyabarongo River is unsafe for human consumption even after prescribed treatment, such as the use of SSF and Sûr’Eau, and could increase the prevalence of waterborne diseases and therefore calls for urgent provision of potable water. Women in the study areas had limited knowledge regarding water storage practices for prevention of household water contamination and this; underscore the need for more water handling practices and hygiene education in rural communities. / Durban University of Technology.