Consumption of microbial-contaminated water can result in diarrheal illnesses and enteropathy with the heaviest impact upon children below the age of five. We aimed to provide a comprehensive analysis of water quality in a low-resource setting in Limpopo province, South Africa. Surveys were conducted in 405 households in rural communities of Limpopo province to determine their water-use practices, perceptions of water quality, and household water-treatment methods. Drinking water samples were tested from households for microbiological contamination. Water from potential natural sources were tested for physicochemical and microbiological quality in the dry and wet seasons. Most households had their primary water source piped into their yard or used an intermittent public tap. Approximately one third of caregivers perceived that they could get sick from drinking water. All natural water sources tested positive for fecal contamination at some point during each season. The treated municipal supply never tested positive for fecal contamination; however, the treated system does not reach all residents in the valley; furthermore, frequent shutdowns of the treatment systems and intermittent distribution make the treated water unreliable. The increased water quantity in the wet season correlates with increased treated water from municipal taps and a decrease in the average contaminant levels in household water. This research suggests that wet season increases in water quantity result in more treated water in the region and that is reflected in residents' water-use practices.

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Enteric infections early in life have been associated with poor linear growth among children in low-resource settings. Point-of-use water treatment technologies provide effective and low-cost solutions to reduce exposure to enteropathogens from drinking water, but it is unknown whether the use of these technologies translates to improvements in child growth. We conducted a community-based randomized controlled trial of two water treatment technologies to estimate their effects on child growth in Limpopo, South Africa. We randomized 404 households with a child younger than 3 years to receive a silver-impregnated ceramic water filter, a silver-impregnated ceramic tablet, a safe-storage water container alone, or no intervention, and these households were followed up quarterly for 2 years. We estimated the effects of the interventions on linear and ponderal growth, enteric infections assessed by quantitative molecular diagnostics, and diarrhea prevalence. The silverimpregnated ceramic water filters and tablets consistently achieved approximately 1.2 and 3 log reductions, respectively, in total coliform bacteria in drinking water samples. However, the filters and tablets were not associated with differences in height (height-forage z-score differences compared with no intervention: 0.06, 95% CI: −0.29, 0.40, and 0.00, 95% CI: −0.35, 0.35, respectively). There were also no effects of the interventions on weight, diarrhea prevalence, or enteric infections. Despite their effectiveness in treating drinking water, the use of the silver-impregnated ceramic water filters and tablets did not reduce enteric infections or improve child growth. More transformative water, sanitation, and hygiene interventions that better prevent enteric infections are likely needed to improve long-term child growth outcomes.