Awareness and perceptions of point-of-use water treatment in high-density areas of Mzuzu city, Malawi

This study examines the awareness and perceptions influencing the adoption of point-of-use (POU) water treatment in high-density areas of Mzuzu City, Malawi. A multimethod approach was employed, comprising household surveys (n = 322), focus group discussions (n = 5), and key informant interviews (n = 5). Awareness, defined per WHO criteria as knowledge of at least one proven method, access, and health benefits, reached 97.8%, driven by near-universal recognition of boiling (97.8%), with 99.7% aware of sourcing and 100% affirming health benefits. Awareness and attitudes were shaped by socio-economic factors, geographic location, education, income, and asset ownership. Logistic regression identified community type (OR=1.27, 95% CI [1.07–1.51], p = 0.005), drinking water source (OR = 0.73, 95% CI [0.55–0.96], p = 0.022), and assets (OR = 0.82, 95% CI [0.69–0.97], p = 0.019) as key predictors of POU practice. Multinomial regression revealed 62% preferred boiling versus 9% for chlorination; community type increased odds of choosing chlorination (OR = 1.49, 95% CI [1.11–2.00], p = 0.007) and boiling (OR = 1.24, 95% CI [1.04–1.47], p = 0.014). The study concludes that POU treatment has potential to improve quality of life in these areas if barriers are addressed and benefits effectively communicated; and recommends further research in diverse urban settings, inclusive advocacy, and development of affordable, effective POU solutions.