Access to safe water remains a critical challenge in rural Nigeria, with serious implications for public health and livelihoods. This study examines water quality, access patterns, and associated health risks in Nsit Ubium Local Government Area of Akwa Ibom State. Using a mixed-methods design, field sampling, laboratory analysis, household surveys, and spatial mapping were employed to evaluate microbial and chemical water quality, source reliability, infrastructure conditions, and accessibility patterns. Findings reveal widespread reliance on unprotected surface water sources and inadequately maintained boreholes. Laboratory results indicate elevated microbial contamination and deviations in selected chemical parameters beyond recommended safety thresholds. Long distances to water sources, seasonal variability, and weak institutional coordination exacerbate household vulnerability, particularly among women and children. Statistical analysis confirms a significant association between unsafe water and the prevalence of waterborne diseases, increased healthcare expenditure, and reduced labour productivity. The study concludes that strengthening rural public health outcomes requires integrated water-quality monitoring, infrastructure rehabilitation, sanitation improvement, and community-based governance systems. These interventions are critical for enhancing rural resilience and achieving sustainable development in agrarian communities.

Keywords: Water quality; Rural water access; Public health; Waterborne diseases; Community water management; Nigeria.