Drinking Water Quality and Health Risk Assessment in Rural Ghana: Evidence from North-East and North Gonja Districts in the Savannah Region

Background: Access to safe drinking water remains a critical public health concern in rural Ghana, particularly in climatically vulnerable and underserved settings. This study assessed the microbiological and chemical quality of drinking water and evaluated nitrate-related health risks in the North Gonja and North-East Gonja Districts of the Savannah Region. Methods: A cross-sectional study was conducted between January and March 2025. A total of 460 water samples were collected from groundwater sources and household storage containers. Microbial analyses targeted total coliforms and Escherichia coli. Physicochemical and chemical parameters included nitrate-nitrogen, pH, residual chlorine, major ions, and trace metals. Data was analyzed using descriptive statistics, chi-square tests, spatial interpolation, and non-carcinogenic health risk assessment based on the hazard quotient (HQ) approach. Results: Widespread microbial contamination was observed, with 91.5% of household water samples positive for total coliforms and 46.6% for E. coli. Contamination of source water was significantly higher in North Gonja than in North-East Gonja. Overall, 49.1% (n = 55) of groundwater sources exceeded the World Health Organization guideline value for nitrate-nitrogen, with exceedances predominantly occurring in North Gonja. Additionally, 67.0% (n = 75) of samples were outside the acceptable pH range (6.5–8.5), including 74 samples below 6.5 and one above 8.5. Residual chlorine was not detected in any of the samples. Health risk assessment indicated potential non-carcinogenic risks associated with nitrate exposure, particularly among infants and children. Conclusions: The study demonstrates significant microbial contamination and nitrate-related health risks in the study area, particularly in North Gonja. Interventions such as improved source protection, routine water quality monitoring, chlorination, household water treatment, and implementation of Water Safety Plans are recommended to enhance drinking water safety and reduce associated public health risks.