The devastating earthquake of 2005 severely damaged over 4000 water and sanitation schemes in northern Pakistan. The present study aimed at testing a low cost household sand filter (HSF) in treating low quality drinking water in disaster-hit areas of northern Pakistan. Two villages were randomly selected for practical demonstration of a low cost drinking water treatment system in earthquake affected areas. The on-site performance of HSF was monitored during the operational period. The data was collected on people perceptions of water quality and handling of the household sand filter (HSF) through in depth focus group discussions, questionnaire and interviews. The results showed that pre-treatment values of drinking water for Escherichia coil, total coliforms and turbidity were 101 cfu/100 ml, 73 cfu/100 ml and turbidity 44 and 16 NTU, respectively. After HSF operation for 10 days, 97% reduction in E coli, total coliforms and turbidity was evidenced. More than 67% of the respondents perceived turbidity as a prime water quality issue responsible for ill health consequences. It was concluded that the designed HSF was efficient in improving drinking water quality for illiterate communities and its success and dissemination to poor communities were prone to locally available construction materials. (C) 2011 Elsevier B.V. All rights reserved.