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Water is broadly thought to be a key determinant of health. However, even if the advantages of improved water supply appear self-evident, hygienic knowledge assimilation needs investigating with particular regard to social representations of dirty/clean and disease transmission. This study uses qualitative data to examine the social representations ofwater and health risks in Ouagadougou, the capital city of Burkina Faso. It focuses especially on the Mossi ethnic group. We found that hygienic knowledge assimilation involves a radical change in the cognitive system over a long-time period, because popular conceptions related to water and health relationships are often at the extreme opposite of biomedical theory. More precisely, education may be insufficient to significantly alter daily hygienic water-use practices, which are more the result of an acculturation process to new ways of thinking and behaving. Education does so in conjunction with other, sometimes equally strong, sometimes even stronger sources of influence. Finally, results show that social representations of health risks are linked to internalized norms and personal experience of knowledge, practices and risks.