Background: Cow milk is a delicate nutritional source for humans. It is easily be contaminated if it‘s not kept in safe way. Milk when secreted in the alveoli of the udder is sterile, mainly contamination occur in three ways with in the udder, outside of the udder and in contact with contaminated milking equipment. Consumption of contaminated milk may lead to the transmission of infectious diseases from animal to human, causing prolonged disease leading to higher health care costs and reduced quality of life, leading to community acquired drug resistance. Therefore, it is important to know the prevalence of drug resistance, milk quality and factors related with the contamination of raw cow milk at household level. Objective: to determine bacteriological quality, antibiotic resistance and related factors associated with contamination of raw cow milk from small-scale producers in Hawassa town Sidama Ethiopia. Method: this was across-sectional study done at Hawassa city, small-scale raw cow milk producers from Nov 2021-Jan 2022. Data was collected using pretested semi-structured interviewer based questionnaire. Cow milk samples and hand swabs was collected and cultured in medical microbiology laboratory for bacterial isolation, identification and antibiotic resistance characterization. Data was analyzed and interpreted using statistical software such as SPSS V 20, descriptive statistics and Bivariate logistic regression analysis was done to indentify factors related with contamination of milk by antibiotic resistant bacteria. Result: In this study the load of total aerobic bacteria CCP1 (8.4x103), CCP2 (1.0x106) and CCP3 (9.8x106) was significant at (p=0.01) f=4.73 this was confirmed by Pos hoc test to differentiate between CCPs, so CCP3 was (p=0.017) with CCP1 and (p=0.038) withCCP2. The bacterial prevalence from 81 households was CoNs 87(16.3%), Klebssiella.spp 85(16.1%), Enteabctor.spp 70(13%), Enteroccoccus.spp 56(10.6%), E.coli 40(9.0%), Shigella.spp 16(3%)….however, Salmonella.spp was not isolated. The multidrug resistance prevalence was 21(4%), from which3(14.3%) were extended spectrum beta lactamase (ESBL) producers. The commonly identified ESBL groups were E.coli 2(9.5%) and E.cloacae 1(4.7%). Also 1(4.7%) S. aureus(methicillin) and 1(4.7%)Enterococcus fecalis vancomycin resistant . VIII Conclusion : There was poor hygienic farming practice. This study also indicated that, the drug resistance is already emerged and affecting the public health, in addition to that ESBL producing bacteria emerged, this needs greater attention. Factors that have direct relationship with antibiotic resistance, such as, awareness about antibiotic utilization and level of education. Those who have formal education have better understanding and awareness about antibiotic utilization and have better hygienic farming practice.