Land-use patterns influence water quality in lotic ecosystems worldwide; consequently, deteriorating water quality affects fish communities and composition and the ecological health of water bodies. This study aimed to evaluate how land use, stream order, and elevation regulate water quality and ecological health in 64 streams based on the following four land cover types: namely, forest, agriculture, urban upstream, and urban downstream regions. Spatial analysis revealed that urban downstream

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... eas had higher nutrient concentrations [total phosphorus (TP) as follows: 117 µg/L; total nitrogen (TN): 5.57 mg/L] and organic pollutants [chemical oxygen demand (COD): 7.71] than other regions. Empirical analysis indicated that TP (R2 = 0.46) had a high relation with chlorophyll-a (Chl-a) compared to TN (R2 = 0.23) and TN:TP (R2 = 0.20). Elevation, stream order, and monsoon season significantly impact nutrients, organic matter, suspended particles, ionic content, and algal chlorophyll concentrations. The index of biotic integrity (IBI) was significantly positively correlated with elevation (R2 = 0.387), indicating that forest streams (high elevation) had better water quality and ecological health than lower-elevation streams. The proportion of insectivore species shows a significant negative relationship with biological oxygen demand (BOD) (R2 = 0.123) and TP (R2 = 0.155). The multi-metric index of biotic integrity (IBI) model suggested that the ecological health of forest streams was in fair condition. In contrast, agricultural streams were in poor condition, and urban upstream and downstream were in very poor conditions. The outcomes of this study indicated that land-use patterns and elevation largely regulate the water quality and ecological health of the streams.