ArticleScientific reports2025
Spatial and multilevel analysis of determinant factors for safely managed sanitation services in Ethiopia.
Article in Scientific reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Abstract
Access to safely managed sanitation services is a major public health concern, particularly in low- and middle-income countries like Ethiopia. Addressing the sanitation problem requires a comprehensive understanding of the spatial variation and determinant factors. This study aims to estimate the prevalence of unimproved sanitation services, identify hotspot areas, predict high-risk zones, detect spatial cluster and determinant factors in Ethiopia. A community-based cross-sectional study was conducted using the 2019 Mini-Ethiopian Demographic Health Survey. A total of 8,663 households were sampled using a stratified two-stage cluster sampling method. Arc-GIS version 10.7.1 software was used to visualize the spatial distribution of unimproved sanitation services. SaTScan version 10.2.5 software was used for detecting and analyzing clusters. To identify determinant factors of unimproved sanitation services, a multilevel logistic regression model was employed. In the multilevel analysis, those variables with a p-value < 0.05 were considered to be significant factors for the use of unimproved sanitation services. Approximately 80.23% [95% CI 79.4-81.1] of the population in Ethiopia uses unimproved sanitation services, with significant spatial differences across regions. Determinant factors for the use of unimproved sanitation services includes, households owning a television [AOR = 0.47; 95% CI 0.38, 0.58], households with a middle wealth index [AOR = 0.50; 95% CI 0.37, 0.67], households with a rich wealth index [AOR = 0.27; 95% CI 0.2, 0.36], being in a metropolitan region [AOR = 0.21; 95% CI 0.12, 0.37], living in rural areas [AOR = 5.52; 95% CI 3.28, 9.3], and households with water access within > 30 min [AOR = 2.13; 95% CI 1.56, 2.9] and ≤ 30 min [AOR = 2.67; 95% CI 2.02, 3.51]. Hotspot areas for the use of unimproved sanitation services were observed in the regions of Benishangul-Gumuz, SNNP, Amhara, Gambela, and some parts of Oromia. The primary cluster with low relative risks was found in Addis Ababa, Dire Dawa, and Harari. More than three-fourths of the Ethiopian population relies on unimproved sanitation services, with significant regional variations. Interventions such as media campaigns, investing in sanitation infrastructure, and establishing a monitoring system are highly recommended to address these issues.
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