Determinants of Improved Household Sanitation Use in Ethiopia: A Multilevel Logistic Regression Analysis.

Introduction: Sanitation is a fundamental human right and a cornerstone of public health. In Ethiopia, access to improved sanitation facilities remains limited, especially in rural areas. Poor sanitation, coupled with inadequate water supply and hygiene, significantly contributes to illness and mortality worldwide, disproportionately affecting developing countries. This study aims to identify individual and community-level factors associated with the use of improved sanitation facilities among Ethiopian households by applying a multilevel logistic regression model to data from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). Methods: This study used data from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS. A total of 6141 households were included in the analysis. A cross-sectional design was used to estimate the use of improved sanitation services at national, regional, urban, and rural levels. To account for the hierarchical nature of the data households nested within community's multilevel logistic regression was employed. This approach allowed for the partitioning of variance into individual and community level components, thereby improving model accuracy and capturing contextual influences on sanitation use. Results: The analysis revealed significant regional disparities in the use of improved sanitation services among Ethiopian households. Married households had higher odds of using improved sanitation (AOR = 1.81, 95% CI: 1.67-4.70), while unmarried (AOR = 0.35, 95% CI: 0.21-0.56) and divorced households (AOR = 0.24, 95% CI: 0.23-0.50) had lower odds compared to widowed households. Rural households were less likely to use improved sanitation than urban ones (AOR = 0.37, 95% CI: 0.140-0.99). Illiterate (AOR = 0.13, 95% CI: 0.08-0.20) and primary-educated (AOR = 0.25, 95% CI: 0.16-0.39) household heads were less likely to access improved sanitation than those with higher education. Poor (AOR = 0.86, 95% CI: 0.44-0.98) and middle-income (AOR = 0.84, 95% CI: 0.42-0.93) households had lower odds compared to rich households. Homeownership (AOR = 2.28, 95% CI: 1.13-2.46) and private latrine use (AOR = 1.43, 95% CI: 1.36-2.65) were significantly associated with higher sanitation use. Conclusion: This study reveals substantial regional and sociodemographic disparities in the use of improved sanitation facilities in Ethiopia. Households headed by married, educated, and wealthier individuals living in urban areas with private latrines and home ownership are more likely to have improved sanitation. Targeted interventions focusing on rural, poorer, less educated, and female-headed households are essential to enhance access to improved sanitation. Addressing these disparities is critical for Ethiopia to achieve its national sanitation goals and contribute toward the Sustainable Development Goals related to health and well-being.