Limited access to improved drinking water, unimproved drinking water, and toilet facilities among households in Ethiopia: Spatial and mixed effect analysis

BACKGROUND: Most people in sub-Saharan countries had limited drinking water services and toilet facilities. The collection of water can affect the health of the whole family, particularly children. Therefore this study aims to investigate determinants of limited access to drinking water services and spatial distributions of limited access to drinking water services, unimproved drinking water sources, and toilet facilities among households in Ethiopia. METHOD: Cross-sectional collected secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey (EDHS). A mixed-effect logistic regression model was used for analysis. The total weighted sample of 10, 183 households was included in the analysis. The study population is comprised of all households who had recorded the time taken to fetch improved drinking water during the survey. The primary outcome of this study is the proportion of households that have limited access to drinking water services. Whereas the secondary outcomes are determinants of limited access to drinking water services and spatial distributions of limited drinking water services, unimproved drinking water sources, and toilet facilities among households in Ethiopia. RESULTS: In this study, 39.74% [95% CI: 38.79, 40.69] of households in Ethiopia had limited access to drinking water services. This proportion ranges from 2.64% in Addis Ababa to 57.35% in the Somali region. Household head, education, residence, and regions were associated with limited access to drinking water services. The spatial analysis showed that the eastern part of Amhara, Afar and the Somali region predicted the highest limited drinking water services. The unimproved drinking water source was detected in the Central part of Amhara, Somalia regions. Almost all regions except Addis Ababa and Diredewa predicted the highest prevalence of unimproved toilet facilities. CONCLUSION: Access to improved drinking water is relatively poor throughout Ethiopia, with some regions experiencing more limited access than others. From individual level variables age, educational level, and sex household head, whereas from community level variables residences, and region were factors significantly associated with access to limited drinking water services. The spatial analysis confirmed that there are inequalities in unimproved drinking water sources, and toilet facilities between regions in Ethiopia. The government of Ethiopia should work to increase the accessibility of improved drinking water at the national level and to narrow the gap in its accessibility between urban and rural residences and between regions. Accessibility to drinking water programs should focus on the disadvantaged group such as non-educated, male head households and living rural residences. All stalk holders should work to improve the quality of drinking water and sanitation facilities.