Magnitude and determinants of improved household latrine utilization in Ethiopia: Multilevel analysis of the mini Ethiopian Demographic Health Survey (EDHS) 2019.

Lack of sanitation is a major global problem mainly for the poor and disadvantaged. According to the 2016 Ethiopian Demographic and Health Surveys (EDHS) report, one out of every three households lack a toilet in Ethiopia and about 56% of rural households use unimproved toilet facilities. We aimed to determine the magnitude of improved household latrine utilization and its determinants in Ethiopia using the mini-Ethiopian Demographic Health Survey (EDHS) 2019 data set. A secondary data analysis was conducted based on the mini 2019 EDHS data set. A total weighted sample of 8663 households were involved in analysis. After selecting the relevant variables for the outcome variable, we have fitted four different models. The null (empty) model with no independent variables and the second model contained the effects of the individual-level factors on the outcome variable. The third model included the influence of the community-level factors on the response variable, and the final multilevel multivariable logistic regression model examined the effects of individual-level and community-level variables on the outcome variable. The measure of variation was quantified using Intra-Class Correlation (ICC), Median Odds Ratio, and Proportional Change in Variance (PCV). The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was used to show the strength of association and statistical significance was declared at p value < 0.05. The magnitude of improved latrine utilization in Ethiopia was 19.5% with 95% CI (18.6%, 20.3%). The factors: educational status (AOR = 1.67; 95% CI: (1.10, 2.55), highest wealth index (AOR = 3.73; 95% CI: (2.73, 5.12), urban residence (AOR = 3.09; 95% CI: (1.68, 5.67), living in Addis Ababa (AOR = 4.08; 95% CI: (1.03, 16.2) and Dire Dawa (AOR = 8.22; 95% CI: (2.46, 27.42) and Somali regions (AOR = 3.11; 95% CI: (1.15, 8.42) were significantly associated to improved latrine utilization in Ethiopia. The magnitude of improved latrine utilization was quite low in Ethiopia. Higher wealth index, living in more urbanized areas, and the household head's educational status were all significant predictors of improved latrine utilization. The finding implies a need to increase household's access to latrine facilities and improve latrine utilization, particularly for rural households in the country.

Tesfaw A ，Tiruneh M ，Mamuye M ，Walle Z ，Teshager W ，Teshome F ，Taye A ，Dessalegn W ，Walle G ，Gebeyehu AA ... -  《PLoS One》

Prevalence and Determinants of Household Access to Improved Latrine Utilization in Somalia: Health Demographic Survey (SHDS) 2020.

The aim of this research paper is to determine the prevalence of improved household latrine utilization and its determinants in Somalia, using the Somali Health Demographic Survey (SHDS) 2020 dataset. Limited sanitation is a major global problem mainly for the poor and disadvantaged. According to the SHDS 2020 report, around 22.3% of households in Somalia utilize unimproved toilet facilities. In this study, a secondary data analysis was carried out on the SHDS 2020 dataset. The study included 15 826 households weighted for representativeness. Four models were constructed after identifying relevant factors for the outcome variable. The first model, null (empty), had no independent variables. The second model assessed the effect of individual-level determinants on the outcome. The third model determined how community-level variables influenced on the response variable. Finally, a multilevel multivariable logistic regression model examined the combined impact of individual- and community-level factors on the outcome variable. The prevalence of improved latrine utilization in Somalia was (41.1%). The factors: educational status (AOR: 1.899 (1.598, 2.258)), wealth index (AOR: 7.815 (6.990, 8.736)), urban residence (AOR: 2.467 (2.262, 2.690)), households living in various regions/states, including Hirshabelle, Galmudug, Southwest, Puntland, Jubaland, and Somaliland, indicate statistically significant findings and were more likely to utilize improved latrines (AOR: 0.259 (0.229, 0.294)), (AOR: 0.223 (0.196, 0.254)), AOR: 0.196 (0.168, 0.230)), (AOR: 0.220 (0.194, 0.251)), (AOR: 0.204 (0.180, 0.232)), (AOR: 0.086 (0.077, 0.095)). Hirshabelle had a 0.259 times more likelihood of improved latrine utilization than the rest of the regions/states, (AOR: 0.259 (0.229, 0.294)). The prevalence of improved latrine utilization was quite low in Somalia. Higher wealth index, living in more urbanized areas, and the household head's educational status were all significant predictors of improved latrine utilization. The finding implies a need to increase household's access to latrine facilities and improve latrine utilization, particularly for rural households in the country.

Ahmed HA ，Ali DA 《-》

Individual and community-level determinants, and spatial distribution of institutional delivery in Ethiopia, 2016: Spatial and multilevel analysis.

Tesema GA ，Mekonnen TH ，Teshale AB 《PLoS One》

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

Belay DG ，Andualem Z 《PLoS One》

Unimproved source of drinking water and its associated factors: a spatial and multilevel analysis of Ethiopian demographic and health survey.

Drinking water quality has been a major public health concern in lower and middle income countries where access to improved water supplies is limited. Ethiopia is thought to have one of the worst drinking water infrastructures in the world. This study aimed to assess the spatial variation and determinants of using unimproved sources of drinking water in Ethiopia using recent nationally representative data. A population-based cross-sectional study was employed with the recent EDHS data of 2019. A total of 8663 households were sampled using a stratified two-stage cluster sampling method. Kuldorff's SaTScan version 9.6 software was used to generate spatial scan statistics. ArcGIS version 10.7 software was used to visualize the spatial patterns of unimproved drinking water sources. A multilevel multivariable mixed-effect logistic regression was used to identify factors associated with the use of an unimproved drinking water source. In the multivariable multilevel analysis, those variables with a p-value < 0.05 were considered to be significant predictors of using an unimproved source of drinking water. Around 31% (95% CI: 30%, 32%) of the population in Ethiopia uses unimproved sources of drinking water with significant spatial variation across the country. Households aged 41-60 [AOR = 0.69; 95%CI; 0.53, 0.89] as compared to the households aged 10-25, households having middle wealth index [AOR = 0.48; 95%CI; 0.40, 0.59], and households having a rich wealth index [AOR = 0.31; 95%CI; 0.25, 0.39] as compared to the poor households, living in high community literacy level [AOR = 0.36; 95%CI; 0.16, 0.80], living in high-level community poverty [AOR = 3.03; 95%CI; 1.32, 6.98], rural residence [AOR = 7.88; 95%CI; 2.74, 22.67] were significant predictors of use of unimproved source of drinking water. Hot spot areas of use of unimproved drinking water sources were observed in Amhara, Afar, and Somalia regions and some parts of SNNPR and Oromia regions in Ethiopia. The primary clusters were found in Ethiopia's Somalia and Oromia regions. Around one third of the Ethiopian population utilizes unimproved source of drinking water and it was distributed non-randomly across regions of Ethiopia. The age of the household head, wealth status of the household, residence, community poverty level, and community literacy level were found to be significantly associated with utilizing unimproved drinking water source. State authorities, non-governmental organizations and local health administrators should work to improve the quality of drinking water particularly for high risk groups such as communities living in high poverty and low literacy, poor households, rural residents, and hot spot areas to decrease the adverse consequences of using unimproved drinking water source.

Aragaw FM ，Merid MW ，Tebeje TM ，Erkihun MG ，Tesfaye AH ... -  《BMC PUBLIC HEALTH》