Exploring geographical variations and inequalities in access to improved water and sanitation in Ethiopia: mapping and spatial analysis.

Ensuring access to improved water and sanitation remains a public health challenge in Ethiopia. Exploring access to improved drinking-water supply and sanitation will help to track the progress towards achieving the Sustainable Development Goals. The aim of this study was to explore geographical variations and inequalities in access to improved drinking water and sanitation in Ethiopia. A total of 16,650 households from 643 enumeration areas of the recent Ethiopian Demographic and Health Survey 2016 data were extracted and included in the analysis. World Health Organization recommended definitions were used to measure indicators of improved drinking water and sanitation at enumeration areas. SaTScan™ software was used for spatial analysis using enumeration areas as centers for exploring geographical variations of improved water and sanitation. Absolute and relative inequalities were used to quantify regional inequalities in access to improved water and sanitation. Nationwide access to improved drinking water and sanitation in Ethiopia was 49.6% (95% CI: 48.4-50.7) and 6.3% (5.8-6.8), respectively, with large variations between and within regions (using the categories and definitions that were in effect for monitoring coverage in 2016). Access to improved drinking water ranged from 28.5% in Somali Region to 95.3% in Addis Ababa city whereas access to improved sanitation ranged from 1.7% in Amhara Region to 24% in Dire Dawa city. Households lacking access to improved water and sanitation were clustered in northern (Amhara Region) and southern (Southern Nations, Nationalities, and Peoples' Region) parts of Ethiopia. Most enumeration areas had very low level of access to improved drinking water and/or sanitation. This analysis demonstrated the existence of geographical variations and inequalities in access to improved drinking water and sanitation in Ethiopia. Therefore strategies to improve access for safe drinking water and sanitation should consider geographical variations and inequalities at a subnational scale.