Spatial distribution and determinants of unimproved sanitation facilities among households in Somalia: Using Somalia integrated household budget survey (SIHBS 2022)

by Omar Muhumed Maidhane, Omran Salih, Abdisalam Hassan Muse, Abdirahman Omer Osman, Muse H. Abdi, Mahdi Hashi Hassan, Nur Mohamud Ali, Shacban Abdilahi Elmi Background Access to adequate sanitation remains a critical public health challenge in Somalia, where a large portion of the population relies on unimproved facilities due to persistent conflict, climate shocks, and political instability.

This reliance contributes to a high burden of waterborne diseases. This study aimed to assess the spatial distribution of unimproved sanitation and identify its individual and community-level determinants using recent national data to inform targeted interventions.

Methods This study is a secondary analysis of the 2022 Somalia Integrated Household Budget Survey (SIHBS), which included 7,212 households. The primary outcome was the use of unimproved sanitation facilities, categorized according to the WHO/UNICEF Joint Monitoring Programme (JMP) definitions.

We employed a multilevel logistic regression model to identify individual and community-level determinants associated with unimproved sanitation. To analyze the spatial patterns of unimproved sanitation, we used Global Moran’s I for spatial autocorrelation and the Getis-Ord Gi* statistic for hotspot analysis.