Trends and factors influencing household use of unimproved water sources in Ethiopia: a multivariate decomposition analysis of EDHS data

Abstract

BACKGROUND: Access to safe drinking water remains a major public health challenge in Ethiopia. Despite infrastructure investments, many communities still depend on unimproved water sources, exposing them to waterborne disease and slowing progress toward Sustainable Development Goal 6, which calls for universal access to clean water and sanitation. OBJECTIVE: This study examined trends in household (HH) reliance on unimproved water sources in Ethiopia between 2005 and 2019 using the Ethiopian Demographic and Health Surveys (EDHS) data, and identified the key factors driving these patterns through multivariate decomposition analysis. METHODS: The study used data from repeated cross-sectional surveys conducted by EDHS in 2005, 2011, 2016, and 2019. Each survey employed a stratified two-stage cluster sampling technique to collect data from a representative sample of 55,736 HHs. This study assessed the proportion of HHs using unimproved water sources and applied multivariate decomposition analysis to determine how household characteristics and socio-demographic and economic factors contributed to the observed changes. RESULTS: The proportion of HHs using unimproved water sources declined from 38.40% in 2005 to 31.02% in 2019, driven by both changes in household composition and stronger effects of socioeconomic factors. About 42.38% of the reduction was explained by shifts in characteristics such as fewer rural households, declines in poor households, and improvements in education, while 57.62% was due to the growing influence of these factors-especially education, wealth, and residence-on water access. Households in small peripheral regions, particularly Somali (51.84%) and Afar (45.73%), where pastoralist populations remain prevalent, continue to show high dependence on unimproved drinking water sources. Rural-to-urban transitions, rising educational attainment, and reductions in poverty contributed significantly for the decline, though increases in HHs headed by individuals with no formal education, poorer households, and communities with low literacy slowed progress. CONCLUSION: Ethiopia has made progress in reducing reliance on unimproved water sources, reflecting improvements in infrastructure and socio-economic conditions. However, persistent disparities across regions and socio-economic groups highlighted the need for targeted interventions. Strengthening rural water systems, education, and community engagement could be essential to achieve equitable access and advance Sustainable Development Goal 6.