Unimproved Sources of Drinking Water and the Associated Factors: A Multilevel Analysis of Somalia Health and Demographic 2020 Data

Abstract

Background: Safe drinking water is a universal right, yet millions across sub-Saharan Africa, including Somalia remain dependent on unsafe and unprotected water sources. According to World Health Organization (WHO) and UNICEF, unimproved water sources pose a high risk of contamination, particularly from fecal matter, creating serious public health challenges. Despite international interventions, Somalia continues to struggle with ensuring reliable access to clean water. This study utilizes data from the 2020 Somalia Health and Demographic Survey (SHDS) to examine the determinants of reliance on unimproved water sources through a multilevel analytical approach. Methods: This study employed a cross-sectional design drawing on the nationally representative SHDS 2020 dataset. A three-stage stratified cluster sampling method was used, encompassing 32,300 households from both rural and urban settings. Multilevel logistic regression models were applied to investigate how household and community-level factors shape reliance on unimproved drinking water. The main outcome variable was the type of water source accessed, classified as improved or unimproved. Independent variables included demographic, socioeconomic, and geographic factors, such as education, wealth index, gender, age, and place of residence. Results: The findings reveal that both individual- and community-level determinants significantly influence the likelihood of using unimproved water sources. Households headed by women, those located in rural or nomadic communities, and those with limited education were more prone to using unimproved sources. Clear regional disparities emerged, with areas, such as Middle Shabelle and Banadir showing higher prevalence rates. Economic status was also a strong predictor, with poorer households facing the greatest dependance on unsafe water. These results highlight the multifaceted nature of water accessibility challenges in Somalia and underscore the need for regionally tailored interventions.