Unimproved source of drinking water and the associated factors: Insights from the 2020 Somalia demographic and health survey.

Access to safe drinking water is a fundamental human right and a critical public health concern, particularly in lower- and middle-income countries with limited infrastructure. Somalia faces significant challenges in providing improved drinking water sources, with a high prevalence of unimproved sources. This study analyzes data from the SHDS 2020 to investigate the prevalence of unimproved drinking water sources and identify associated factors. A cross-sectional study of 32,300 participants was conducted to identify factors associated with using unimproved drinking water sources. Multivariable logistic regression analysis was performed using Stata 16 software. Variables with a p-value < 0.05 in bivariate analysis were included in the multivariate model. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were used to estimate the association of significant variables with the outcome. Approximately 22.04% (95% CI: 21.5%, 22.4%) of the Somali population utilizes unimproved drinking water sources. Households with a head aged 20 years and above (AOR = 0.88, p = 0.059) were less likely to rely on unimproved sources than households with a head under 20 years. Female household heads (AOR = 1.17, p = 0.000) were more likely to use unimproved sources than male household heads. Unemployed partners (AOR = 1.14, p = 0.000) were more likely to use unimproved sources than employed partners. Rural (AOR = 1.12, p = 0.013) and nomadic (AOR = 0.93, p = 0.175) residents were more likely to use unimproved sources than urban residents. Households in Mudug (AOR = 31.18, p = 0.000), Nugaal (AOR = 4.15, p = 0.000), Bari (AOR = 5.26, p = 0.000), and Sanaag (AOR = 2.52, p = 0.000) regions were less likely to use unimproved sources compared to households in other regions. These findings highlight the urgent need for Somalia to improve its provision of safe and accessible water sources.