Demoze Lidetu, Adane Kassaw Chekole, Azanaw Jember, Akalewold Eyob, Enawugaw Tenagne, Tigabie Mitkie, Tesfaye Amensisa Hailu, Yitageasu Gelila
Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Environmental and Occupational Health and Safety, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
PLoS One. 2025 Mar 20;20(3):e0318189. doi: 10.1371/journal.pone.0318189. eCollection 2025.
According to the WHO/UNICEF Joint Monitoring Programme, unimproved drinking water sources include unprotected wells and springs, surface water (e.g., rivers, lakes), vendor-provided water, bottled water (without improved alternatives), and tanker truck-provided water. In East Africa, 68.7% of water at very high risk comes from such sources. Using unimproved drinking water sources can lead to serious health risks, including waterborne diseases such as cholera, dysentery, typhoid fever, and hepatitis. Therefore, this study aimed to map the spatial distribution of unimproved drinking water sources in the region.
We analyzed recent Demographic and Health Survey (DHS) data from 12 East African countries (Burundi, Comoros, Ethiopia, Kenya, Madagascar, Mozambique, Malawi, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe). A total of 206,748 households were sampled in 12 East African countries. Data management and analysis were carried out in several stages, beginning with data cleaning, followed by statistical weighting and data merging. This was then followed by geospatial analysis and mapping, and finally, spatial cluster detection.
Spatial clusters of unimproved drinking water sources were identified within the study area (Global Moran's I: 0.018, z-score: 87.10, p < 0.05). A total of 167 significant spatial windows containing primary and secondary clusters were identified. The first spatial window contained the primary clusters, while the remaining 166 spatial windows contained secondary clusters. Primary clusters were found in Madagascar and coastal Mozambique, with secondary clusters distributed across all 12 countries analyzed.
This study identified significant clusters, hotspots, and outliers (high-high clusters) of unimproved drinking water sources across various East African countries. To address these issues effectively, priority should be given to the identified clusters, hotspots, and high-high clusters. Primary recommendations include expanding water treatment facilities, improving water distribution systems, and protecting drinking water sources. Secondary recommendations emphasize strengthening regulations, conducting research, and fostering public-private partnerships to ensure sustainable access to clean water. Finally, we urge collaboration among governments, international organizations, and NGOs to enhance water infrastructure. Their efforts should focus on providing technical assistance, financial support, capacity building, project implementation, advocacy, and financing for drinking water infrastructure in the region. Further research integrating health outcome data with spatial analysis could help identify high-risk regions where the impacts of unimproved water sources are most pronounced.
根据世界卫生组织/联合国儿童基金会联合监测计划，未改善的饮用水源包括未受保护的水井和泉水、地表水（如河流、湖泊）、供应商提供的水、瓶装水（无更好的替代水源）以及油罐车提供的水。在东非，68.7%的高风险水源来自此类。使用未改善的饮用水源会导致严重的健康风险，包括霍乱、痢疾、伤寒和肝炎等水源性疾病。因此，本研究旨在绘制该地区未改善饮用水源的空间分布。
我们分析了来自12个东非国家（布隆迪、科摩罗、埃塞俄比亚、肯尼亚、马达加斯加、莫桑比克、马拉维、卢旺达、坦桑尼亚、乌干达、赞比亚和津巴布韦）的最新人口与健康调查（DHS）数据。在12个东非国家共抽取了206,748户家庭作为样本。数据管理和分析分几个阶段进行，首先是数据清理，接着是统计加权和数据合并。然后进行地理空间分析和绘图，最后是空间聚类检测。
在研究区域内确定了未改善饮用水源的空间聚类（全局莫兰指数：0.018，z分数：87.10，p < 0.05）。共识别出167个包含主要聚类和次要聚类的显著空间窗口。第一个空间窗口包含主要聚类，其余166个空间窗口包含次要聚类。主要聚类出现在马达加斯加和莫桑比克沿海地区，次要聚类分布在所有12个被分析的国家。
本研究确定了东非各国未改善饮用水源的显著聚类、热点和离群值（高高聚类）。为有效解决这些问题，应优先关注已识别的聚类、热点和高高聚类。主要建议包括扩大水处理设施、改善供水系统以及保护饮用水源。次要建议强调加强监管、开展研究以及促进公私伙伴关系以确保可持续获取清洁用水。最后，我们敦促政府、国际组织和非政府组织之间开展合作以加强水基础设施建设。他们的努力应集中在为该地区的饮用水基础设施提供技术援助、财政支持、能力建设、项目实施、宣传和融资。将健康结果数据与空间分析相结合的进一步研究有助于识别未改善水源影响最为显著的高风险地区。
