Unimproved water sources in Ethiopia: Spatial variation and household point-of-use treatment practice based on 2016 Demographic and Health Survey

Abstract Background Improved water sources are not equally available in all geographical regions. Populations dependent on unsafe water sources are recommended to treat their water at point-of-use using adequate methods to reduce associated health problems. In Ethiopia, the spatial distribution of households using unimproved water sources have been incomplete or ignored in most of the studies. Moreover, evidence on the point-of-use water treatment practice of households dependent on such water sources is scarce. Therefore, the current study is intended to analyse the spatial distribution of unimproved water sources by wealth quintiles at country level and point-of-use treatment practices using nationally representative data. Method: The data of 2016 Ethiopian Demographic and health survey (EDHS) conducted on 16650 households from 643 clusters were used for the analysis. For spatial analysis, the raw and spatially smoothed coverage data was joined to the geographic coordinates based on DHS cluster identification code. Global spatial autocorrelation was performed to analyse whether the pattern of unimproved water coverage is clustered, dispersed, or random across the study areas. Once a positive global autocorrelation was confirmed, a local spatial autocorrelation analysis was applied to detect local clusters. The point-of-use water treatment is analysed based on reported use of either boiling, bleach, filtration or SODIS. Result There were 5005 households using unimproved water sources for drinking purpose. Spatial variation of unimproved water coverage was observed with high coverage observed at Amhara, Afar, Southern Nations Nationalities and People and Somalia regions. Disparity in unimproved water coverage between wealth quintiles was also observed. The reported point-of-use water treatment practices among these households is only 6.24%. The odds of point-of-use water treatment among household heads with higher education status is 2.5 times high (95%CI = 1.43–4.36) compared to those who did not attend education. Conclusion An apparent clustering trend with high unimproved water coverage was observed between regions and among wealth quintiles hence indicates priority areas for future resource allocation and the need for regional and national policies to address the issue. Promoting households to treat water prior to drinking is essential to reduce health problems.