ACCESS TO WATER AND SANITATION FACILITIES AND ASSOCIATED FACTORS AMONG HOUSEHOLDS IN THE SLUM AREAS OF JIGJIGA CITY, EASTERN ETHIOPIA

Abstract

Background: Access to safe water and improved sanitation remains a major public health challenge in rapidly expanding urban slum areas of Ethiopia. However, there is limited empirical evidence examining both the level of access to improved water, sanitation, and hygiene (WASH) services and their associated determinants in informal settlements of emerging regional cities. This study assessed access to improved water supply and sanitation facilities and identified associated factors among slum households in Jigjiga City, Somali Regional State, Ethiopia. Objective: To assess access to water supply and sanitation facilities and examine factors associated with improved water supply and sanitation among households in the slum areas of Jigjiga City, Somali Regional State, eastern Ethiopia, from 15 July to 31 August 2023. Methods: A community-based cross-sectional study was conducted among 404 slum households in Jigjiga City from 15th July to 31st August 2023. 404 Households were selected using a systematic random sampling technique, whereby every 19kth household was chosen after a random starting point from a complete household list to ensure representative sampling. Data were collected from 404 selected households through face-to-face interviews using a structured questionnaire and an observational checklist to assess household water and sanitation conditions. Data were coded, cleaned, and entered into Epi-Data version 3.1 and exported to STATA version 13 for analysis. Model fitness was assessed using the log-likelihood ratio test. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with access to improved water supply and sanitation. Adjusted Odds Ratios (AORs) with 95% confidence intervals (CIs) were used to determine associations, and statistical significance was declared at p < 0.05. Results: Nearly all households (99.3%) reported access to a drinking water source; however, only 30.7% had piped water on premises, while the majority (69.3%) relied on water vendors, classified as unimproved sources. Female-headed households were 49% less likely to have access to an improved water supply compared with male-headed households (AOR = 0.51; 95% CI: 0.28–0.92). Households headed by individuals with secondary education (AOR = 2.48; 95% CI: 1.14–5.40) and those with diploma-level education or higher (AOR = 4.62; 95% CI: 1.85–11.54) had higher odds of having piped water on premises compared with households headed by illiterate individuals. viii Compared with low-income households, middle and high-income households showed significantly higher odds of access to improved water supply (AOR = 3.42; 95% CI: 1.59–7.33 and AOR = 5.89; 95% CI: 2.67–12.97, respectively). Households residing in semi-permanent (AOR = 0.29; 95% CI: 0.13–0.63) and temporary dwellings (AOR = 0.33; 95% CI: 0.15–0.70) were significantly less likely to have improved water access. Access to improved sanitation facilities was reported by 30.9% of households. Household head education, household income, location of the water source, availability of handwashing facilities, and presence of soap or detergent were significantly associated with sanitation access. Households headed by individuals with diploma-level education or higher were more likely to have improved sanitation (AOR = 3.02; 95% CI: 1.20–7.62). Middle-income (AOR = 1.78; 95% CI: 1.01–3.16) and high income households (AOR = 2.41; 95% CI: 1.09–5.33) had higher odds of improved sanitation compared with low-income households. Households using piped water off-premises were 52% less likely to have improved sanitation (AOR = 0.48; 95% CI: 0.22–0.97). Availability of handwashing facilities (AOR = 2.41; 95% CI: 1.08–5.37) and presence of soap or detergent (AOR = 2.76; 95% CI: 1.20–6.36) were also positively associated with improved sanitation. Conclusion and Recommendations: Access to improved water supply and sanitation services in the slum areas of Jigjiga City remains limited and unevenly distributed, and is significantly associated with disparities in education, income, housing conditions, and gender. Strengthening water supply infrastructure, promoting community-based sanitation programs, implementing gender-sensitive WASH interventions, and expanding affordable piped water connections through public–private partnerships are important strategies for improving equitable WASH access in urban slum settings of Jigjiga City.