Factors associated with access to improved water and sanitation in 31 sub-Saharan African countries

Inadequate access to water, sanitation, and hygiene is a significant driver of communicable disease spread and contributes to the burden of non-communicable illnesses. Therefore, we examined the determinants of access to improved water and sanitation across 31 countries in sub-Saharan Africa.

We analysed Demographic and Health Survey data from 2014 to 2024 among a weighted sample of 475 300 households. The pooled prevalence and predictors of access to improved water and sanitation were analysed using a meta-analysis and Poisson regression.

The pooled prevalence of access to improved water was 82.82% [95% CI (82.41%-83.24%)], but improved sanitation was 57.61% [95% CI (57.16%-58.05%)]. Household heads aged ≥35 years, those who have attained higher education, those who are female, and households of higher wealth status and exposure to mass media were associated with higher prevalence of accessing improved water and sanitation. Living in rural areas reduced the prevalence of accessing improved water and sanitation.

The study found that the proportions of households' access to improved drinking water sources were high compared with toilet facilities in sub-Saharan Africa, which demands the need to tailor strategies to increase the coverage of access to toilet facilities while continuing to expand access to improved drinking water sources.