Temporal Analysis of Sanitation and Water Development Indicators in Tunisia: 2012-2023

Abstract Background Access to sanitation and water resources is a cornerstone of the ‘One Health’ approach, which encompasses the holistic integration of human, animal and environmental health considerations. We aimed to elucidate the temporal trajectory of sanitation and water resource development in Tunisia across successive years. Methods Data from the Multiple Indicator Cluster Survey in Tunisia, a UNICEF-conducted repeated cross-sectional survey, was used to compare trends in access to improved water sources, utilization of improved sanitation facilities, and handwashing practices across 2012, 2018, and 2023. Results In 2023, we observed that 20.9% of households did not have access to drinking water on site, compared with 12.7% in 2018 (p = 0.15). The availability of drinking water in sufficient quantity was 69.8% in 2023 and 80.6% in 2018 (p = 0.37). In 2023, 78.1% of the population had access to an improved water source, compared with 86.3% in 2018 and 95.7% in 2012 (p = 0.4), 80% in urban areas and 73% in rural areas (p = 0.57). In 2023, 12.5% of the population consumed water from sources contaminated with Escherichia coli, compared with 20.5% in 2018 (p = 0.16). Disparities in Escherichia coli detection were observed between rural (21%) and urban (8.3%) areas (p = 0.01). In 2023, 92.1% of households had access to handwashing facilities equipped with soap and water, compared with 89.9% in 2018 and 91.5% in 2012 (p = 0.98). The breakdown between urban and rural areas was 95.1% and 86.4% respectively (p = 0.51). Conclusions Access to improved water sources, sanitation, and handwashing practices remains high over time, but regional disparities persist. Improved water quality directly reduces the transmission of waterborne pathogens, emphasizing the need to address regional disparities and socio-economic inequalities to promote public health nationwide. Key messages • Challenges persist in tunisia regarding sanitation and access to water. • Regional disparities threaten public health.