Spatial distribution and determinants of unimproved sources of drinking water among Somali households: spatial and multilevel analysis using nationwide survey data

Access to safe drinking water, vital for public health, is critical in fragile Somalia, prone to water scarcity due to poor management. This study investigates spatial distribution and determinants of unimproved drinking water sources in Somali households. Using 2020 Somalia Health and Demographic Survey (SHDS) data, a mixed-methods approach included: descriptive statistics for prevalence; multilevel binary logistic regression identifying factors (individual, household, community) in unimproved water reliance; and spatial analysis (Moran's I, Gi*) for patterns, hotspots. Results reveal significant disparities: 54.7% of poorest households used unimproved sources versus 2.6% of wealthiest. Abandoned household headship showed 65% higher odds (AOR = 1.653) of using unimproved sources. Radio ownership reduced odds (AOR = 0.836). Banaadir region (AOR = 6.571 vs Awdal) and nomadic communities (AOR = 31.91) faced substantially higher odds. Higher community literacy surprisingly increased odds (AOR = 2.443). Significant spatial autocorrelation (Moran's I = 0.278, p<0.05) was identified, with northern hotspots and southwestern cold spots of unimproved water use. Individual, household, community, and spatial factors influence access to unimproved drinking water in Somalia, revealing profound socio-economic, geographic inequities. Targeted, context-specific interventions are crucial to address these disparities, improve safe water access, and help achieve SDG 6.