Spatio-temporal trends and patterns of unmet basic sanitation service needs in Ethiopia from 2011 to 2019

ABSTRACT Lack of access to basic sanitation services remains a global challenge, particularly in developing countries like Ethiopia. This study used weighted household data from the Ethiopian Demographic and Health Survey to investigate the spatiotemporal trends and patterns of unmet basic sanitation services from 2011 to 2019. STATA version 17, ArcGIS Pro and SatScan for non-spatial and spatial analysis. The results showed that urban areas decreased from 80.11% (2011) to 72.85% (2019), while rural areas remained stable at 94.03% (2011) and 93.98% (2019). Regional inequalities were evident, with Gambella increasing from 89.79 to 97.11%. The analysis confirmed non-random patterns with significant clusters of unmet basic sanitation needs. In 2011, primary clusters included East Gambella, SNNPs, Sidama, South West Ethiopia, West and South Oromia, and Western Somali regions (LLR = 91.77, p<0.001). By 2016, severe challenges shifted to Amhara and Benishangul Gumuz regions (LLR = 192.23, p,0.001). Despite some progress in 2019, clusters persisted in Southern Nations, Nationalities, and Peoples' Region, South West Ethiopia, Sidama, West Oromia, Gambella, and Benishangul-Gumuz (LLR = 74.39, p,0.001). The study indicates systemic disparities in Ethiopia's access to basic sanitation services, emphasizing the need for targeted interventions, improved resource allocation, and strategic sanitation initiatives.