Published in PLOS One on 2026-04-24, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Omar Muhumed Maidhane, Omran Salih, Abdisalam Hassan Muse, Abdirahman Omer Osman, Muse H Abdi, Mahdi Hashi Hassan, Nur Mohamud Ali, Shacban Abdilahi Elmi, Alfredo Luis Fort
Source: PLOS One • DOI 10.1371/journal.pone.0348029
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Access to adequate sanitation remains a critical public health challenge in Somalia, where a large portion of the population relies on unimproved facilities due to persistent conflict, climate shocks, and political instability. This reliance contributes to a high burden of waterborne diseases. This study aimed to assess the spatial distribution of unimproved sanitation and identify its individual and community-level determinants using recent national data to inform targeted interventions.
This study is a secondary analysis of the 2022 Somalia Integrated Household Budget Survey (SIHBS), which included 7,212 households. The primary outcome was the use of unimproved sanitation facilities, categorized according to the WHO/UNICEF Joint Monitoring Programme (JMP) definitions. We employed a multilevel logistic regression model to identify individual and community-level determinants associated with unimproved sanitation. To analyze the spatial patterns of unimproved sanitation, we used Global Moran’s I for spatial autocorrelation and the Getis-Ord Gi* statistic for hotspot analysis.
Overall, 36.87% of Somali households use unimproved sanitation facilities. There are significant disparities across residence types, with the highest prevalence among nomadic populations (83.28%), followed by rural (51.10%) and urban (23.88%) residents. The multilevel analysis revealed that households in permanent/formal housing (AOR: 3.42) and those with IDP status (AOR: 3.18) had significantly higher odds of using unimproved sanitation. At the community level, urban residence was paradoxically associated with higher odds of unimproved sanitation (AOR: 7.99) compared to rural areas, while nomadic populations had significantly lower odds (AOR: 0.04), likely reflecting a high prevalence of open defecation not captured as a “facility.” Spatial analysis identified significant hotspots of unimproved sanitation in the Hiraan (90.65%) and Bay (80.39%) regions, and cold spots in Banadir (5.37%) and Lower Shabelle (3.70%).
The findings highlight deep inequalities in sanitation access across Somalia, driven by geographic location, socioeconomic status, and population group. The high prevalence of unimproved sanitation, especially among nomadic, rural, and displaced populations, calls for urgent, geographically-targeted interventions. A multi-pronged approach is necessary, focusing on the specific needs of different communities and addressing the underlying structural and individual-level drivers of poor sanitation to advance public health and sustainable development goals in the region.
1. Introduction
Access to adequate and equitable sanitation is a fundamental human right and a critical component of public health and sustainable development [1]. Globally, 3.5 billion people still lacked safely managed sanitation in 2022, with 419 million practicing open defecation [2]. The disease burden resulting from inadequate sanitation is immense, contributing to the transmission of diseases like cholera, typhoid, and intestinal worm infections, which disproportionately affect children under five [3,4]. Poor sanitation is a significant factor in environmental degradation and is closely linked to childhood stunting and malnutrition [8,17]. The Sustainable Development Goals (SDGs), particularly Target 6.2, aim to achieve universal access to sanitation for all and end open defecation by 2030, paying special attention to the needs of women, girls, and those in vulnerable situations [5].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Omar Muhumed Maidhane, Omran Salih, Abdisalam Hassan Muse, Abdirahman Omer Osman, Muse H Abdi, Mahdi Hashi Hassan, Nur Mohamud Ali, Shacban Abdilahi Elmi, Alfredo Luis Fort. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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