Socioeconomic and geographic inequalities in access to improved drinking water among rural households in Ghana: Evidence from the 2017/18 Multiple Indicator Cluster Survey

Background Access to improved drinking water is a critical public health priority and a central target of Sustainable Development Goal (SDG) 6.1. While Ghana has made national progress in water access, rural areas continue to face substantial disparities shaped by socioeconomic, geographic, and service-related factors. Understanding these inequities is essential for advancing equitable water policies and interventions. Methods We analyzed data from the 2017/18 Ghana Multiple Indicator Cluster Survey (MICS), focusing on 5,838 rural households. Access to improved drinking water sources was defined according to WHO/UNICEF Joint Monitoring Programme standards and coded as a binary outcome. Explanatory variables included sociodemographic characteristics, household wealth, ecological zone, connectivity, and water-use behaviours. Descriptive statistics, bivariate associations, and survey-weighted logistic regression models were employed, accounting for clustering and stratification. Results Overall, 79% of rural households reported using improved drinking water sources. Access varied significantly by wealth, education, sex of household head, and ecological zone. In multivariable models, household wealth demonstrated the strongest associations: compared to the poorest households, middle- and high-wealth households had 3.28 (95% CI: 2.61–4.13) and 7.64 (95% CI: 5.18–11.29) times higher odds of using improved sources, respectively. Female-headed households and those in the Savannah zone also had higher odds of access. Service-related factors such as water collection time and perceived insufficiency influenced source use, while households using improved sources were less likely to treat water. Conclusions Access to improved drinking water in rural Ghana remains uneven, shaped by interlinked socioeconomic and geographic factors. The findings highlight the need to complement national coverage statistics with equity-sensitive monitoring and planning. Strengthening rural water policy frameworks to address disparities in service quality and household capacity is critical for achieving SDG 6.1.