Rural-Urban schism: Access to improved water and sanitation in Sub-Sahara Africa

Abstract Background: Access to potable water and adequate sanitation remains a major public health challenge, particularly in sub-Saharan Africa (SSA), where coverage is critically low, especially in rural areas. Despite progress, disparities between urban and rural populations persist, impacting health outcomes and overall well-being. Objective: This study aimed to identify factors influencing access to improved water sources and sanitation in selected SSA countries. Methods: The study analyzed Demographic and Health Survey (DHS) data from 31 SSA countries. A complex survey design was used to assess disparities in water and sanitation access. Descriptive and multivariate analyses, including Poisson regression models, were conducted to determine associations between demographic factors and access to improved water and sanitation. Results: Overall, 75.8% of the population had access to improved water sources, while 52.0% had access to improved sanitation. However, rural dwellers had significantly lower access (64.0% for water, 40.0% for sanitation) compared to urban residents (93.0% for water, 74.0% for sanitation). Socioeconomic factors such as wealth index, education level, and sex of the household head were significantly associated with access. The poorest households had only 51.0% access to improved water compared to 97.0% among the wealthiest. Educational attainment was significantly linked with improved access [APR=1.04(1.03 ­– 1.05)], while female-headed households had slightly higher access rates for improved water source than male-headed households (APR = 1.08(1.07 – 1.09). Conclusion: Disparities in access to improved water and sanitation persist, particularly among rural populations and lower-income groups. Governments in SSA should prioritize investments in water and sanitation infrastructure, particularly in rural areas, to address these inequities. Sustainable policies and targeted interventions are necessary to bridge the gap and ensure universal access to clean water and sanitation. Keywords: Improved water source, sanitation, sub-Saharan Africa, rural-urban disparity, Demographic and Health Survey