Abstract
Access to and use of improved water sources and sanitation facilities in Sub-Saharan Africa (SSA) remains a significant public health concern, with notable variations across countries. Achieving the Sustainable Development Goals related to water and sanitation require evidence on current levels of access and factors that shape them. This study examined household access to and use of improved water sources and sanitation facilities, as well as the determinants of their use in SSA. Demographic and Health Survey data from 465,208 households across 30 SSA countries conducted between 2014 and 2025 was used for this study. Descriptive analyses examined access levels. Multivariable Poisson regression with robust variance was used to identify the factors associated with reported use. Overall, 76.3% of households had access to and use of improved water sources, 56.7% had access to improved toilets, and 35.4% had access to basic sanitation facilities (unshared improved toilet facilities), with wide variations across countries. Significant factors associated with access and use of improved toilet and sanitation facilities included wealth and residence, while educational attainment was significantly associated with access to and use of improved water sources. The findings highlight that disparities in access to water and sanitation exist in the SSA region, with household wealth, place of residence, and education significantly associated with households’ access and use of improved water sources and sanitation facilities. Governments in SSA should prioritize improving access to water and sanitation, particularly in underserved areas. Additionally, targeted strategies are needed to address disparities driven by socioeconomic and demographic factors.