{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:30:54Z","timestamp":1787682654060,"version":"build-2784847793"},"reference-count":62,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T00:00:00Z","timestamp":1742428800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>According to the WHO\/UNICEF Joint Monitoring Programme, unimproved drinking water sources include unprotected wells and springs, surface water (e.g., rivers, lakes), vendor-provided water, bottled water (without improved alternatives), and tanker truck-provided water. In East Africa, 68.7% of water at very high risk comes from such sources. Using unimproved drinking water sources can lead to serious health risks, including waterborne diseases such as cholera, dysentery, typhoid fever, and hepatitis. Therefore, this study aimed to map the spatial distribution of unimproved drinking water sources in the region.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We analyzed recent Demographic and Health Survey (DHS) data from 12 East African countries (Burundi, Comoros, Ethiopia, Kenya, Madagascar, Mozambique, Malawi, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe). A total of 206,748 households were sampled in 12 East African countries. Data management and analysis were carried out in several stages, beginning with data cleaning, followed by statistical weighting and data merging. This was then followed by geospatial analysis and mapping, and finally, spatial cluster detection.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Spatial clusters of unimproved drinking water sources were identified within the study area (Global Moran\u2019s I: 0.018, z-score: 87.10, p &lt;\u2009 0.05). A total of 167 significant spatial windows containing primary and secondary clusters were identified. The first spatial window contained the primary clusters, while the remaining 166 spatial windows contained secondary clusters. Primary clusters were found in Madagascar and coastal Mozambique, with secondary clusters distributed across all 12 countries analyzed.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study identified significant clusters, hotspots, and outliers (high-high clusters) of unimproved drinking water sources across various East African countries. To address these issues effectively, priority should be given to the identified clusters, hotspots, and high-high clusters. Primary recommendations include expanding water treatment facilities, improving water distribution systems, and protecting drinking water sources. Secondary recommendations emphasize strengthening regulations, conducting research, and fostering public-private partnerships to ensure sustainable access to clean water. Finally, we urge collaboration among governments, international organizations, and NGOs to enhance water infrastructure. Their efforts should focus on providing technical assistance, financial support, capacity building, project implementation, advocacy, and financing for drinking water infrastructure in the region. Further research integrating health outcome data with spatial analysis could help identify high-risk regions where the impacts of unimproved water sources are most pronounced.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0318189","type":"journal-article","created":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T19:06:12Z","timestamp":1742497572000},"page":"e0318189","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Spatial analysis of unimproved drinking water source in East Africa: Using Demographic and Health Survey (DHS) data from 2012\u20132023"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8906-0689","authenticated-orcid":true,"given":"Lidetu","family":"Demoze","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kassaw Chekole","family":"Adane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jember","family":"Azanaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyob","family":"Akalewold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tenagne","family":"Enawugaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitkie","family":"Tigabie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amensisa Hailu","family":"Tesfaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gelila","family":"Yitageasu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,3,20]]},"reference":[{"key":"pone.0318189.ref001"},{"issue":"1","key":"pone.0318189.ref002","doi-asserted-by":"crossref","first-page":"e0245237","DOI":"10.1371\/journal.pone.0245237","article-title":"Water affordability and human right to water implications in California","volume":"16","author":"JJ Goddard","year":"2021","journal-title":"PLoS One"},{"key":"pone.0318189.ref003"},{"key":"pone.0318189.ref004","volume-title":"Evaluation of World Bank\/French Development Agency financed Urban Water Reform Programme in Lagos Water Corporation (2005-2017)","author":"B Babalobi","year":"2023"},{"issue":"4","key":"pone.0318189.ref005","doi-asserted-by":"crossref","first-page":"283","DOI":"10.2471\/BLT.13.119594","article-title":"Why \u201cimproved\u201d water sources are not always safe","volume":"92","author":"A Shaheed","year":"2014","journal-title":"Bull World Health Organ"},{"key":"pone.0318189.ref006","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.jrurstud.2019.02.021","article-title":"Choice and quantity demand for improved and unimproved public water sources in rural areas: Evidence from Benin","volume":"69","author":"E Gross","year":"2019","journal-title":"J Rural Studies"},{"key":"pone.0318189.ref007"},{"key":"pone.0318189.ref008"},{"key":"pone.0318189.ref009","doi-asserted-by":"crossref","DOI":"10.5772\/intechopen.103927","article-title":"Water shortages: Cause of water safety in sub-Saharan Africa.","volume-title":"Drought-impacts and management","author":"C Matchawe","year":"2022"},{"key":"pone.0318189.ref010","author":"WHO"},{"issue":"1","key":"pone.0318189.ref011","doi-asserted-by":"crossref","first-page":"66","DOI":"10.2166\/washdev.2019.107","article-title":"Household water treatment using adequate methods in sub-Saharan countries: evidence from 2013\u20132016 demographic and health surveys","volume":"10","author":"A Geremew","year":"2020","journal-title":"J Water, Sanitation and Hygiene for Development"},{"issue":"4","key":"pone.0318189.ref012","doi-asserted-by":"crossref","first-page":"e1001626","DOI":"10.1371\/journal.pmed.1001626","article-title":"Geographical inequalities in use of improved drinking water supply and sanitation across Sub-Saharan Africa: mapping and spatial analysis of cross-sectional survey data","volume":"11","author":"RL Pullan","year":"2014","journal-title":"PLoS Med"},{"issue":"1","key":"pone.0318189.ref013","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1186\/s12889-020-08957-2","article-title":"Hotspots of unimproved sources of drinking water in Ethiopia: mapping and spatial analysis of Ethiopia demographic and health survey Data 2016","volume":"20","author":"GG Bogale","year":"2020","journal-title":"BMC Public Health"},{"key":"pone.0318189.ref014","unstructured":"WHO U. 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In.: March; 2018."},{"issue":"2","key":"pone.0318189.ref034","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1145\/3487893","article-title":"Statistically-robust clustering techniques for mapping spatial hotspots: A survey","volume":"55","author":"Y Xie","year":"2022","journal-title":"ACM Computing Surveys (CSUR)"},{"key":"pone.0318189.ref035","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.biocon.2018.03.005","article-title":"Rain, forests and farmers: Evidence of drought induced deforestation in Madagascar and its consequences for biodiversity conservation","volume":"221","author":"S Desbureaux","year":"2018","journal-title":"Biological Conservation"},{"key":"pone.0318189.ref036","doi-asserted-by":"crossref","first-page":"121711","DOI":"10.1016\/j.watres.2024.121711","article-title":"Assessing future intra-basin water availability in madagascar: Accounting for climate change, population growth, and land use change","volume":"257","author":"RZ 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2023)"},{"issue":"2","key":"pone.0318189.ref040","first-page":"021003","article-title":"Limited role of climate change in extreme low rainfall associated with southern Madagascar food insecurity, 2019\u201321","volume":"1","author":"LW Harrington","year":"2022","journal-title":"Environmental Research: Climate"},{"issue":"6","key":"pone.0318189.ref041","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1108\/DPM-08-2023-0211","article-title":"The distribution of Cyclone Idai\u2019s water impacts in Beira, Mozambique","volume":"33","author":"C RI McCordic","year":"2024","journal-title":"Disaster Prevention and Management: An International Journal"},{"key":"pone.0318189.ref042","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1007\/s11269-014-0817-6","article-title":"Multi-criteria analysis framework for potential flood prone areas mapping","volume":"29","author":"G Papaioannou","year":"2015","journal-title":"Water resources 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India"},{"issue":"12","key":"pone.0318189.ref046","doi-asserted-by":"crossref","first-page":"158","DOI":"10.4236\/gep.2016.412012","article-title":"Trends of extreme temperature and rainfall indices for arid and semi-arid lands of south eastern Kenya","volume":"4","author":"S Marigi","year":"2016","journal-title":"Journal of Geoscience and Environment Protection"},{"issue":"25","key":"pone.0318189.ref047","doi-asserted-by":"crossref","first-page":"4555","DOI":"10.1002\/hyp.11378","article-title":"Spatial distribution and temporal trends of rainfall and erosivity in the Eastern Africa region","volume":"31","author":"AA Fenta","year":"2017","journal-title":"Hydrological Processes"},{"key":"pone.0318189.ref048","first-page":"39","article-title":"Impact of climate change on water quality and its assessment","volume-title":"In Visualization Techniques for Climate Change with Machine Learning and Artificial Intelligence","author":"PK KH Yadava","year":"2023"},{"key":"pone.0318189.ref049","volume-title":"Water, sanitation and poverty","author":"C Bosch","year":"2001"},{"key":"pone.0318189.ref050","unstructured":"Franz E: Toa Kitu Kidogo: Corruption in East Africa. 2012."},{"issue":"1","key":"pone.0318189.ref051","doi-asserted-by":"crossref","first-page":"89","DOI":"10.2166\/washdev.2014.029","article-title":"Access to improved sanitation facilities in low-income informal settlements of East African cities","volume":"5","author":"K Okurut","year":"2015","journal-title":"Journal of water, sanitation and hygiene for development"},{"issue":"1","key":"pone.0318189.ref052","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40068-020-00194-1","article-title":"Natural resource degradation tendencies in Ethiopia: a review","volume":"9","author":"S Wassie","year":"2020","journal-title":"Environmental systems 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Governance structures and sustainability of the rural deep underground water sources in Sub-Saharan Africa: A case of lessons from Uganda Central Sub Region. 2023."},{"key":"pone.0318189.ref057","volume-title":"Towards an advanced water service level: Microbial drinking water quality management at government schools and healthcare facilities in resource-constrained rural settings, Kabarole Uganda","author":"R Akamanya"},{"key":"pone.0318189.ref058","unstructured":"Milanesio P, Garola A. 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