{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:36:55Z","timestamp":1789087015575,"version":"build-2803163510"},"reference-count":84,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"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 id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Open defecation is a harmful and unsafe practice that contributes to environmental pollution and disproportionately affects developing nations, particularly those in Sub-Saharan Africa. According to the World Health Organization (WHO) and the United Nations International Children\u2019s Emergency Fund (UNICEF) Joint Monitoring Programme (JMP), Sub-Saharan Africa is home to 46% of the global population still practising open defecation. Socio-economic factors, cultural norms, and individual attitudes play crucial roles in shaping sanitation behaviours and influencing open defecation practices. Therefore, this study aims to determine the prevalence, spatial distribution, and geographic inequalities of open defecation in Sub-Saharan Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A community-based cross-sectional survey was conducted, including 20,130 clusters and 496,957 households from 34 Sub-Saharan African countries. The Demographic and Health Survey (DHS) data were weighted, cleaned, and analyzed using Microsoft Excel, Stata version 17, ArcGIS version 10.7, and SaTScan\u2122 version 10.1. Spatial analyses were performed using ArcGIS version 10.7 and Kulldorff\u2019s SaTScan\u2122 version 10.1, while Geographically Weighted Regression (GWR) analyses were conducted using ArcGIS version 10.7.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of open defecation among households in Sub-Saharan Africa was 23.24% (95% CI: 23.12\u201323.35). The practice was clustered across enumeration areas (Global Moran\u2019s I\u2009=\u20090.25, Z-score\u2009=\u2009366.12, P-value\u2009\u2264\u20090.001). The Getis-Ord Gi* statistic identified hotspots of open defecation primarily in East Africa, Central Africa, and West Africa. Anselin Local Moran\u2019s I detected both high and low clusters of open defecation, while SaTScan cluster analysis identified 146 windows containing significant clusters of households practising open defecation across Sub-Saharan Africa. Geographically Weighted Regression (GWR) analysis revealed that several factors were positively associated with open defecation, including lack of educational attainment, unimproved drinking water sources, lack of basic access to water, younger household heads, and extreme poverty. Additionally, household size greater than four, the richest households and urban and rural residency were negatively associated with open defecation practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study reveals a high prevalence of open defecation (23.24%) in Sub-Saharan Africa with significant geographic clustering, particularly in East, Central, and West Africa. This estimate is higher than the 18% reported by the 2021 WHO\/UNICEF Joint Monitoring Programme (JMP). Novel spatial and GWR analyses uncovered associations with poverty, lack of education, water access, age of household heads, and wealth status. These findings underscore the need for geographically targeted, multi-sectoral sanitation interventions that address underlying socio-demographic disparities. Future research should explore the effectiveness of spatially tailored programs and integrate behavioral insights to accelerate progress toward Sustainable Development Goal 6.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0336938","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T18:23:29Z","timestamp":1765995809000},"page":"e0336938","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["The prevalence, spatial distribution and geographic weighted regression of open defecation practice in sub-Saharan Africa using demographic and health survey (DHS) data"],"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":"Natnael","family":"Gizachew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshetu Abera","family":"Worede","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adem Tsegaw","family":"Zegeye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yayeh Walle","family":"Molalign","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5532-6097","authenticated-orcid":true,"given":"Mitkie","family":"Tigabie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abiy Ayele","family":"Angelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyob Akalewold","family":"Alemu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7398-4956","authenticated-orcid":true,"given":"Gelila","family":"Yitageasu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"issue":"1","key":"pone.0336938.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2166\/washdev.2017.048","article-title":"The sanitation and hygiene targets of the sustainable development goals: scope and challenges","volume":"8","author":"D Mara","year":"2017","journal-title":"Journal of Water, Sanitation and Hygiene for Development"},{"issue":"1","key":"pone.0336938.ref002","doi-asserted-by":"crossref","first-page":"2675","DOI":"10.1007\/s10668-023-03992-6","article-title":"Priority regions for eliminating open defecation in Africa: implications for antimicrobial resistance","volume":"27","author":"OE Fagunwa","year":"2025","journal-title":"Environ Dev Sustain"},{"key":"pone.0336938.ref003","unstructured":"World Bank. World Toilet Day. https:\/\/blogs.worldbank.org\/en\/opendata\/world-toilet-day-420-million-people-are-defecating-outdoors?utm_source"},{"key":"pone.0336938.ref004","doi-asserted-by":"crossref","first-page":"1178630219828370","DOI":"10.1177\/1178630219828370","article-title":"Open defecation practices in Lodwar, Kenya: A mixed-methods research","volume":"13","author":"PJ Busienei","year":"2019","journal-title":"Environmental Health Insights"},{"issue":"7","key":"pone.0336938.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0219246","article-title":"What motivates open defecation? A qualitative study from a rural setting in Nepal","volume":"14","author":"N Bhatt","year":"2019","journal-title":"PLoS One"},{"issue":"1","key":"pone.0336938.ref006","doi-asserted-by":"crossref","first-page":"19095","DOI":"10.1038\/s41598-024-70102-5","article-title":"Under five children diarrhea prevalence and associated factors in slum areas of Gondar City Northwest Ethiopia: a community based cross-sectional study","volume":"14","author":"L Demoze","year":"2024","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0336938.ref007","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1186\/s12887-024-04900-1","article-title":"Detection of spatial, temporal and spatiotemporal distribution of diarrhea incidence among under-five children in Central Gondar zone, Northwest Ethiopia: a time-series study (2019-2022)","volume":"24","author":"G Yitageasu","year":"2024","journal-title":"BMC Pediatr"},{"issue":"1","key":"pone.0336938.ref008","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1186\/s12879-025-10772-2","article-title":"Spatiotemporal variation of under-5 children diarrhea incidence and associated meteorological factors in central Gondar zone, Northwest Ethiopia. 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Open defecation. https:\/\/washdata.org\/monitoring\/sanitation\/open-defecation?utm_source"},{"issue":"1","key":"pone.0336938.ref020","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1186\/s41043-024-00644-x","article-title":"Open defecation among Kenyan households: an analysis of demographic and health survey 2022 and census report of 2019","volume":"43","author":"J Njuguna","year":"2024","journal-title":"J Health Popul Nutr"},{"issue":"1","key":"pone.0336938.ref021","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s41182-022-00416-5","article-title":"Open defecation practice and its determinants among households in sub-Saharan Africa: pooled prevalence and multilevel analysis of 33 sub-Saharan Africa countries demographic and health survey","volume":"50","author":"DG Belay","year":"2022","journal-title":"Trop Med Health"},{"issue":"9","key":"pone.0336938.ref022","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(24)00270-5","article-title":"Uncertainty in key population size estimates in sub-Saharan Africa","volume":"12","author":"BO Olakunde","year":"2024","journal-title":"Lancet Glob Health"},{"issue":"1","key":"pone.0336938.ref023","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S0176-2680(99)00051-8","article-title":"Political culture and economic performance in sub-Saharan Africa","volume":"16","author":"CK Rowley","year":"2000","journal-title":"European Journal of Political Economy"},{"issue":"1","key":"pone.0336938.ref024","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1186\/s13643-020-01511-6","article-title":"Open defecation-free slippage and its associated factors in Ethiopia: a systematic review","volume":"9","author":"TA Abebe","year":"2020","journal-title":"Syst Rev"},{"key":"pone.0336938.ref025","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1093\/oxfordhb\/9780198816959.013.8","article-title":"Mapping the Sahelian Space","volume-title":"The Oxford Handbook of the African Sahel","author":"OJ Walther","year":"2021"},{"key":"pone.0336938.ref026","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/B978-0-12-409548-9.12034-2","article-title":"The Sahara Desert Hydroclimate and Expanse: Natural Variability and Climate Change","volume-title":"Encyclopedia of the World\u2019s Biomes","author":"S Nigam","year":"2020"},{"key":"pone.0336938.ref027","unstructured":"Britannica. Sub-saharan Africa. https:\/\/www.britannica.com\/place\/sub-Saharan-Africa"},{"key":"pone.0336938.ref028","unstructured":"Guide to DHS Statistics. 2023. https:\/\/dhsprogram.com\/data\/Guide-to-DHS-Statistics\/Analyzing_DHS_Data.htm"},{"issue":"7","key":"pone.0336938.ref029","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0307362","article-title":"Spatial variation and geographical weighted regression analysis to explore open defecation practice and its determinants among households in Ethiopia","volume":"19","author":"NM Derseh","year":"2024","journal-title":"PLoS One"},{"issue":"1","key":"pone.0336938.ref030","doi-asserted-by":"crossref","first-page":"28142","DOI":"10.1038\/s41598-025-13816-4","article-title":"Determinants and spatial patterns of solid fuel use in East Africa based on demographic and health survey data from 2012 to 2023","volume":"15","author":"G Yitageasu","year":"2025","journal-title":"Sci Rep"},{"key":"pone.0336938.ref031","volume-title":"The DHS Program: Guide to DHS Statistics","author":"ICF","year":"2021"},{"issue":"12","key":"pone.0336938.ref032","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0277565","article-title":"Exploring the spatial variation and associated factors of childhood febrile illness among under-five children in Ethiopia: Geographically weighted regression analysis","volume":"17","author":"NB Gelaw","year":"2022","journal-title":"PLoS One"},{"key":"pone.0336938.ref033","doi-asserted-by":"crossref","DOI":"10.3389\/frwa.2025.1487795","article-title":"Geospatial analysis of limited access to drinking water services in East African countries: insights from recent demographic and health surveys","volume":"7","author":"G Yitageasu","year":"2025","journal-title":"Front Water"},{"issue":"3","key":"pone.0336938.ref034","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0318189","article-title":"Spatial analysis of unimproved drinking water source in East Africa: Using Demographic and Health Survey (DHS) data from 2012-2023","volume":"20","author":"L Demoze","year":"2025","journal-title":"PLoS One"},{"issue":"1","key":"pone.0336938.ref035","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1186\/s12889-018-6213-z","article-title":"Prevalence, patterns, and predictors of diarrhea: a spatial-temporal comprehensive evaluation in India","volume":"18","author":"Nilima","year":"2018","journal-title":"BMC Public Health"},{"key":"pone.0336938.ref036","doi-asserted-by":"crossref","first-page":"1466610","DOI":"10.3389\/fpubh.2024.1466610","article-title":"Spatial, temporal, and spatiotemporal cluster detection of malaria incidence in Southwest Ethiopia","volume":"12","author":"L Demoze","year":"2025","journal-title":"Front Public Health"},{"key":"pone.0336938.ref037","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/1475-2875-8-68","article-title":"Using the SaTScan method to detect local malaria clusters for guiding malaria control programmes","volume":"8","author":"M Coleman","year":"2009","journal-title":"Malar J"},{"issue":"1","key":"pone.0336938.ref038","doi-asserted-by":"crossref","first-page":"2848","DOI":"10.1186\/s12889-025-24184-z","article-title":"Determinants and geographic distribution of unimproved sanitation facilities in sub-Saharan Africa, spatial and multilevel analysis using demographic and health survey (DHS) data","volume":"25","author":"L Demoze","year":"2025","journal-title":"BMC Public Health"},{"issue":"9","key":"pone.0336938.ref039","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0273793","article-title":"Modeling spatial determinants of initiation of breastfeeding in Ethiopia: A geographically weighted regression analysis","volume":"17","author":"S Hailegebreal","year":"2022","journal-title":"PLoS One"},{"key":"pone.0336938.ref040","doi-asserted-by":"crossref","first-page":"243","DOI":"10.4135\/9780857020130.n13","article-title":"Geographically weighted regression","volume-title":"The Sage handbook of spatial analysis","author":"AS Fotheringham","year":"2009"},{"issue":"1","key":"pone.0336938.ref041","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/gean.12316","article-title":"A Route Map for Successful Applications of Geographically Weighted Regression","volume":"55","author":"A Comber","year":"2022","journal-title":"Geographical Analysis"},{"key":"pone.0336938.ref042","doi-asserted-by":"crossref","first-page":"204","DOI":"10.4324\/9781351191234-20","article-title":"Mapping the Results of Geographically Weighted Regression","volume-title":"Landmarks in Mapping","author":"J Mennis","year":"2017"},{"issue":"1","key":"pone.0336938.ref043","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1186\/s12936-025-05573-6","article-title":"Malaria prevalence and its determinants across 19 sub-Saharan African countries: a spatial and geographically weighted regression analysis","volume":"24","author":"G Yitageasu","year":"2025","journal-title":"Malar 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Health"},{"issue":"2","key":"pone.0336938.ref050","doi-asserted-by":"crossref","first-page":"143","DOI":"10.2166\/washdev.2022.136","article-title":"Community engagement in water, sanitation and hygiene in sub-Saharan Africa: does it WASH?","volume":"12","author":"E Tsekleves","year":"2022","journal-title":"Journal of Water, Sanitation and Hygiene for Development"},{"issue":"1","key":"pone.0336938.ref051","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1186\/s13104-019-4519-2","article-title":"Effect of community led total sanitation and hygiene (CLTSH) implementation program on latrine utilization among adult villagers of North Ethiopia: a cross-sectional study","volume":"12","author":"B Gebremariam","year":"2019","journal-title":"BMC Res Notes"},{"key":"pone.0336938.ref052","volume-title":"Progress on household drinking water, sanitation and hygiene 2000\u20132020: five years into the SDGs","author":"World Health 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influencing open defecation in Haiti: a cross-sectional study","volume":"22","author":"B Paul","year":"2022","journal-title":"BMC Public Health"},{"key":"pone.0336938.ref060","article-title":"Analyses of health surveys indicates regions of priority to eliminate open defecation in Africa and implication for antimicrobial resistance burden","author":"OE Fagunwa","year":"2023","journal-title":"medRxiv"},{"issue":"2","key":"pone.0336938.ref061","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1037\/1082-989X.11.2.193","article-title":"Assessing heterogeneity in meta-analysis: Q statistic or I2 index?","volume":"11","author":"TB Huedo-Medina","year":"2006","journal-title":"Psychol Methods"},{"key":"pone.0336938.ref062","doi-asserted-by":"crossref","first-page":"11786302241226774","DOI":"10.1177\/11786302241226774","article-title":"Determinants of Open Defecation Among Rural Women in Ghana: Analysis of Demographic and Health Surveys","volume":"18","author":"E Appiah-Effah","year":"2024","journal-title":"Environ Health Insights"},{"issue":"2","key":"pone.0336938.ref063","doi-asserted-by":"crossref","first-page":"320","DOI":"10.2166\/washdev.2016.004","article-title":"Equity in access to water supply and sanitation in Ethiopia: an analysis of EDHS data (2000\u20132011)","volume":"6","author":"S Seyoum","year":"2016","journal-title":"Journal of Water, Sanitation and Hygiene for Development"},{"key":"pone.0336938.ref064","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.healthplace.2014.05.007","article-title":"The toilet tripod: understanding successful sanitation in rural India","volume":"29","author":"K O\u2019Reilly","year":"2014","journal-title":"Health Place"},{"issue":"10","key":"pone.0336938.ref065","doi-asserted-by":"crossref","first-page":"8314","DOI":"10.1002\/2014WR015899","article-title":"Why do households invest in sanitation in rural Benin: Health, wealth, or prestige?","volume":"50","author":"E 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state, Sudan","volume":"10","author":"MA Aldawaha","year":"2022","journal-title":"International Journal of Research -GRANTHAALAYAH"},{"key":"pone.0336938.ref069","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1186\/1471-2458-14-1260","article-title":"Shared toilet users\u2019 collective cleaning and determinant factors in Kampala slums, Uganda","volume":"14","author":"IK Tumwebaze","year":"2014","journal-title":"BMC Public Health"},{"issue":"4","key":"pone.0336938.ref070","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/S1473-3099(10)70224-3","article-title":"Hygiene: new hopes, new horizons","volume":"11","author":"V Curtis","year":"2011","journal-title":"Lancet Infect Dis"},{"issue":"7","key":"pone.0336938.ref071","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-071296","article-title":"Associations of WHO\/UNICEF Joint Monitoring Program (JMP) Water, Sanitation and Hygiene (WASH) Service Ladder service levels and sociodemographic factors with 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water supply, sanitation and hygiene","author":"Organization WH","year":"2017"},{"issue":"2","key":"pone.0336938.ref078","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1007\/s11205-015-0912-y","article-title":"Socioeconomic and Demographic Predictors of Potable Water and Sanitation Access in Ghana","volume":"126","author":"EA Adams","year":"2015","journal-title":"Soc Indic Res"},{"issue":"12","key":"pone.0336938.ref079","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1016\/j.socscimed.2007.03.010","article-title":"Behavioral indicators of household decision-making and demand for sanitation and potential gains from social marketing in Ghana","volume":"64","author":"MW Jenkins","year":"2007","journal-title":"Soc Sci Med"},{"key":"pone.0336938.ref080","article-title":"Community-driven sanitation improvement in deprived urban neighbourhoods","volume-title":"Meeting the challenges of local collective action, co-production, affordability and a trans-sectoral approach","author":"G McGranahan","year":"2013"},{"key":"pone.0336938.ref081","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.worlddev.2016.06.019","article-title":"Learning from Sustained Success: How Community-Driven Initiatives to Improve Urban Sanitation Can Meet the Challenges","volume":"87","author":"G McGranahan","year":"2016","journal-title":"World Development"},{"key":"pone.0336938.ref082","first-page":"257","article-title":"Improving water and sanitation services in rural areas","volume-title":"Attacking Africa\u2019s poverty","author":"J Lane","year":"2006"},{"key":"pone.0336938.ref083","doi-asserted-by":"crossref","DOI":"10.1596\/1813-9450-6360","volume-title":"Impact evaluation of a large-scale rural sanitation project in Indonesia","author":"LA Cameron","year":"2013"},{"key":"pone.0336938.ref084","doi-asserted-by":"crossref","first-page":"788922","DOI":"10.3389\/fpubh.2021.788922","article-title":"Public Willingness to Pay for and Participate in 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