BACKGROUND: Access to sanitation and healthy housing conditions are essential for public health, reducing the spread of diseases and improving overall well-being. However, millions of people, particularly in low-income countries, still lack access to basic sanitation and housing facilities. This study assessed household sanitation and crowding status in a rapidly developing urban area of Addis Ababa.

METHODS: Data were extracted from the household census conducted from December 2022 to January 2023 at the Addis-HDSS site. Availability of basic sanitation facilities was defined as the presence of privately owned sanitation facilities within the household. Household crowding was measured by the number of occupants per bedroom. Multivariable logistic regression was used to identify factors associated with access to sanitation facilities (STATA/SE 14.2). A p-value of <0.05 was considered statistically significant.

RESULTS: The study included 30,533 households. Overall, 76.37% (95% CI: 74.86–77.2) lacked access to basic sanitation facilities. Most households (67.42%) lived in overcrowded housing. Educational status of the household head and household size were significantly associated with sanitation access. Households with college-educated heads were more likely to have access to basic sanitation (AOR 2.52, 95% CI: 2.27–2.79), while overcrowded households were less likely to have such access (AOR 0.06, 95% CI: 0.040–0.063).

CONCLUSIONS: A large proportion of households lacked basic sanitation facilities and lived in overcrowded housing, which increases the risk of infectious disease transmission. Improving sanitation and housing conditions is crucial for reducing health risks and improving public health outcomes.

KEYWORDS: Sanitation, Household crowding index, Ethiopia