Rural-urban disparities in the population practicing open defecation in Somalia, 2000-24: a longitudinal equity analysis.

OBJECTIVES: Open defecation remains a sanitation issue in Somalia. We assessed the prevalence and rural-urban inequality from 2000 to 2024. METHODS: We analyzed 25 country-level estimates from the WHO Health Inequality Data Repository, derived from the WHO and UNICEF Joint Monitoring Programme. Version 7.0 of the Health Equity Assessment Toolkit calculated the rural-urban differences, prevalence ratios, population attributable risks, and population attributable fractions, with urban residence as the reference. Producer adjustments were retained; the toolkit did not generate sampling weights. We used annual point estimates because the uncertainty intervals were unavailable. RESULTS: Rural open-defecation prevalence decreased from 83.47% in 2000 to 26.40% in 2024, urban prevalence from 10.78% to 1.76%, and national prevalence from 59.30% to 14.44%. The rural-urban difference narrowed from 72.69 to 24.65 percentage points, whereas the prevalence ratio increased from 7.74 to 15.04 as urban prevalence declined. In 2024, the population attributable risk was -12.69 percentage points, and the population attributable fraction was -87.85%. CONCLUSION: The prevalence of rural areas remained higher. The narrowing absolute difference and rising prevalence ratio show why both measures are important. The findings support context-specific rural sanitation planning and monitoring of Sustainable Development Goal target 6.2.