BackgroundClean water is an essential element for human health, wellbeing, and prosperity. Every human being has the right to access safe drinking water. But, in now day, due to rapid population growth, illiteracy, lack of sustainable development, and climate change; it still faces a global challenge for about one billion people in the developing nation. The discontinuity of drinking water supply puts in force households either to use unsafe water storage materials or to use water from unimproved sources. This study aimed to identify the determinants of water source types, use, quality of water, and sanitation perception of physical parameters among urban households in North-West Ethiopia.MethodsA community-based cross-sectional study was conducted among households from February to March 2019. An interview-based pre-tested and structured questionnaire was used to collect the data. Data collection samples were selected randomly and proportional to each kebeles’ households. MS Excel and R Version 3.6.2 was used to enter and analyze the data; respectively. Descriptive statistics using frequencies and percentages were used to explain the sample data concerning the predictor variable. Both bivariate and multivariate logistic regressions were used to assess the association between the independent and the response variables.ResultsFour hundred eighteen (418) households have participated. Based on the study undertaken, 78.95% of households used improved and 21.05% of households used unimproved drinking water sources. Households drinking water sources are significantly associated with age of participant (x2 = 20.392, df=3), educational status (x2 = 19.358, df=4), source of income (x2 = 21.777, df=3), monthly income (x2 = 13.322, df=3), availability of additional facilities (x2 = 98.144, df=7), cleanness status (x2 =42.979, df=4), scarcity of water (x2 = 5.1388, df=1) and family size (x2 = 9.934, df=2). The logistic regression analysis also indicated as those factors are significantly determined (p 0.05) the water source types used by households. Factors such as availability of toilet facility, household member type, and sex of head of the household are not significantly associated with the drinking water sources.ConclusionThe study showed that being an older age group of the head of the household, being government employer, merchant and self-employed, being a higher income group, the presence of all facilities in the area, lived in a clean surrounding and lower family size are the determinant factors of using drinking water from improved sources. Therefore; the local, regional, and national governments and other supporting organizations shall improve the accessibility and adequacy of drinking water from improved sources through short and long time plans for the well-being of the community in the area.