Knowledge, Attitudes, and Practices Associated with Access to Selected Public Toilets - A Case of Nairobi City
Keywords:
Public toilets, sanitation access, toilet accessibility, hygiene practicesAbstract
Access to safe and hygienic toilet facilities in public spaces is a critical and pressing public health priority. Despite global initiatives, disparities persist across economically developing countries, where inadequate sanitation infrastructure hinders progress toward universal health coverage and the Sustainable Development Goals. In Kenya, particularly within urban areas, ensuring access to functional and hygienic public toilets remains a significant challenge, public toilets are often overlooked, poorly maintained, and insufficient to meet demand. This study examined knowledge, attitudes, and practices associated with access to selected public toilets in Nairobi’s Central Business District (CBD). The study employed a cross-sectional design with a descriptive quantitative approach. Participants were randomly selected upon exiting public toilet facilities until the target sample was achieved. Primary data was collected using structured open-ended questionnaires, interviews, and observational spot checks as the main tools, and analysed using SPSS Version 29 with reference to global sanitation standards. Findings revealed that most respondents (76.5%) recognized the importance of public sanitation, while 89.3% reported using public toilets. However, 91.3% considered the facilities inadequate, citing poor maintenance, long distances, and unhygienic or unsafe conditions. Daily use was low (6.7%), with many respondents resorting to alternatives such as urinating behind buildings, a practice also confirmed during spot checks. Accessibility challenges were evident, as some respondents were unaware of exact facility locations. Dissatisfaction was high, with 39.3% highlighting concerns over hygiene and safety. While 88.9% of respondents demonstrated willingness to pay for access, affordability remained a barrier for others, underscoring the equity implications of pay-to-use models. The study concludes that improving sanitation in Nairobi requires both infrastructural and behavioural interventions. Proper maintenance, increased facility coverage, and equitable pricing structures are essential. Additionally, collective responsibility acknowledged by 71.5% of respondents alongside targeted hygiene education campaigns, will be critical for enhancing urban sanitation, safeguarding health, and advancing inclusive development.
References
1) Adjibolosoo, S. V., Ofori, B. D., Adongo, P. B., Afranie, S., & Yirenya-Tawiah, D. R. (2020). The influence of culture on open defecation in some basic schools in selected districts in Ghana: A preliminary study. PLoS One, 15(10), e0239491
2) Adugna, d. (2023). challenges of sanitation in developing counties: evidenced from a study of fourteen towns, Ethiopia. Heliyon, 9(4), e12932. https://doi.org/10.1016/j.heliyon.2023.e12932
3) Ahuma-Smith, C., Bavuno, S., & Dokyi, G. O. (2020). The Characteristics and Management Practices of Public Toilets in Wa, Ghana. Civil and Environmental Research, 12(6), 85-95.
4) Ali, S. M., Rashid, S. F., & Islam, M. (2020). Are awareness and practice of hygiene linked? Evidence from urban slums in Dhaka, Bangladesh. Journal of Water, Sanitation and Hygiene for Development, 10(4), 768–778. https://doi.org/10.2166/washdev.2020.126
5) AlSakkaf, K. A., Bahattab, A. A., & Bawazir, A. A. (2023). Knowledge and Practices Related to Water, Sanitation, and Hygiene among Household Residents in Selected Districts, Abyan Governorate. Yemeni Journal of Medical and Health Research, 12(1/2), 1-17.
6) Amadi, S. N., Eze, M. E., & Okafor, J. I. (2022). Community awareness and sanitation practices: Implications for public health in urban slums. African Journal of Environmental Health, 28(3), 112–124.
7) Amato, H. K., Martin, D., Hoover, C. M., & Graham, J. P. (2022). Somewhere to go: assessing the impact of public restroom interventions on reports of open defecation in San Francisco, California from 2014 to 2020. BMC Public Health, 22(1), 1673. https://doi.org/10.1186/s12889-022-13904-4
8) Amoah, p., Frempong, g. k., & Donkor, e. (2021). sanitation services in Ghanaian cities: a comparative analysis of user satisfaction. international journal of environmental health research, 31(5), 535–547. https://doi.org/10.1080/09603123.2020.1778457
9) Appiah-Effah, E., Boakye, K. B., Salihu, T., Duku, G. A., Fenteng, J. O., Boateng, G., … & Nyarko, K. B. (2024). Determinants of open defecation among rural women in Ghana: Analysis of Demographic and Health Surveys. Environmental Health Insights, 18, Article e12932. https://doi.org/10.11786302241226774
10) Babbar, K., Das, U., Ashraf, D., Shpenev, A., & Bicchieri, C. (2023). Unlocking the Role of Social Norms: How They Shape Women’s Public Toilet Usage in India. American Journal of Tropical Medicine and Hygiene, 109(5), 1177–1186 doi:10.4269/ajtmh.23-0220
11) Barker, T., Capone, D., Amato, H. K., Clark, R., Henderson, A., Holcomb, D. A. & Brown, J. (2023). Public toilets have reduced enteric pathogen hazards in San Francisco. PLOS Water, 2(8), e0000152. https://doi.org/10.1371/journal.pwat.0000152
12) Bartlett S. (2003). Water sanitation and urban children: The need to go beyond improved provision. Environ Urban, 15(2):57–70.
13) Bishoge, O. K. (2021). Challenges facing sustainable water supply, sanitation and hygiene achievement in urban areas in sub-Saharan Africa. Local Environment, 26(7), 893-907. https://doi.org/10.1080/13549839.2021.1931074
14) Bongfen, M. (2024). Toilet availability and use in public places in Buea: Implications for public health. Occupational Diseases and Environmental Medicine, 12(3), 161–171. https://doi.org/10.4236/odem.2024.123013
15) Burian, S. J., Nix, S. J., Pitt, R. E., & Durrans, S. R. (2000). Urban wastewater management in the United States: Past, present, and future. Journal of Urban Technology, 7(3), 33-62.
16) Chandana, N., & Rao, B. (2021). Status of sustainable sanitation chain in rural, semi-urban, and urban regions: a case study of Maharashtra, India. Journal of Water, Sanitation and Hygiene for Development, 11(1), 112-125. https://doi.org/10.2166/washdev.2020.020
17) Chinkaka, M., Brooke, A., & Fenner, R. (2025). Assessing the vulnerability of districts to waterborne diseases in Harare, Zimbabwe. Journal of Water, Sanitation and Hygiene for Development. https://doi.org/10.2166/washdev.2025.009
18) Colombo, V. P., Orina, F., Meme, H., Koffi, J. A., Koné, B., & Utzinger, J. (2023). Environmental determinants of access to shared sanitation in informal settlements: A cross-sectional study in Abidjan and Nairobi. Infectious Diseases of Poverty, 12(34). https://doi.org/10.1186/s40249-023-01078-z
19) Demartoto, A., Zunariyah, S., & Pujihartati, S. H. (2022). Clean and Healthy Public Toilet in Amenities Development in Surakarta Tourist Destinations. Proceedings of the First Australian International Conference on Industrial Engineering and Operations Management, Sydney, Australia, December 20-22, pp. 899-906.
20) Deshmukh, S., Ghooli, S., & Kurle, R. S. (2020). A study to assess the awareness and practice regarding utilization of sanitary toilet in the rural villages of Kalaburagi district. Int J Community Med Public Heal [Internet], 7(3), 1184. http://dx.doi.org/10.18203/2394-6040.ijcmph20200988
21) Fadairo, O., Alabi-Adelakun, O., & Adetunji, A. (2020). Promoting community-led water, sanitation and hygiene interventions in rural settlements in Oyo state, Nigeria: Lessons from Agele and Mogba communities of Ibarapa-East Local Government Area. Rural-Urban Link Sustain Dev, 163, 176-201.
22) Ginja, S., Gallagher, S., & Keenan, M. (2021). Water, sanitation and hygiene (WASH) behaviour change research: why an analysis of contingencies of reinforcement is needed. International Journal of Environmental Health Research, 31(6), 715-728.
23) Guterres, A. (2020). The sustainable development goals report 2020. United Nations publication issued by the Department of Economic and Social Affairs, 1-64.
24) Gwimbi, P., George, M., & Moyo, T. (2020). Sanitation service delivery in small towns: Understanding community preferences and willingness to pay in Zimbabwe. Journal of Environmental and Public Health, 2020, Article ID 7812340. https://doi.org/10.1155/2020/7812340
25) Hallberg, O. (2021). Public toilets in an intersectional perspective – The call for change. Unpublished degree project. Kth Royal Institute of Technology. Stockholm, Sweden.
26) Handan T. E., Maimuna, A. A., Shekari, V., Shamsudeen, U., & Davou, H. D. (2023). Assessment Of Knowledge, Attitudes and Practices on Water, Sanitation and Hygiene in Zaria Local Government Area, Kaduna State. Science World Journal,18(3), 422-428. https://dx.doi.org/10.4314/swj.v18i3.15
27) Kaluli, j. w., Kabubo-Mariara, j., & Mutune, j. (2023). inequalities in access to improved sanitation in kenya: a spatial and socio-economic analysis. African journal of environmental science and technology, 17(1), 1–13. https://doi.org/10.5897/ajest2022.3151
28) Kenya National Bureau of Statistics. (2019). 2019 Kenya Population and Housing Census, Volume i: Distribution of Population by County and Sub-County, Number of Households, and Average Household Size. KNBS.
29) Kim, J., Hagen, E., Muindi, Z., Mbonglou, G., & Laituri, M. (2022). An examination of water, sanitation, and hygiene (WASH) accessibility and opportunity in urban informal settlements during the COVID-19 pandemic: Evidence from Nairobi, Kenya. Science of the Total Environment, 823, 153398. https://doi.org/10.1016/j.scitotenv.2022.153398
30) Malolo, R., Kumwenda, S., Chidziwisano, K., Kambala, C., & Morse, T. (2021). Social outcomes of community-based water, sanitation and hygiene intervention. Journal of Water, Sanitation and Hygiene for Development, 11(3), 483-493. https://doi.org/10.2166/washdev.2021.264
31) Mutuku, F., Khush, R., & Peletz, R. (2021). Willingness to pay for improvements in rural sanitation: Evidence from a cross-sectional survey of three rural counties in Kenya. PLOS ONE, 16(5), e0251500. https://doi.org/10.1371/journal.pone.0251500
32) Otieno, m. a., Onyango, g. m., & Wamicha, w. n. (2022). barriers to water, sanitation, and hygiene in sub-saharan africa: a systematic review. journal of water, sanitation and hygiene for development, 14(7), 497–508. https://doi.org/10.2166/washdev.2022.212
33) Peletz, R., MacLeod, C., Samuel, E., Easthope-Frazer, A., Khush, R., & Others. (2021). Will households invest in safe sanitation? Results from an experimental demand trial in Nakuru, Kenya. International Journal of Environmental Research and Public Health, 18(9), Article 4462. https://doi.org/10.3390/ijerph18094462
34) Seidu, A. A., Arthur, S., Yawson, A., & others. (2022). Demographic disparities in unimproved drinking water and sanitation in Ghana: a nationally representative cross-sectional study. BMJ Open, 12(7), e0605954. https://doi.org/10.1136/bmjopen-2021-0605954
35) Simiyu, S. N., Kweyu, R. M., Antwi-Agyei, P., et al. (2020). Barriers and opportunities for cleanliness of shared sanitation facilities in low-income settlements in Kenya. BMC Public Health, 20, Article 1632. https://doi.org/10.1186/s12889-020-09768-1
36) Simiyu, s., Mumma, j., & Cumming, o. (2021). user perspectives on shared sanitation facilities in informal settlements: a study from Nairobi, Kenya. international journal of environmental health research, 31(4), 426–437. https://doi.org/10.1080/09603123.2020.1743704
37) UNICEF & WHO. (2023). progress on household drinking water, sanitation and hygiene 2000–2022: africa regional snapshot. who/unicef joint monitoring programme (jmp)https://cdn.who.int/media/docs/default-source/wash-documents/sanitation/jmp-africa-snapshot_v3final_3nov.pdf
38) United Nations Water (2022). GLAAS 2022: Global Analysis and Assessment of Sanitation and Drinking-Water — Strong systems and sound investments: Evidence on accelerating progress on sanitation, drinking-water and hygiene. WHO. https://www.who.int/publications/m/item/glaas-2022-report
39) WHO & UNICEF joint monitoring programme (jmp). (2023). progress on household drinking water, sanitation and hygiene 2000–2022: africa regional snapshot.
40) WHO/UNICEF joint monitoring programme (2023). progress on household drinking-water, sanitation and hygiene 2000-2022: special focus on gender. https://www.who.int/publications/m/item/progress-on-household-drinking-water--sanitation-and-hygiene-2000-2022---special-focus-on-gender
41) WHO/UNICEF joint monitoring programme (2023). sanitation. https://washdata.org/monitoring/sanitation
42) World Bank. (2020, February 19) Providing Sustainable Sanitation and Water services to Low-income Communities in Nairobi. Retrieved from-https://www.worldbank.org/en/news/feature/2020/02/19/providing-sustainable-sanitation-and-water-services-to-low-income-communities-in-nairobi
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Beverlyne Brenda , Muchiri Eric, Kagendo Dorothy (Author)

This work is licensed under a Creative Commons Attribution 4.0 International License.









