The dynamics and determinants of household shared sanitation cleanliness in a heterogeneous urban settlement in Southwest Nigeria

Abstract

The study assessed the behavioural contexts of household shared sanitation (SS), the factors that could enhance its cleanliness and sustainable maintenance in the study area. The study design was cross-sectional in nature. A pretested, interviewer-administered questionnaire with 113 questions provided information on knowledge, attitude and SS maintenance practices from 312 respondents selected through a four-stage sampling technique. Data were analysed by descriptive, chi-square and logistic regression statistics with attitude and toilet cleanliness as the dependent variables, while the sociodemographic characteristics, knowledge and practice, including the toilet cleanliness index, were the explanatory variables at P<0.05. The mean age of respondents was 46.1±16.4 years. The majority were women (62.7%), tenants (64.7%) and had a secondary education (61.3%). In addition, 27.9% and 2.7% of respondents had shops and gender-segregated SS, respectively. Their knowledge and attitudes were good (66.3%) and positive (72.1%), while the majority (60.3%) of the SS was dirty. Almost two-thirds (62.8%) and 37.2% of respondents, respectively, had one and two or more compartments of unimproved pit toilets (31.6%) and water closets (28.6%), while 1.4% practiced open defaecation, despite having SS. More than two-fifths of SS were cleaned daily (45.4%) by women (52%), using water and soap (33.4%). Most households (93.4%) complied with the SS cleaning routines, with non-compliance attributed to lack of interest (29.5%), apathy when others defaulted (27.9%), lack of time (26.2%) and inadequate water (14.8%). There was a significant association between attitudes and education (P=0.025), wealth (P=0.011) and toilet-cleaning frequency (P=0.015). The positive behaviour determinants of SS are factual knowledge (P=0.039), efforts required to clean (P=0.019), the ability to remember (P=0.011) and cleaning commitment (P=0.040), while freedom of expression among households using SS was a positive predictor ofavoiding conflict, among the social dilemma factors. Good knowledge and positive attitudes were reported among users of SS, although with mixed practice and behaviour patterns. Factual knowledge, cleaning commitments and freedom of expressions predict SS cleanliness, which should be reinforced using periodic messages and structured health promotion strategies.