Beyond Latrine Ownership: The Sanitation Access-Use Paradox and Persistent Open Defecation in Suburban Edo State, Nigeria
Favour Oritsetsemaye Edema , MBBS, College of Health Sciences, Igbinedion University, Okada, Edo State, Nigeria; Department of Interdisciplinary Research and Statistics, PENKUP Research Institute, Birmingham, United Kingdom. Barakat Kofoworola Alaaya , MBBS, Department of Internal Medicine, Federal Medical Centre Jabi, Abuja, Nigeria; Department of Interdisciplinary Research and Statistics, PENKUP Research Institute, Birmingham, United Kingdom Thelma Oluchi Onuoha , MBBS, Military Hospital Lagos, Lagos State, Nigeria; Department of Interdisciplinary Research and Statistics, PENKUP Research Institute, Birmingham, United Kingdom. Nzubechukwu Ngozika Dibiaezue , MBBS, College of Health Sciences, Igbinedion University, Okada, Edo State, Nigeria; Department of Interdisciplinary Research and Statistics, PENKUP Research Institute, Birmingham, United Kingdom. Joshua Adekunle David , MBBS, College of Health Sciences, Igbinedion University, Okada, Edo State, Nigeria; Department of Interdisciplinary Research and Statistics, PENKUP Research Institute, Birmingham, United Kingdom. Khadijat Abdulwasiu , MBBS, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria; Department of Interdisciplinary Research and Statistics, PENKUP Research Institute, Birmingham, United Kingdom. Kennedy Oberhiri Obohwemu , PhD, Department of Interdisciplinary Research and Statistics, PENKUP Research Institute, Birmingham, United Kingdom. Maureen Aghiosikhaino Kadiri , PhD, Department of Community Medicine, University of Port Harcourt Teaching Hospital, Rivers State; Department of Interdisciplinary Research and Statistics, PENKUP Research Institute, Birmingham, United Kingdom. Oluchi Lucky Kingsley-Onyeulo , MPH, Department of Community Medicine, Faculty of Health Sciences, Ahmadu Bello University Teaching Hospital, Zaria; Department of Interdisciplinary Research and Statistics, PENKUP Research Institute, Birmingham, United Kingdom. Olusegun Timothy Ojetola , MHPM, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria; Department of Interdisciplinary Research and Statistics, PENKUP Research Institute, Birmingham, United Kingdom. Hendrith Esene , FMCPH, College of Health Sciences, Igbinedion University, Okada, Edo State, Nigeria
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Abstract
Open defecation remains an important sanitation challenge in Nigeria, and the presence of household latrines does not necessarily indicate consistent latrine use. This paper examined the relationship between household latrine ownership and self-reported open-defecation practice in Okada, a suburban community in Edo State, Nigeria, while also describing perceived conditions associated with continued open defecation. A community-based cross-sectional survey was conducted among adults aged 18 years and above. Of 288 questionnaires distributed, 254 were returned and analysed, giving a response rate of 88.2%. Data were collected using a structured self-administered questionnaire and analysed using descriptive statistics, cross-tabulations and Pearson's chi-square tests. Open defecation was reported by 134 respondents (52.8%), while 214 (84.3%) reported having a latrine at home. Among respondents with household latrines, 121 of 214 (56.5%) reported practising open defecation, compared with 13 of 40 (32.5%) respondents without household latrines. Household latrine ownership was significantly associated with open-defecation practice (χ² = 7.816, p = .005). This association indicates that latrine ownership and consistent avoidance of open defecation did not coincide within the surveyed population and should not be interpreted as evidence that latrine ownership promotes open defecation. Frequently reported perceived explanations for continued open defecation included lack of water or dirty toilet facilities (93.3%), unhygienic toilet conditions (92.9%), lack of toilet facilities (92.1%), poverty (91.3%), long distance from toilet facilities (86.6%) and the perception that open defecation was of limited importance (76.4%). Perceived low importance was also significantly associated with open-defecation practice (χ² = 9.937, p = .002). The findings identify a clear sanitation access-use gap and show that household latrine ownership alone is an incomplete indicator of sanitation behaviour. Sanitation programmes should therefore assess not only facility availability, but also functionality, accessibility, cleanliness, water availability and sustained use.
Keywords
Open defecation, latrine ownership, sanitation behaviour, sanitation access, toilet utilisation, WASH, Nigeria
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Copyright (c) 2026 Favour Oritsetsemaye Edema, Barakat Kofoworola Alaaya, Thelma Oluchi Onuoha, Nzubechukwu Ngozika Dibiaezue, Joshua Adekunle David, Khadijat Abdulwasiu, Kennedy Oberhiri Obohwemu, Maureen Aghiosikhaino Kadiri, Oluchi Lucky Kingsley-Onyeulo, Olusegun Timothy Ojetola, Hendrith Esene

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