Knowledge, attitudes, and practices associated with access to sanitation in open public places – a case of Nairobi city

Access to safe, clean and reliable public toilets remains a significant urban sanitation challenge in Nairobi, where inadequate provision, poor maintenance and multiple accessibility barriers continue to impede appropriate sanitation practices. This study assessed the knowledge, attitudes and practices related to access and utilization of selected public toilets within Nairobi City’s Central Business District (CBD) and identified the key determinants shaping user experiences.

A descriptive quantitative cross-sectional design was employed, involving purposive selection of four public toilet facilities and random sampling of users. A total of 298 respondents completed the survey, yielding a 74.5% response rate. Data were collected through structured questionnaires and observational spot checks, analyzed using descriptive statistics, and complemented by thematic synthesis of observational findings. Results indicated high awareness of public toilet locations (87.9%) and frequent utilization (89.3%).

Despite recognizing their importance (76.5%), respondents overwhelmingly perceived the facilities as inadequate (89.3%) and insufficient in number (91.3%). Although awareness of sanitation-related health risks was high (95.0%), dissatisfaction with facility conditions (70.8%) and negative user experiences (70.5%) were prevalent. Nonetheless, willingness to pay for services remained strong (88.9%), with KES 10 cited as the most preferred amount. The study further revealed a persistent gap between sanitation knowledge and actual practices, with poor management, unclean environments, water shortages, insecurity and other accessibility constraints emerging as critical barriers.

Observational assessments corroborated user reports of deficiencies in facility condition and operational reliability. The study concludes that effective access to public toilets is contingent not only on their physical availability but also on adequacy, cleanliness, safety, affordability, accessibility and consistent management. It recommends increased investment in public sanitation infrastructure, strengthened maintenance and regulatory systems, improved affordability and accessibility measures, and enhanced user participation in monitoring and management processes.