What drives toilet cleanliness in urban schools? Roles of infrastructure, resources, and hygiene promotion in Kampala

• Toilet cleanliness factors vary by school type, requiring tailored interventions • Clean toilets are most common in schools with basic sanitation service levels • Health clubs improve toilet cleanliness in all school types except public schools • Rainwater harvesting is the top predictor of toilet cleanliness in Kampala schools • Boarding schools maintain cleaner toilets due to stricter sanitation policies Access to clean toilets in schools is essential for a conducive learning environment and safeguarding pupils' health. Urban schools often face sanitation challenges stemming from overcrowding, inadequate facilities, and differences in management practices across school categories such as public or private, primary or secondary, day or boarding, and service level classifications. Identifying key factors influencing toilet cleanliness is vital for improving urban school sanitation. This study investigated the drivers of toilet cleanliness through a cross-sectional study conducted in Kampala City, in Uganda. Kampala City has 852 schools of which 274 were selected for this study. Data collection comprised 274 structured observations guided by a checklist, 548 questionnaires administered to Head Teachers and Sanitation Teachers, and 40 key informant interviews. Logistic regression and decision tree modeling were used for data analysis. Across all school types, significant associations were observed between toilet cleanliness and facility privacy, sex segregation, presence of health clubs, handwashing facilities with soap and water, rainwater harvesting systems, sanitation budget, and toilet paper availability. The decision tree model identified rainwater harvesting, handwashing facilities, and health clubs as the strongest predictors of toilet cleanliness, in that order. Findings indicate that policymakers and school administrators should prioritize investment in water access, hygiene infrastructure, and health clubs to improve and sustain toilet cleanliness in urban schools.