Latrine utilization and associated factors among households in Menz Keya Gabreal District, North Shewa Zone, Amhara Region, Ethiopia, 2023: A mixed study approach

Despite improved latrine coverage in Ethiopia, inconsistent utilization persists, threatening public health. Addressing behavioral, cultural, and structural determinants is crucial to designing effective, sustainable sanitation strategies and eliminating open defecation nationwide. This study aimed to assess latrine utilization and associated factors among households in Menz Keya Gabreal District, North Shewa Zone, Amhara Region, Ethiopia, 2023: A mixed study approach. A community-based mixed-methods cross-sectional study was conducted in Menz Keya Gabreal District, North Shewa Zone, Amhara Region, Ethiopia, from July 10 to August 30, 2023. Guided by the health belief model, the study examined psychosocial factors of latrine utilization. Quantitative data were collected from 617 systematically selected households using structured questionnaires and observational checklists, while qualitative data were obtained through in-depth interviews with 12 purposively selected key informants. Data was coded, entered, and cleaned by Ep-Data v-4.6, and then exported to Statistical Package for the Social Sciences (SPSS) version 26 for analysis. The degree of association was assessed by computing the adjusted odds ratio (AOR) with 95% confidence intervals (CI). Statistical significance was decided at a P-value < 0.05. Qualitative data were analyzed by using Atlas.ti25 software. Overall, 45.6% of households demonstrated adequate latrine utilization, 95% CI [41.9-49.3]. Utilization was significantly higher among households with adequate knowledge [AOR = 7.70; 95% CI: 4.59-12.91], positive attitudes [AOR = 2.60; 95% CI: 1.62-4.17], durable construction (cement/stone latrines: [AOR = 4.39; 95% CI: 1.89-10.21], and when initiated by health extension workers [AOR = 7.00; 95% CI: 3.39-14.47] or self-motivation [AOR = 7.28; 95% CI: 3.46-15.30]. Conversely, households without under-five children [AOR = 0.38; 95% CI: 0.23-0.61], women regularly making morning/evening trips [AOR = 0.31; 95% CI: 0.19-0.50], and the presence of alternative defecation sites [AOR = 0.19; 95% CI: 0.08-0.41] were less likely to utilize latrines. Qualitative findings highlighted misconceptions about feces, cultural practices, poor child feces management, and environmental barriers. Latrine construction alone does not guarantee consistent use. Socio-demographic, cultural, and behavioral factors critically influence utilization. Strengthening behavior change communication, enhancing community ownership, and ensuring continuous health extension follow-up are essential to sustain sanitation practices and advance national open-defecation-free goals.