Knowledge, Attitudes, and Practices Associated with Access to Selected Public Toilets - A Case of Nairobi City

Abstract Access to safe and hygienic toilet facilities in public spaces is a critical and pressing public health priority. Despite global initiatives, disparities persist across economically developing countries, where inadequate sanitation infrastructure hinders progress toward universal health coverage and the Sustainable Development Goals. In Kenya, particularly within urban areas, ensuring access to functional and hygienic public toilets remains a significant challenge, public toilets are often overlooked, poorly maintained, and insufficient to meet demand. This study examined knowledge, attitudes, and practices associated with access to selected public toilets in Nairobi’s Central Business District (CBD). The study employed a cross-sectional design with a descriptive quantitative approach. Participants were randomly selected upon exiting public toilet facilities until the target sample was achieved. Primary data was collected using structured open-ended questionnaires, interviews, and observational spot checks as the main tools, and analysed using SPSS Version 29 with reference to global sanitation standards. Findings revealed that most respondents (76.5%) recognized the importance of public sanitation, while 89.3% reported using public toilets. However, 91.3% considered the facilities inadequate, citing poor maintenance, long distances, and unhygienic or unsafe conditions. Daily use was low (6.7%), with many respondents resorting to alternatives such as urinating behind buildings, a practice also confirmed during spot checks. Accessibility challenges were evident, as some respondents were unaware of exact facility locations. Dissatisfaction was high, with 39.3% highlighting concerns over hygiene and safety. While 88.9% of respondents demonstrated willingness to pay for access, affordability remained a barrier for others, underscoring the equity implications of pay-to-use models. The study concludes that improving sanitation in Nairobi requires both infrastructural and behavioural interventions. Proper maintenance, increased facility coverage, and equitable pricing structures are essential. Additionally, collective responsibility acknowledged by 71.5% of respondents alongside targeted hygiene education campaigns, will be critical for enhancing urban sanitation, safeguarding health, and advancing inclusive development.