Exploring barriers for public latrine utilization among selected towns in Awi zone, Amhara region, Northwest Ethiopia, 2023

Abstract

Background

Public latrine utilization remains critical for the safe disposal of human excrement and good sanitation in low-income countries, including Ethiopia. Nearly 80% of the communicable disease burden in the country is related to inadequate sanitation and hygiene. Therefore, data are required qualitatively to show the current barriers to public latrine utilization, particularly in densely populated urban communities in the study area.

Objective

To explore barriers to public latrine utilization among selected towns in Awi Zone, Northwest Ethiopia.

Methods

A phenomenological study design was carried out. Among the phenomenological approaches, the descriptive phenomenological method was used to get rich, thick, detailed information and lived experiences of the study participants. Descriptive statistics on socio-demographic characteristics among study participants were also elaborated. One-day training was provided for investigators, facilitators, and supervisors on how to use developed tools and approaches for the study participants. A purposive sampling technique was implemented for in-depth interviews, key informants, and focus group discussions. The required data were collected using semi-structured open-ended interviews, and the recorded data were transcribed. Major themes were identified carefully and synchronized accordingly.

Results

A total of 51 individuals participated in the study for 3 FGDs, 11 in-depth interviews, and 8 key informants. The mean age of the study participants was 36.1 (SD ± 8.49) years, ranging from 24 to 56 years. In this study; poor administrative commitment, poor utilization of public latrines, absence of responsible personnel employment to control public latrines, absence of infrastructures which may be used for good handling of public latrines, poor responsibility among health professionals, poor cooperation of the concerned bodies and absence of revised rules and regulations for hygienic activities were contextually identified themes as barriers for public latrine utilization.

Conclusion

The utilization of public latrines and management were affected by multi-dimensional barriers. Lower attention of district administrators, irresponsible use of public latrines among urban communities, and inappropriate cooperation of health professionals and stakeholders were among the barriers influencing the effective utilization of public latrines. Zonal, woreda, and town administrators, including the municipality at each town, could expand good handling of public latrines, on-time repairing, assigning responsible personnel to control it, and early identification of gaps for public latrines for better utilization, must be taken into account.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-22213-5.

Introduction

Background

Public latrine utilization could be defined as the use of the latrine by all the community members in the residence they settled [1]. Making accessible and proper utilization of public latrines are thoughtful components of public health, but up till now abundant obstacles have been hampering their effective use. These blockades are complicated by encircling circumstantial, psychosocial, and technical factors [1]. Globally, about 2.3 billion people still have no basic sanitation services and have continued their lives without basic sanitation services [2]. Based on the study, which was conducted in southern Asia, the number of people practicing open defecation has relatively declined from 1990 till now but in Sub-Saharan African countries, the number of people practicing open defecation has dramatically increased [3]. The recent statistics from the Joint Monitoring Program (JMP) of the United Nations Children’s Fund and the World Health Organization reveal that nearly 29% of Ethiopians, about 28 million people practiced poor latrine utilization [4]. Improving public latrine access for hygienic services in a rapidly urbanizing world is an increasingly important issue, but it is the most challenging problem for governments, international development agencies, such as the World Bank, urban planners, designers, and sanitarians [5]. Latrine utilization, the main cause of transmittable disease control, is still at a lower level in developing nations including Ethiopia. Unsatisfactory practices like the limited utilization of sanitary facilities pollute the environment and water sources and are associated with street-based markets and cooked foods [6]. Proper utilization of public latrines is an essential and cost-effective approach to overcome the disease burden involved with inappropriate human excreta management, especially among people living in densely populated urban areas [7]. In developing nations, almost half of the population does not have access to sanitary facilities to avoid human excreta in an appropriate way [8]. In Ethiopia, up to 60% of the current disease burden is attributable to poor sanitation facilities where 15% of total deaths are from diarrhea, mainly among the large population of under-five year’s children and mostly concerned was unsafe human excreta disposal. Within the interval of one and two years of Open Defecation Free (ODF) certificate provision, the majority of Ethiopia’s ODF communities return [9]. No more attentions are given to public latrines and the handling of these latrines is very poor. There are no assigned individuals to keep common latrines for public service, becoming easily contaminated and making service utilizers uninterested in using them. Public latrine utilizers defecate and urinate around the pit and out of the pit within the constructed shade [10]. This finding was unique because no other findings were done to overcome problems for public latrine utilization-related issues in the study area. Exploring problems concerning human excreta disposal may be urgently needed for prioritizing, designing, and initiating intervention programs aimed at the hygienic condition of the town [11]. The process of priority setting may start with the current challenges and the miracles regarding public latrine utilization. Therefore, the purpose of this study is to provide appropriate data regarding public latrine utilization, to reduce, control, or avoid human excreta-related diseases, and to do action research (interventional activities) based on the identified barriers [12].

Statement of transparency

Study area and period

Awi zone is found in the Amhara region of Ethiopia with a total area of 9,148.43 km². It is bordered on the West by Benishangul-Gumuz Region, on the north by North Gondar zone, and on the East by the West Gojjam zone. Topographically, Awi zone is relatively fertile and flat. Its elevation varies from 1800 m to 3,100 m above sea level with an average altitude of 2300 m. There are about nine woredas/districts in this zone, including Injibara, Dangila, Agew Gimjabet, Tilili, Adis Kidame, Azena, Zigem, Jawi, and Chagni. These towns have a total of 36 urban kebeles ( 10,5,3, 3,3,2,2,3,5) respectively. The administrative center for this zone is Injibara town. Three towns; Injibara, Dangila, and Chagni were purposively selected for the study depending on their large population density. We intended to dig out barriers to poor practice of public latrine utilization relying on the assumption that public latrine user flow and frequency increases in densely populated urban areas. To explore barriers and promote future intervention, doing research in such areas could be helpful to expand the proper utilization of public latrines in the whole districts of Awi Zone. Another assumption for this finding was, during the study of pure qualitative research, both the study area and the study participants could be selected purposively, using a non-probability sampling technique and generalizing of our findings was not considered because of the pure qualitative nature of the finding. Injibara is located 447 km away from Addis Ababa and 118 km away from Bahir Dar, the capital city of Ethiopia and Amhara region respectively. It is found at latitude and longitude of 10°57′N 36°56′E, in Banja Shekudad woreda at an elevation of 2,560 m above sea level. The district’s annual temperature is 22.84ºC (73.11ºF) and it is 0.61% higher than Ethiopia’s average temperature. Injibara typically receives about 104.73 millimeters (4.12 inches) of precipitation and has 162.48 rainy days (44.52% of the time) annually and its Humidity is close to 40%. On the other hand; Dangila and Chagni towns are 38 and 52 KMs away from Injibara town respectively. Dangila has a latitude and longitude of 11°16′N 36°50′E with an elevation of 2137 m above sea level with area coverage of 918.40 square kilometers. The district’s annual temperature is 21.26ºC (70.27ºF). This town typically accepts about 97.52 millimeters (3.84 inches) of rainfall and has 151.28 rainy days (41.45% of the time) annually. On the other hand, Chagni town has a latitude and longitude of 10°57′N 36°30′E and an elevation of 1583 m above sea level. The mean annual temperature and rainfall in the town are 21.6 °C and 1896.6 milliliters respectively. World Bank and water, sanitation and hygiene (WASH) were the NGOs working in the study areas. Based on the projected population in 2022, the population density was 1,322,692, of which about 648,295 were males.

The study was conducted from Sept 01/09/2022 to June 30/06/2023. The map of the study area was computed with Arc GIS software (Fig. 1).

Fig. 1.

The map of study area for the study, exploring barriers to public latrine utilization among selected towns in Awi Zone, Amhara Region, Northwest Ethiopia

Study design

A phenomenological study design of a descriptive qualitative approach was carried out.

Sample size and sampling technique

Different types of qualitative study designs are found. Some examples are grounded theory, ethnographic, narrative research, historical, case studies, and phenomenology. For our study, phenomenological study design was employed because it focuses on exploring the essence of human understandings and open-minded the meaning of people attributed to those experiences. It seeks to capture the underlying structures and core aspects of these experiences without imposing preconceived theories or interpretations. Due to these reasons, we have used this type of qualitative study design. There are also two main approaches for phenomenological study designs, descriptive and interpretive. In descriptive phenomenology, any previous information the researcher has about the phenomena should not influence the study. On the other hand, in the case of interpretive phenomenology, the researcher’s previous awareness or experience of the phenomena under inquiry is essential to the study. Therefore; our preference for this study was a descriptive phenomenological approach to get the lived experience of the study participants. The investigation was done using a purposive sampling technique for in-depth interviews, key informants, and focus group discussions. An in-depth interview was carried out with 11 study participants in the community living in which poor public latrine utilization is being practiced and using shades for both living and shopping. Three investigators, three facilitators, and two supervisors participated in the entire activities of the research. The health extension workers from each kebeles of selected towns, sanitarians, and city beauty and safety officers from the municipality were selected as key informants. The study participants who use their shades for both living and shopping and the nearby community who were not included for in-depth interviews and utilizing public latrines were included in the focus group discussions.

Data collection procedures

Data were collected using a semi-structured open-ended interview guide. One-day training was provided for investigators, facilitators, and supervisors. The study participants for in-depth interviews were selected based on their workplaces those who are using their shades for both living and shopping. Key informants were selected carefully depending on their role and academic status. Regarding focus group discussion, the study participants were, almost similar in their socioeconomic status, since they were provided shade for both living and shopping. Those who used their shades for both living and shopping and who were not included in in-depth interviews were selected for focus group discussions. The study participants were homogenous and the information we gathered from them was regarding barriers to public latrine utilization in different aspects. There were three FGDs, and the total number of study participants for FGDs was 32. It was conducted by the facilitators, note-takers, and the investigators as moderators. The interviews and discussions were held in the Amharic and Agaw languages, following a friendly approach by adding probing questions to make the environment easy to participate in and discuss.

Selection procedure and tools

Participants were guaranteed confidentiality and anonymity. They were informed that they have the right to interrupt the interview at any time if they feel any discomfort. Oral informed consent was obtained from every respondent before participation began. The semi-structured open-ended interview guide was developed in English for in-depth interviews, key informants, and FGDs; then the guide was translated into the local languages Amharic and Agaw. The questionnaire also included the participant’s demographic profile. Each interview took an average of 10–30 min, 25–60 min, and 32–90 min, for an in-depth interview, key informants, and focus group discussions respectively. The tool used for each component, in-depth interview, key informant and focus group discussion, and open-ended interview guide, has been attached as supplementary data 1.

Data processing and analysis

The data were prepared and organized, and the transcripts were printed out. The notes and recorded documents were gathered. Then the data were reviewed, and initial codes were created. The fields notes were re-written accordingly and recorded documents were listened to repeatedly to understand the concepts of each participant’s response. To ensure meticulousness and to check the quality of data analysis, codes/pseudonyms were allocated to the participants to maintain privacy for each transcription and record. The Amharic transcripts were translated into English by the principal investigators with the help of English language instructors. Then the themes were identified carefully and synchronized accordingly.

Truth-worthiness of the study

Member checking

The transcribed data, interpretations, and conclusions were returned to the contestants to correct errors and challenges that were professed as wrong interpretations and data triangulation using multiple respondents with different age groups.

Prolonged engagement

The interview and the FGD took an average of ten minutes to ninety minutes respectively with active participation. Therefore, the study was conducted on the public latrine utilization of urban communities who live in the study area.

Credibility

The results, all in-depth interviews, key informants, and focus group discussions, depending on guidelines, were evaluated by experts before the data collection. Orientation was given to three facilitators who had participated in focus group discussions about the purpose of the discussion and the responsibility to avoid pointless interruptions and keep the rights of the participants.

Transferability

To uphold the transferability of the finding, appropriate probes were used to obtain comprehensive information during in-depth interviews, key informants, and FGD, as well as field notes and digital audio records were used for all interviews and focus group discussions before and during the analysis.

Dependability

To maintain the honesty of the research process, member checking and prolonged engagements were made after FGD, in-depth interviews, and key informants. The conformability of this study was assured by persistent observations of participants’ body movements, facial expressions, eye gaze, and tone of speech, and everything that was recorded at the time of the interview and focus group discussions. Flexibility and a friendly relationship between researchers and participants were mandatory to receive input and comments.

Conceptual definition of terms

Public latrine

Common or shared latrine, constructed for human excreta disposal.

Public latrine utilization

The practice of the community to use the common or shared latrine.

Barriers

Obstacles and challenges to get and utilize public latrine.

Exploring

Identifying barriers contextually.

Shades

Temporary residence which is used for both living and shopping.

Result

Characteristics of respondent

A total of 51 individuals participated in the study for 3 FGDs, 11 in-depth interviews, and 8 key informants. The mean age of the study participants was 36.1 (SD ± 8.49) years, ranging from 24 to 56 years (Table 1).

Table 1.

Socio-demographic characteristics of participants on exploring barriers for public latrine utilization among selected towns in Awi zone, Amhara region, Northwest Ethiopia, June 2023

Category	Variable	Frequency	Percent
Age of respondent	24–33	21	41.2
	34–43	22	43.1
	> 43	8	15.7
Sex	Male	30	58.8
	Female	21	41.2
Religion	Orthodox	50	98.0
	Muslim	1	2.0
Educational Level	Cannot read and write	2	3.9
	primary school	12	23.5
	Secondary school	8	15.7
	College and above	29	56.9
Occupational status	Farmer	1	2
	Government employee	22	43.1
	Private employee	28	54.9
Marital status	Single	11	21.6
	Married	38	74.5
	Widowed	1	2
	Divorced	1	2

The analysis was focused on the study’s grand theme, and sub-themes, and each of these sub-themes was analyzed in detail with its corresponding categories. The respondents saying on each part were carefully separated and written in the appropriate ways of qualitative research writing (Table 2).

Table 2.

The study has one grand theme, seven sub-themes, and their categories to study participants on exploring barriers for public latrine utilization among selected towns in Awi zone, Amhara region, Northwest Ethiopia, June 2023

Grand theme	Sub-themes	Categories
Barriers for Public Latrine Utilization	Poor administrative commitment	Kebele and city administrators, Mayors
	Poor cooperation of concerned bodies	World bank and Nongovernmental organizations
	Poor responsibility of health professionals	Health extension workers, Sanitarians
	Absence of revised rules and regulations	Decision making power
	Poor management of public latrine	Handling, community engagement, Sustainability
	Absence of responsible personnel to control public latrine	Open defecation, open urination, disease
	Poor infrastructures for public latrine utilization	Absence of water, absence of water carriage

Barriers to public latrine utilization

Unsanitary management of human excreta would make the surroundings unhygienic, leading to water and food contamination and contributing to more than 80% of communicable disease transmission.

Poor administrative commitment

Kebele and city administrators and mayors

The majority of respondents reported that most kebele and city administrators, including Mayors, do not pay attention to construction, utilization of public latrines, and keeping the environment free from human excrements. Most of the time, they do not see the issues of public latrines like other day-to-day activities.

“In this case, wherever you go, this responsibility is only given to health professionals, but more focus should be provided to mayors, administrators, and other bodies, for example, if you select a certain place to construct PL, it will be impossible because mayors should allow that place, administrators starting from kebele up to woreda and integration is required to get a place, the municipality should participate since we cannot construct it anywhere like rural areas. From health professionals, we can educate the general health issues related to it, and other activities should be supported by different levels of administrators.”(Male, 38 years old).

Poor cooperation of concerned bodies

World bank and NGOs

Most of the respondents suggested that there was no integration totally for public latrine construction and utilization, like other activities that are taking place in the town. To be effective and to be fruitful, collaboration should be established to make the town in general and the surroundings in particular free and neat.

“Urban development is the one it concerns, next to those health offices, additionally; a municipality should take a great part because it concerns it. But the main thing I think is the World Bank because it works with more of the towns. There are huge amounts of budgets planned, but we did not see the planned budgets for sanitation activities. E… for urban development, for cobblestone, ditches boy, and shades, etc., they do more. The first thing that we should focus on is that the health bureau does not occupy urban wash (NGOs). The other one is a rural wash, which constructed good public latrines and works on institutional latrines. No focus is given to urban wash (NGOs). Because urban areas are the sources of infections due to overcrowded living. To do or to strengthen this, the Health Bureau should do more, and additional findings should be given for the Health Bureau to support it. This finding and research should be supported, especially by higher education institutions. That is why we raise this issue always whenever we get a meeting. “(Male, 43 years old).

Poor responsibility of health professionals

As reported by the majority of respondents the commitment and responsibility to give health education, to strengthen the habit of using public latrines becomes very poor nowadays. In previous times, the sanitarians and in recent times, the health extension workers were practicing their profession in a good manner but today no more activities are being done by them regarding the hygienic activities in the town.

Health extension workers (HEWs)

“Okay, among the challenges; Public latrines are not distributed or expanded everywhere, additionally, as the habit of urinating everywhere is adopted by the community. The poor awareness of the community is obvious because, nowadays, no awareness-creation activities are being done by Health Extension Workers.” (Male, 37 years).

Sanitarians

“On behalf of me, I was a professional, and to speak frankly, I was an environmental health professional. Now I am a master of public health in reproductive health. In the previous time, there was a commitment even among sanitarians, but not today to facilitate such activities. There was a strong law. To bring and repeat that, there should be revised rules and regulations for sanitarians to be effective. The sanitarians considering the activities should be assigned unless they may not be effective. E…. it should also be supported with a budget and continuous follow-up. To some extent, the sanitarian professionals have become idle.”(Male, 52 years old).

Absence of revised rules and regulations

It was reported that in the previous time, there were strong rules and regulations regarding town hygienic activities, including public latrines. In addition to this, the power for decision-making was in the hands of the health professionals, particularly, sanitarians. The sanitarians were under control if they made any mistake by the rules and the regulations proclaimed.

Decision-making Power

“The absence of rules and regulations is considered as a bottleneck to hygienic activities, in my opinion. In the previous time, he/she was a professional and could decide, but nowadays, there are no professionals, and there are also no rules and regulations to do so. Even if there is any type of activity regarding PL, this professional cannot decide because he/she is a member of the committee simply. But if this is revised and returned to the professionals, with rules and regulations of hygienic activities, it will become better. Because working in groups with different sector combinations is very difficult to decide as a health professional and as a paramedical.” (Male, 46 years old).

Poor management of public latrine

The study participants reported that planned management for public latrines was not yet established. Even though public latrines are small in number, the management is very poor.

Handling

“E… there are some public latrines now, but for handling, there are no assumptions to consider as their property. The users did not put papers in baskets after using them, and they did not add water after use. Due to this, the public toilet is easily becoming dirty. Users do not have a sense of their property, which is a big problem for poor sanitation.“(Male, 31 years old).

Community engagement

“No commitment of engagement among community to handle it properly.” (Male, 46 years old).

Sustainability

“To take this responsibility, the community who is living near that place should be considered. To be sustainable, we should focus on its benefits more during education because communicable and non-communicable diseases and communicable disease nearly 80- are coming due to the poor usage of latrine. And to prevent this, the latrine should be well prepared and properly used, in my opinion. Once solved, it should not be returned back. I understand the question like that. More to be sustainably, the community should be the owner of that latrine unless it will be impossible. In addition, on behalf of the professions, there should be follow-up every day, every week, every two days not to be returned back. “(Female, 36 years old).

Absence of responsible personnel to control public latrine

Most of the study participants suggested that for the public latrine, there should be some individuals who should be assigned permanently to control and monitor it. Unless such a major is taken, it is impossible to be served with public latrines since they are common and the community never keeps them. Due to these, different health problems can appear, as suggested by the study participants.

Open defecation

“Okay! It is very ugly, and it is impossible to enter and utilize it. It is full of feces, and we cannot place our legs to use it. Because everybody uses it, and no one controls it. It will be possible if we assign responsible individuals unless this problem cannot be solved.” (Male, 38 years old).

Open urination

“E…. some of individuals urinate outside of the latrine, and that will be heated by the sun and taken by air, so its bad smell, causing different disease to us.”(Male, 40 years old).

Disease

“Oh….may bring, influenza, asthma and expose for other different types of disease.” (Female, 24 years old).

Poor infrastructures for PL utilization

The majority of respondents reported that the necessary materials for public latrine utilization were not fulfilled. These problems were leading the community not to use it properly. Without achieving the required materials for public latrine utilization, it is meaningless, and its service time will be for a month or a maximum of two months.

“Okay! That assigned individual may not stand without control, for instance, in larger cities; it is controlled by assigning a guy. But here, if it is practiced, the community will adapt it. Even if you leave the area tomorrow, they may adapt it. Unless there is enough water for hand washing and to add to the latrine after use, it will be contaminated with that latrine rather than used. Without installing water near the latrine, it is possible to be contaminated with associated diseases. Those individuals who are using it may be sellers of vegetables at the market, etc., and then they can contaminate that unless they wash their hands after using the public toilet. “(Female, 34 years old).

Absence of water carriage

“Even though there are public latrines that are found in government sectors, there is poor handling. For instance, in our sector, there was a water carriage, but now it does not exist, and nothing we will do without it. Due to that water carriage, PL is shifted into a ventilated improved latrine (VIP). There is also poor handling of the users, even if those users are educated and have good awareness, they add some unnecessary materials to it. Due to the shortage of water, even the existing PL is not functional.“(Male, 46 years old).

Discussion

Focusing on public latrine and utilization-related problems is a neglected issue currently in developing nations, including Ethiopia [6]. This study is primarily intended to explore barriers to public latrine utilization among purposely selected study areas with a qualitative study design. The human right to sanitation declaration orders that every nation has to ensure physical and financial access to latrine facilities along with services that are reasonably appraised, safe, hygienic, protected, and publicly and culturally acceptable while providing confidentiality and ensuring self-esteem to its citizens [13]. However, regardless of the presence of such well-meaning policy plans, to this day, nearly 892 million people practice either poor utilization of latrines or open defecation worldwide. Such inappropriate using of latrines or open defecation not only the environment to be contaminated but also is the main cause of multiple infectious disease distributions [14]. The barriers to public latrine utilization at which contextually identified in this study were poor administrative and institutional barriers, poor professional and regulatory barriers, poor management and operational barriers, and poor infrastructure and resource barriers. Regarding poor administrative commitment, study participants reported that most kebele and city administrators, including mayors, do not pay more attention to construction, utilization, and keeping the environment free from human excrement. Even though; without their decision, it is impossible even to construct a public latrine. In this case, mayors have the highest power to decide on budget and to allow the site where it should be constructed [15]. The study, which was carried out in Ghana revealed that mayors and policymakers of Accra, the largest city of Ghana, were not taking responsibility for the issues related to latrine construction, utilization, and safe handling. The majority of inhabitants in Accra do not have public latrines. This may be due to poor management of governance bodies and was comparable with our finding [16]. Poor cooperation among stakeholders was another challenge, because of insufficient collaboration between organizations like the World Bank and NGOs. It was described by the respondents that some existing NGOs were mostly working at rural wash rather than in the city. Due to this, public latrine-related activities and city, environmental hygiene was very poor. Another identified barrier in this finding was, poor responsibility among health professionals, particularly health extension workers and sanitarians [17]. The majority of the respondents reported that, in recent years, there was a commitment among health extension workers, but now they are not doing even their day-to-day activities. Among the reasons described by the study participants, in previous time, there was a lot of training regarding environmental hygiene and sanitation [18]. Additionally, no more environmental health professionals were assigned to each health center, whether at the woreda or zonal levels, making public latrine utilization poor. The absence of revised rules and regulations was identified as an additional barrier because inadequate decision-making power and outdated regulations can hinder progress [19]. Regarding poor management and operation, there was poor utilization among users, because they did not assume public latrines as their property. To be effective, issues with handling, community engagement, and sustainability of facilities must be boldly considered. This was in line with the study conducted at Alabama University. It revealed that one of the barriers to public latrine utilization was compatibility (misalignment with current practices) among the community [20]. The absence of responsible personnel is also another contributing barrier to poor public latrine utilization. Respondents declared that without the employment of permanent personnel to keep public latrines, their cleanliness and sustainability are always in question [21]. It is important to supervise and maintain public latrines unless it leads to open defecation and associated health issues. Finally, regarding poor infrastructure and resource barriers, a lack of essential materials such as water supply and water carriage systems can bring about poor public latrine utilization [22]. The study participants reported that without adequate and timely existing infrastructures for public latrines, it is impossible to make them permanent and sustainable for prolonged services [22]. On the other hand, in the public latrines that were found near the market areas, the users may be merchants who may sell vegetables and other raw foods [23]. Therefore, when they leave the toilet without washing their hands, they may contaminate vegetables and other raw food items that were being sold by them. This was related to a study done in the Sidama district, showing that due to a shortage of water and excreta contamination, the prevalence of diarrhea was higher [24].

Conclusions and recommendations

Conclusions

The utilization of public latrines and management were affected by multi-dimensional barriers. Lower attentions of district administrators, irresponsible use of public latrines among urban communities, and inappropriate cooperation of health professionals and stakeholders were among the barriers influencing the effective utilization of public latrines.

Recommendations

Zonal, woreda, and city administrators, including the municipality at each city, could expand good handling of public latrines, on-time repairing, assigning responsible personnel to control it, and early identification of gaps for public latrines for better utilization, must be taken in to account.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Abbreviations

FGD

Focus group discussion

BMC

Bio-medical center

DHS

Demographic health survey

EDHS

Ethiopian demographic health survey

FGD

Focus group discussion

GTP

Growth and transformation plan

KM

Kilo meter

LMICs

Lower and middle income countries

MOH

Ministry of health

NCHS

National centre for health statistics

SSA

Sub-Saharan Africa

MOH

Ministry of health

SSA

National centre for health statistics

SSA

Sub-Saharan Africa

WHO

World health organization

SSA

Public latrine

HEW

Health extension workers

ODF

Open defecation free

JMP

Joint monitoring program

Author contributions

SB, HT, and TED participated in the design, data collection, data analysis, investigation and interpretation. TDT, ATA, ETF, AMD and WMA also participated in supervision, methodology and interpretation, and drafting of the manuscript. All authors read and approved the final manuscript.

Funding

No funding was gained for this study and it was done alone by the authors.

Data availability

The datasets or recorded documents used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethical approval and consent to participate

Ethical clearance was obtained from Injibara University College of Medicine and Health Sciences, Research Council members. The study followed ethical principles outlined in the Declaration of Helsinki, ensuring that the study participants’ privileges, protection, and well-being were prioritized. Informed verbal consent was acquired from each study participant. They were fully cognizant regarding the study’s purpose and the processes included. The importance of the study was described, and all study participants confirmed their voluntary consent to participate. The consent process was approved by the research council members and waived as per the reference number “Injibara University Public Health Department 326/09,” dated December 26, 2022. Before conducting the interviews, participants were guaranteed that their participation was voluntary and confidential and that they could withdraw at any time without consequence. The ethical clearance letter has been attached as supplementary data 2 for more information on ethical clearance.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.