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1.1 Background to the study

Open defecation continues to be a critical health challenge globally, affecting almost 1 billion people worldwide and contributing significantly to an estimated 842,000 people who die yearly from sanitation-related diseases. Open defecation is a major environmental health problem facing many countries in sub-Saharan Africa. Although open defecation rates have been reducing gradually since 2000, the Millennium Development Goals (MDGs) era ended without all countries in sub-Saharan Africa achieving target 7.C., which included reducing by half the proportion of the population without sustainable access to basic sanitation by 2015. Some estimates indicate that, at the current rate, this can only be achieved by 2026. All sustainable development goal (SDG) regions saw a drop in the number of people practicing open defecation, except for sub-Saharan Africa, where high population growth led to an increase in open defecation from 204 million to 220 million, and in Oceania, where the practice increased from 1 million to 1.3 million. This information is supported by studies such as Osumanu and Kosoe, which shows that open defecation in Ghana has increased over the years resulting in several environmentally endemic health problems.

The existence of open defecation is associated with diseases, under nutrition and poverty, and is usually considered as an affront to personal dignity. Those countries where open defecation is most widely practiced have the highest numbers of deaths of children under the age of five, as well as high levels of under nutrition, high levels of poverty, and large disparities between the rich and poor [3]. In sub-Sahara Africa, 200,000 children under the age of five die from diarrhoea annually, while the numbers dying from cholera within the region are similarly high because of poor sanitation, hygiene practices, and unsafe water supplies.

Nigeria has been ranked second after Sudan in Africa for open defecation, with almost 5 million Nigerians in the rural areas not having access to any toilet facility. The number of people practicing open defecation in Nigeria was reported at 18.75% in 2015. This refers to the percentage of the population defecating in the open, such as in fields, forests, bushes, open bodies of water, on beaches, and in other open spaces or those who dispose human excreta with solid waste. The practice is most prevalent in the Upper East Region with about 89% of the people without any form of latrine, followed by the Northern Region with about 72%. Households which have no toilet facilities of any kind available for use at home in the northern part of the couintry mostly resort to use of the bush or the field or small receptacles that are available for defecation. The seriousness of the situation is that children are the leading culprits, particularly because toilet facilities are usually not designed to meet their needs.

Though open defecation is predominantly a rural phenomenon, it is estimated that 8.22% of the urban population in sub-Saharan Africa practice open defecation. The practice of open defecation in urban areas needs attention because research has shown that detrimental health impacts (particularly for early life health) are more significant from open defecation when the population density is high. For instance, the same amount of open defecation is twice as bad in a place with a high population density average vis-a-vis a` low population density average.

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