Association Between Exposure to “Clean Nigeria, Use the Toilet” Social and Behaviour Change Communication Campaign and Public Knowledge, Attitude and Open Defecation Practice in Ebonyi State, Nigeria

Background: Open defecation (OD) has remained a threat to the attainment of SDG 6 (sanitation and hygiene). This study measured the level of exposure to the “Clean Nigeria, Use the Toilet” campaign against open defecation, determined the level of public knowledge about open defecation-related harms and diseases, ascertained the public attitude towards open defecation, and established the prevailing defecation practices and the perceived barriers to toilet usage in Ebonyi state, the most prevalent OD state in Nigeria. Methods: The study employed a survey design, using a structured questionnaire for data collection. The multi-stage sampling technique was employed in selecting the respondents from two randomly selected Local Government Areas (LGAs) in the state. Analysis was conducted using 384 valid responses. Results: The results were presented in simple percentage frequency tables and interpreted through the descriptive method, while the Chi-Square test was used to analyse the formulated hypotheses, using the decision rule of p < 0.05. The findings show a high level of awareness of the campaign against open defecation, through the radio and community engagements by environmental activists/NGOs, even though regular access to such information was limited. The results also showed inadequate knowledge of the public health implications of open defecation, whereas good knowledge of environmental consequences was reported. The study found favourable attitudes toward OD practice and persistent open defecation, and major barriers to toilet usage include the high cost of toilet construction, lack of access to toilet facilities, poor sanitation and management of available toilets, and perceived risks of contracting infection from public toilets. However, the Chi-Square values showed that the SBCC campaign was significantly associated with knowledge, attitude, and practice (p < 0.05). Conclusions: The study concluded that localised, culturally relevant and socio-demographically targeted communication interventions, grassroot advocacy, community watch, and neighbourhood taskforce on open defecation, in addition to the provision of aids for the construction of modern toilets with water facilities, are required to combat open defecation in Ebonyi and related contexts in Nigeria.