Sanitation and Hygiene Practice: Challenges and Solutions to Improve Mental Health in Yenagoa Local Government Area, Bayelsa State

Poor sanitation and hygiene remain among the greatest unaddressed public health issues globally. According to the WHO, in 2022, only 57% of the world’s population used a safely managed sanitation service, leaving over 1.5 billion people without even basic sanitation, and about 419 million people practicing open defecation. Unsafe sanitation extends its harm beyond infectious diseases; it contributes to anxiety, loss of dignity, risk of assault, and other psychosocial harms that undermine mental health and well-being (WHO, 2024). Such statistics correspond with growing recognition that sanitation is not only a physical or environmental concern but also a determinant of mental health. Globally, inadequate sanitation and hygiene often contextualised within the WASH (water, sanitation, and hygiene) framework remain major contributors to disease burden. According to the World Health Organization (2024), unsafe sanitation accounts for approximately 564,000 deaths annually, largely among children, while poor hygiene significantly contributes to diarrhoeal diseases and acute respiratory infections. Beyond these physical health outcomes, recent global discourse highlights that inadequate sanitation is also associated with psychosocial distress, including feelings of shame, anxiety, and fear linked to unsafe or poorly maintained facilities. For example, Sclar et al. (2018) conducted a systematic review and qualitative synthesis and found that lack of safety, privacy, and dignity in sanitation contexts produces anxiety, decreased social well-being, and contributes to stress. Kimutai et al. (2023), in a meta-analysis, identified elevated rates of depression and anxiety in communities experiencing water and sanitation insecurity. In Sub-Saharan Africa, the challenges of sanitation and hygiene are especially pronounced. Across the region, many countries lag behind global averages in terms of safely managed sanitation services, handwashing facilities, and access to improved water sources. The Joint Monitoring Programme (JMP) data show that large proportions of health care facilities still operate without basic hygiene or sanitation services, and many households rely on unimproved sanitation or practice open defecation (WHO/UNICEF, 2025). A pooled analysis of 33 Sub-Saharan African countries revealed that open defecation remains widespread and is associated with lower socioeconomic status, rural residence, limited education, and inadequate sanitation infrastructure (Belay, Asratie, Aragaw et al., 2022). These deficits are not only physical health hazards but also carry psychosocial burdens: anxiety about use of unsanitary facilities, fear of assault (especially for women and girls), compromised dignity, and broader implications for community cohesion and well-being (Bisung & Elliott, 2016; Ross, Cumming, Dreibelbis et al., 2021). Within the Nigerian context, sanitation and hygiene challenges are immense and long-standing. Although the country has made some progress in WASH access, many Nigerians still lack safely managed sanitation and hygiene services, particularly in peri-urban and informal settlements. Open defecation persists in many parts of Nigeria, especially in rural and slum areas, due to poverty, inadequate infrastructure, and weak enforcement of sanitation regulation (Abubakar, 2018). Urban sanitation deficits are exacerbated by rapid urbanization, population growth, overcrowding, and environmental vulnerabilities (e.g. frequent flooding), which compromise drainage infrastructure and amplify waste pollution (solid waste, sewage). Moreover, unsafe disposal of faecal matter and wastewater is often observed in cities where soakaways or pit latrines overflow, or sewage is dumped into water bodies without treatment. These practices give rise to waterborne diseases (cholera, typhoid, diarrhoea) and other public health risks. Importantly, recent Nigerian studies have begun documenting the psychological and social consequences of poor sanitation and hygiene. For example, a study of peri-urban Nigerian students explored school sanitation-related psychosocial stressors and found that public school students experienced significantly higher stress linked to inadequate toilets (high student-to-toilet ratios), poor cleanliness, lack of privacy, disease fears, as well as open defecation-related anxiety (Roche, Bain, & Cumming et al., 2021). That study showed that these stressors were associated with school absenteeism, urine/fecal retention, and missed classes, especially among girls (Roche et al., 2021). Another local study in Yenagoa Metropolis assessed prevalence and awareness of open air defecation and its health implications, finding that many households still practice open defecation, motivated by socio-economic status, perceived affordability, lack of awareness, and absence of accessible latrines (Amawulu, Bunsen, & Esther, 2019). Solid waste disposal practices in Yenagoa have also been studied: Stanley, Orakwuemma, Onumajuru, Opukeme, & Onaghise (2018) found that although awareness of proper waste management was high, constraints such as manpower, equipment shortage, and unplanned settlements hinder effective waste collection and disposal, resulting in accumulations of refuse in many parts of the metropolis. Bayelsa State, being part of the Niger Delta region, faces unique environmental and infrastructural challenges. Its geography riverine, flood-prone, with many surface water bodies complicates both sanitation facility design and maintenance. Many households rely on surface water and hanging latrines (structures built over water), or dispose of child faeces into surface water, which raises both disease risk and environmental contamination. Despite these exposures, the epidemiological record (at least in the public domain) is less clear on mental health outcomes in Bayelsa tied directly to sanitation or hygiene deficits. Outbreaks of waterborne disease such as cholera are recurrent in Bayelsa, and UNICEF has in 2025 emphasized sanitation, handwashing, latrine use, and ending open defecation as key measures in controlling cholera risk in the state (UNICEF, 2025). Contextual factors complicate sanitation and hygiene practice in Bayelsa and similar states: rapid urbanization without commensurate infrastructure planning; poverty and low household incomes limiting ability to pay for improved latrines or waste collection; frequent flooding which destroys sanitation infrastructure or causes sewage overflow; water insecurity, where households lack access to clean water or must rely on contaminated sources; weak governance, inadequate policy enforcement, and constrained budgets for local government sanitation services; gender disparities, especially for women and girls, for whom privacy and safety concerns are acute (e.g. during menstruation, for sanitation at night); cultural practices and awareness levels that may favor traditional open defecation or lax waste disposal behavior. All of these environmental, social, economic and institutional pressures combine to elevate the risk not only of infectious disease but also psychosocial stress, mental health disorders, and diminished quality of life. The study is timely given international and national commitments under the Sustainable Development Goals. SDG 6 aims for clean water and sanitation for all by 2030, including ending open defecation and ensuring equitable access to hygiene services; SDG 3 seeks to ensure healthy lives and promote well-being for all, which necessarily includes mental health. Nigeria’s national policies and plans (e.g., National Water and Sanitation Policy, National Mental Health Policy) acknowledge these goals, but data are lacking on mental health impacts of sanitation deficits in many states, particularly those with challenging geography like Bayelsa. By filling this gap, research in Yenagoa LGA can provide empirical evidence of how sanitation and hygiene practices affect mental health at the community level, especially in riverine and peri-urban settings. This evidence will assist policymakers, environmental health specialists, mental health practitioners, and urban planners to design more holistic interventions that address both physical and psychological dimensions. Moreover, the potential theoretical contribution of integrating sanitation/hygiene frameworks with psychosocial well-being measures is significant. It may help to adapt or refine existing behavioural and environmental health models (e.g. the Health Belief Model, the Ecological Systems Theory) to better account for mental health outcomes in WASH research. Practically, the findings can inform local government and state health authorities in Bayelsa about how to prioritize sanitation investments, hygiene promotion, and mental health support services, especially for vulnerable groups (women, children, low-income households). The study also has implications for sustainable and resilient sanitation planning in flood-prone and riverine geographies, guiding infrastructural choice, service delivery models, waste disposal strategies, and community engagement. In summary, while global and regional evidence strongly shows that inadequate sanitation and hygiene produce both physical disease and psychosocial harm, there remains insufficient context-specific data from Nigerian riverine settings about how these practices contribute to mental health challenges. For Yenagoa LGA in Bayelsa State, understanding the specific pathways, prevalence, and lived experience of mental health impacts from poor sanitation and hygiene is essential. This dissertation will thereby deepen knowledge, address policy gaps, and enable more effective public health and environmental health interventions in this unique and vulnerable context.

The main objective of this study is to assess sanitation and hygiene practices, the associated challenges, and their implications for mental health in Yenagoa Local Government Area, Bayelsa State.

1. 1What are the current sanitation and hygiene practices among households in Yenagoa Local Government Area?
2. 2What are the current hygiene practices among households in Yenagoa Local Government Area?
3. 3What are the major challenges faced by residents in maintaining proper sanitation and hygiene in Yenagoa Local Government Area?
4. 4What is the relationship between sanitation and hygiene conditions and mental health outcomes among residents of Yenagoa Local Government Area?
5. 5What is the level of community awareness, perceptions, and attitudes towards sanitation and hygiene as determinants of both physical and mental health in Yenagoa Local Government Area?

1. H1There is no significant difference in sanitation and hygiene practices between male and female residents of Yenagoa Local Government Area
2. H2There is no significant relationship between sanitation practices and mental health