Rural-urban disparities in population practising open defecation across 47 African countries: a secondary analysis using the WHO health equity assessment toolkit

Access to safe sanitation is a human right, yet millions in Africa practice open defecation, risking disease and environmental harm. Despite global efforts, rural-urban disparities remain, especially in low-income countries. This study examines these disparities to inform policies for equitable sanitation access. To assess rural-urban disparities in open defecation across 47 African countries using WHO and HEAT data, identifying patterns for equitable sanitation policies and SDG 6 progress. This study assessed disparities using WHO and HEAT data, focusing on open defecation prevalence, defined as the population without sanitation facilities. The main inequality measure was the absolute prevalence difference between rural and urban populations. In 2022, South Africa, Mauritius, and Rwanda had near-universal access, with prevalence below 3%. Eritrea, Chad, and South Sudan exceeded 40%, some over 60%. Disparities were pronounced, with rural rates higher. Largest differences were in Niger (66.7 percentage points), Chad (62.2), and South Sudan (65.2). Some countries had minimal disparities, nearly eliminating open defecation in both areas. The study highlights significant sanitation inequalities, with rural areas most affected. It calls for targeted rural interventions, continued urban progress, and equity-focused policies to achieve SDG 6 and improve public health across Africa.