If you build it will they come? Factors influencing rural primary pupils' urination and defecation practices at school in western Kenya

There is a need for a more comprehensive understanding of sanitation behaviors and determinants in the school setting to mitigate health risks, improve sanitation practices and programs, and maximize educational and health impacts. We conducted qualitative research with pupils and teachers in western Kenya to understand where pupils urinate and defecate and what factors influence location selection. Despite the availability of gender-separated latrines at all schools, pupils listed numerous locations for urination and defecation. Several physical environmental, social, and individual factors influence pupils' selection of where to urinate and defecate. Physical environment factors include condition, safety, privacy, accessibility, and availability of facilities; social factors include norms, expectations, and responsibility; and individual factors include experience, routine, risk perception, and personal needs. Students simultaneously weigh several competing factors to determine where to go. The factors that facilitate or hinder latrine use need to be taken into consideration during design, construction, operation and maintenance, if healthy habits are to be formed and sustained.