In refugee settings, safe and private access to sanitation is often constrained by overcrowding and limited infrastructure. While coverage indicators such as toilet availability are often used to monitor progress, they do not capture users lived experiences. The Sanitation-related Quality of Life (SanQoL-5) index measures individual sanitation experiences across five dimensions: privacy, safety, disgust, shame, and disease risk. This study assessed sanitation access and SanQoL-5 among refugee populations in Gambella, Ethiopia, and identify factors associated with variation in SanQoL-5.
We conducted a cross-sectional, representative survey across two refugee settlements in Gambella, Ethiopia, a region hosting approximately 42% of the country's total refugee population. Data were collected on sanitation access, facility type, location and characteristics, alongside experiential outcomes using SanQoL-5 (scored 0–1; higher scores indicate better quality of life). Generalised linear regression models were used to explore associations between SanQoL-5 scores, and hypothesised factors, including gender, facility type and location, construction quality, and cleaning arrangements. Analyses were stratified by toilet location (on- or off-compound) following evidence of effect modification.