AbstractOpen defecation (OD), the practice of defecating in open spaces rather than designated toilets or latrines, remains a critical public health challenge in Nigeria, particularly in rural areas. Despite global efforts through initiatives such as the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs), open defecation persists due to socio-economic, cultural, and infrastructural factors. This review explores the determinants of open defecation in Nigeria, including poverty, education, cultural practices, and inadequate sanitation facilities, while highlighting its devastating public health implications, such as the spread of waterborne diseases, parasitic infections, and antimicrobial resistance. Additionally, the economic and social impacts of open defecation, such as increased healthcare costs, diminished productivity, and gender-based violence, are discussed. Strategies for addressing this menace such as improved access to sanitation facilities, behaviour change communication, and the establishment of robust policy and legal frameworks are proposed. Addressing open defecation is not merely a sanitation issue but a critical public health priority that requires coordinated efforts to achieve sustainable solutions and improve health outcomes in Nigeria.