Environmental sanitation satisfaction and associated factors among residents from National Sanitary Cities.

Objective: Residents are not only beneficiaries of National Sanitary City development but also participants who judge whether sanitation improvements translate into tangible daily benefits. This study assessed residents' subjective satisfaction with urban environmental sanitation and its associated factors to identify weaknesses relevant to people-centered sanitation governance. Methods: Between November 2021 and April 2022, a multistage sampling method was employed to evaluate the environmental sanitation satisfaction of 17,865 residents in National Sanitary Cities and non-National Sanitary Cities within four provincial-level administrative regions using a standardized structured questionnaire. Results: To meet the evaluation requirements, we selected 80 and 90% of the total scores as the criteria for judging satisfaction. At the 80% satisfaction cut-off point, 22.038% of residents expressed satisfaction with environmental sanitation, with residents in National Sanitary Cities showing a higher level of satisfaction (23.375%). Environmental sanitation satisfaction was associated with gender, educational level, age, occupation, living area, residence duration, and health literacy ( Conclusion: The findings suggest that National Sanitary City status was more clearly related to high-level environmental sanitation satisfaction. Overall satisfaction remained low, and residents' perceptions were also shaped by demographic, socioeconomic, living-area, and regional contextual factors. Routine attention to residents' subjective perceptions can complement objective sanitation indicators and help refine people-centered policy actions.