Background: Access to adequate Water, Sanitation, and Hygiene (WASH) facilities in rural schools remains challenging, resulting in poor sanitation and hygiene practices and increased risk of waterborne diseases among students. Despite having better resources, urban schools face challenges like limited resources and high student populations that strain WASH facilities. The study evaluates WASH practices among primary and secondary students in urban and rural Iringa, Tanzania, focusing on comparing reported practices and identifying factors associated with WASH practices.

Methods: This study used a cross-sectional design among 1,536 students from 64 primary and secondary schools in rural and urban Iringa, Tanzania. Data were collected through structured questionnaires and analyzed using Statistical Package for Social Sciences (SPSS) version 26, focusing on descriptive and comparative statistics to assess WASH practices and identify significant relationships between variables.

Results: The study found that 53.5% of rural students had adequate WASH practices, compared to 85.9% in urban areas. A Mann-Whitney U test showed a significant difference in practice scores (Z = −3.545, P < 0.001), with urban schools having a median score of 78.57% versus 57.14% in rural schools. Although binary logistic regression did not reveal a significant relationship between the two groups, it indicated that public schools (AOR = 2.129), students in the Kilolo district (AOR = 15.979), and boarding students (AOR = 2.874) were more likely to inadequate WASH practices.

Conclusion: This study revealed rural-urban disparities among students regarding WASH practices, highlighting the urgent need for targeted interventions in rural schools.