In a community where a centralized sewage system is absent, the pit toilet is the most prominent alternative, the common health problems associated with the use of pit toilet are mostly those diseases that occur via the feaco-oral transmission route. This study investigated the health problems associated with use of pit toilets among secondary school students in Gokana Local Government Area, Rivers State. A descriptive cross sectional design was adopted with a population consisting of all students in public schools in Gokana LGA, Rivers State. The sample size of 400 was selected using a systematic sampling technique. A structured questionnaire with a reliability coefficient of 0.88 was used.  Data was analyzed with the aid of the Statistical Products for Service Solutions (SPSS version 26), using percentage and Chi-square at 0.05 level of significance. The finding of the study showed that among those who used pit toilet, 41.9% had worm infection, 37.9% had dysentery, 28.6% had cholera, 21.7% had diarrhea, and 81.8% had skin problem. Statistically significant association was found between use of pit toilet and diarrhea (X²-value = 122.81, df = 1, p = 0.00), dysentery (X²-value = 72.15, df = 1, p = 0.00), cholera (X²-value = 79.77, df = 1, p = 0.00), worm infection (X²-value = 60.17, df = 1, p = 0.00), and skin problem (X²-value = 61.95, df = 1, p = 0.00).It was concluded that, the health problems associated with use of pit toilets were diarrhea, dysentery, cholera, worm infection, and skin problem. It was recommended among others that the government should provide resources for the expansion of accessible, clean sanitation with accompanying health education and targeted outreach for vulnerable school populations. Also, community stakeholders should reinforce the importance of integrating sanitation infrastructure upgrades into worm control programs by working in collaboration with the community healthcare workers. 

Keywords: pit latrines, sanitation hygiene, fecal–oral transmission, diarrheal diseases, helminth infections, school health, cross-sectional study, Rivers State, Nigeria.