In developing countries, e.g., Nigeria, several communities have limited access to sanitation and sanitation facilities, thus such communities dump their solid and liquid wastes indiscriminately. The aim of this study was to assess access to sanitation, and compare basic sanitation facilities between upland and coastal communities of Akwa Ibom State. With a cross-sectional design, 420 respondents were selected and administered questionnaires to obtain information on sanitation and sanitation facilities of the communities using a multi-stage random sampling technique. Result shows that faecal disposal facilities available for upland and coastal communities were respectively 187(89.05%) and 98(46.67%). 30(26.79%) of households defecate in open bodies of water in the coastal areas, while upland communities do not. Also, 9(39.13%) and 64(57.14%) of upland and coastal areas respectively, defecate in bushes/swamps, while 14(60.87%) and 18(16.07%) bury their faeces in pits. On the whole, improved sanitation coverage recorded 61.90% and 38.10% respondents for the rural upland and coastal communities respectively, while unimproved sanitation coverage for upland and coastal communities recorded 31.43% and 68.57% respectively. This indicates that sanitation facilities and coverage are worse in the rural coastal areas. In conclusion, both upland and coastal communities of Akwa Ibom State still lack adequate sanitation, although the upland communities enjoy relatively improved sanitation than the coastal communities.