Use of an evidence based tool to inform action and sanitation investments in Kumasi, Ghana

UNC Water and Health Conference

Presenter: Habib Yakubu

Periodically, resource-challenged municipal governments in urban areas of low-income countries face decisions on how to set priorities for sanitation investments and focus resources for impact. This is primarily due to their lack of knowledge of existing innovative evidence- based sanitation tools. SaniPath exposure assessment tool evaluates the public health risks from poor sanitation and unsafe fecal sludge management in low-income urban areas. It has been deployed in 43 neighborhoods in 9 cities ; Accra, Ghana; Vellore, India; Maputo, Mozambique; Siem Reap, Cambodia; Dhaka, Bangladesh; Atlanta, United States; Lusaka, Zambia; Kampala, Uganda and Kumasi; Ghana. The most recent shit flows diagram indicates that only an estimated 45% of the fecal sludge is treated. Four neighborhoods of varying geographic and socio economic characteristics were selected for the deployment of the SaniPath tool based on extensive engagement with Kumasi Metropolitan Assembly (KMA). Trained environmental health assistants collected environmental samples and behavior data from multiple pathways in Moshie Zongo, Dakodwom, Fante Newtown and Ahodwo. The nine pathways investigated were; river water, street food, raw produce, drinking water, bathing water, open drain water, soil, public latrines and floodwater. The unit of analysis of the tool is exposure to fecal contamination. Exposure is a measurement of the average amount of E.coli ingested per month (dose) and the percent of the population exposed to fecal contamination per pathway. The most common dominant exposure pathway for children across all the four neighborhoods was open drains. A large percent of the child population was exposed, ranging from 85% to 95% and a high average dose between 10^6 to 10^8 colony forming units (CFU). For adults, the most dominant pathway varied across all the four Page 50 of 56 neighborhoods. Raw produce was the most common dominant pathway in Moshie Zongo, with 78% of the adult population exposed, and a high dose of >10^7. Bathing water was the most dominant pathway in Fante Newtown; with 81% of the population exposed and a high dose of >10^7. Open drains was the most dominant pathway in Ahodwo and Dakodwom with population exposed >61% and high dose values > 10^6. KMA has used this information to take immediate action in two neighborhoods. Firstly, they investigated the source of contamination of a surface water and sanctioned the property owner who had illegally connected directly a shared latrine’s fecal waste into a community river. Secondly, KMA rolled out a school hygiene program to educate primary school students on good hygiene practices within their school compound, in public spaces around open drains and in school toilets. There are other ongoing plans to use the results to inform their sanitation planning, practice and investments. These actions, show that with commitment and access to evidence based sanitation tools, municipal governments in urban areas are capable of using evidence based sanitation tools to prioritize and focus their sanitation investments.

SaniPath Training Hub Evidence to Action

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Comparison of SaniPath Exposure Assessments in Low-Income Urban Areas in Eight Countries

UNC Water and Health Conference

Presenter: Wolfgang Mairinger

The SaniPath exposure assessment tool compares risks of exposure to fecal contamination in urban environments across multiple exposure pathways. The tool has been deployed in 39 neighborhoods in 8 cities: Accra, Ghana, Vellore, India; Maputo, Mozambique; Siem Reap, Cambodia; Dhaka, Bangladesh; Atlanta, United States; Lusaka, Zambia; and Kampala, Uganda. Ten exposure pathways were investigated (open drains, ocean water, surface water, floodwater, public latrines, soil, bathing water, raw produce, drinking water, and street food) through behavior surveys and environmental sample analyses. Exposure was expressed as monthly dose (average amount of fecal contamination ingested as measured by E. coli colony-forming units [CFU]) and the percent of population exposed to fecal contamination for each pathway. Magnitude of fecal contamination, frequency of exposure behavior, and estimated fecal exposures were compared across pathways, neighborhoods and cities. The most common dominant exposure pathways for adults were raw produce, open drains, and street food and for children were open drains, produce, and floodwater. For produce, the dose was usually very high (>106 CFU/month), and a large percent of the population was exposed (>80%). For street food, average E. coli concentration ranged from 101.3 CFU/serving in one neighborhood in Lusaka, Zambia to 105.5 CFU/serving in one neighborhood in Dhaka, Bangladesh. Exposure to open drains resulted in high doses (>104 CFU/month), but the population exposed varied (5%-92%) even within the same city. Exposure to fecal contamination via floodwater, usually affected a high percent of population (>80%) but had variable doses (102.5- 1010 CFU/month). Both dose and percent of population exposed varied for public latrines and municipal piped water. This information can help city governments choose effective interventions to reduce the risk of exposure to fecal contamination. Widespread risks from contaminated produce and street food within and across cities underscore the link between excreta management and food safety and need for global action.

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Kumasi Metropolitan Assembly wins "Dignified City Award" in Sanitation Challenge for Ghana

The Sanitation Challenge for Ghana was a competition held from November 2015 to June 2019 for Metropolitan, Municipal, and District Assemblies (MMDAs) to facilitate transformational changes to city-wide sanitation services in Ghana. Kumasi Metropolitan Assembly (KMA) received the "Dignified City Award" for its innovative partnerships with the private sector, use of aquaculture, skilled and knowledgeable staff, and strong support from the local government. KMA stood out among the rest of the field by demonstrating an ability to garner commitment from local leadership and for rehabilitating the local waste treatment pond to generate revenue through aquaculture.

KMA won £400,000 from the UK Aid funded competition, which will be used to implement strategic, evidence-driven plans. The results from the SaniPath deployment in Kumasi will be used to help guide these investments to ensure the greatest possible impact on public health.

TREND also received a special prize of £10,000 for its collaborative approach to building capacity and collecting actionable data with KMA (including deployment of the SaniPath Tool) .