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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.

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