A faecal exposure assessment of farm workers in Accra, Ghana: a cross sectional study.

BACKGROUND: Wastewater use in urban agriculture is common as a result of rapid urbanisation, and increasing competition for good quality water. In order to minimize risks to farmers and consumers of wastewater irrigated produce the World Health Organization (WHO) has developed guidelines for the safe use of wastewater in agriculture. These guidelines are based on a Quantitative Microbial Risk Assessment (QMRA) model, though the reliability of this model has been questioned due to a lack of primary data. This study aimed to assess the ability of the WHO guidelines to protect farmers' health, by identifying and quantifying key exposures associated with the transmission of faecal pathogens in wastewater irrigated agriculture. METHODS: Eighty farmers were observed and interviewed during the dry and wet seasons, and water and soil samples were analysed for the presence of E. coli. STATA 12 was used for descriptive analyses of farmers' exposure and risk practices, and also to determine risk factors for soil and irrigation water contamination, while the WHO QMRA model and @Risk 6 were used to model farmers' infection risk to pathogens. RESULTS: The results showed that although irrigation water was highly contaminated (5.6 Log E. coli/100 ml), exposure to farm soil (2.3 Log E. coli/g) was found to be the key risk pathway due to soil-to-mouth events. During the observations 93 % of farmers worked barefoot, 86 % experienced hand-to-soil contact, while 53 % experienced 'soil'-to-mouth events, while no 'water' to mouth contacts were observed. On average, farmers were found to have 10 hand-to-mouth events per day. From the indicator based QMRA model the estimated norovirus infection risk to farmers was found to be higher than guidelines set by the WHO. CONCLUSIONS: This study found exposure to soil as the critical pathway of pathogen risk in wastewater farmers, and that this risk exceeded recommended health targets. The study recommends the incorporation of hand-to-mouth events, the use of actual pathogen concentrations, and the use of direct exposure frequencies in order to improve the reliability of risk estimates from QMRA models

Risk Perceptions of Wastewater Use for Urban Agriculture in Accra, Ghana.

Poor food hygiene is a significant risk to public health globally, but especially in low and middle-income countries where access to sanitation, and general hygiene remain poor. Food hygiene becomes even more pertinent when untreated, or poorly treated wastewater is used in agriculture. In such circumstances the WHO recommends the adoption of a multiple-barrier approach that prescribes health protective measures at different entry points along the food chain. This study sought to assess the knowledge and awareness of wastewater use for crop production, its related health risks, and adoption of health protective measures by farmers, market salespersons and consumers using questionnaires and focus group discussions. In the period from September 2012 to August 2013, 490 respondents were interviewed during two cropping seasons. The study found that awareness of the source of irrigation water was low among consumers and street food vendors, though higher among market vendors. In contrast, health risk awareness was generally high among salespersons and consumers, but low among farmers. The study found that consumers did not prioritize health indicators when buying produce from vendors but were motivated to buy produce, or prepared food based on taste, friendship, cost, convenience and freshness of produce. Similarly, farmers' awareness of health risk did not influence their adoption of safer farm practices. The study recommends the promotion of interventions that would result in more direct benefits to both producers and vendors, together with hygiene education and enforcement of food safety byelaws in order to influence behaviour change, and increase the uptake of the multiple-barrier approach

Water, sanitation and hygiene (WASH) in schools: results from a process evaluation of the National Sanitation Campaign in Tanzania

This study assesses the intermediate outcomes of the Tanzania National Sanitation Campaign (NSC) for schools. A cross-sectional study was designed as part of a process evaluation of the NSC in Tanzania on 70 primary schools and 54 regional and district education officers. Data was collected between August and December 2014 using questionaires, key informant interviews, and desk studies. The results showed that only 50% of schools met the Tanzania guideline of 50 boys per drop hole, while 43% met the guideline of 40 girls per drop hole. In addition, 53% of schools had a reliable water supply, 43% had some functional handwashing stations, but only 29% and 19% had water and soap available at the stations, respectively. Overall, the implementation of the NSC in schools was found to be effective, though poor planning and coordination, inadequate funding, and low technical capacity were identified as barriers to achieve the intended objectives. The study recommends stronger and coordinated stakeholder partnerships with clearly defined roles including cost sharing. Government and other stakeholders should also consider the impact of increasing funding for both software and hardware components to improve the enabling environment, and to develop a standardised monitoring mechanism for sustainable school water, sanitation and hygiene.</jats:p

Where Shared Sanitation is the Only Immediate Option: A Research Agenda for Shared Sanitation in Densely Populated Low-Income Urban Settings.

Shared sanitation is not currently accepted within the international normative definitions of "basic" or "safely managed" sanitation. We argue that pro-poor government strategies and investment plans must include high-quality shared sanitation as an intermediate step in some densely populated urban areas. User experience must be considered in establishing the definition of high quality. We call for additional research on effective interventions to reach these quality standards and for the development of rigorous measures applicable to global monitoring

Needs assessment to strengthen capacity in water and sanitation research in Africa:experiences of the African SNOWS consortium

Despite its contribution to global disease burden, diarrhoeal disease is still a relatively neglected area for research funding, especially in low-income country settings. The SNOWS consortium (Scientists Networked for Outcomes from Water and Sanitation) is funded by the Wellcome Trust under an initiative to build the necessary research skills in Africa. This paper focuses on the research training needs of the consortium as identified during the first three years of the project

How Much Will Safe Sanitation for all Cost? Evidence from Five Cities

Global sustainable development goals call for universal access to safely managed sanitation by 2030. Here, we demonstrate methods to estimate the financial requirements for meeting this commitment in urban settings of low-income countries. Our methods considered two financial requirements: (i) the subsidies needed to bridge the gap between the willingness-to-pay of low-income households and actual market prices of toilets and emptying services and (ii) the amounts needed to expand the municipal waste management infrastructure for unserved populations. We applied our methods in five cities– Kisumu, Malindi, Nakuru in Kenya; Kumasi in Ghana; and Rangpur in Bangladesh and compared three to five sanitation approaches in each city. We collected detailed cost data on the sanitation infrastructure, products, and services from 76 key informants across the five cities, and we surveyed a total of 2381 low-income households to estimate willingness-to-pay. We found that the total financial requirements for achieving universal sanitation in the next 10 years and their breakdown between household subsidies and municipal infrastructure varied greatly between sanitation approaches. Across our study cities, sewerage was the costliest approach (total financial requirements of 16–24 USD/person/year), followed by container-based sanitation (10–17 USD/person/year), onsite sanitation (2–14 USD/person/year), and mini-sewers connecting several toilets to communal septic tanks (3–5 USD/person/year). Further applications of our methods can guide sanitation planning in other cities

Understanding the Barriers and Opportunities for Effective Management of Shared Sanitation in Low-Income Settlements—The Case of Kumasi, Ghana

Improved sanitation for all is a daunting task for low-income countries, and shared toilets often provide an alternative to private household sanitation for most urban residents. This study sought to provide better understanding of the existing barriers and opportunities for improved management of shared sanitation. The study used focus group discussions and in-depth interviews with 70 users (landlords and tenants) of shared sanitation in Kumasi, Ghana to assess barriers and opportunities of &ldquo;high-quality&rdquo; shared sanitation. The commonly used toilet facilities were dry toilets&mdash;Kumasi Ventilated Improved Pit latrine and Ventilated Improved Pit latrines; and flush systems&mdash;water closet and pour flush connected to septic tanks. Between 2 and 21 households, or 4 and 84 people, shared one facility. Participants&rsquo; description of &ldquo;high-quality&rdquo; (Ideal) shared sanitation was centred on cleanliness, user behaviour, smell, and user crowding. They also identified challenges of shared sanitation as overcrowded users, poor user behaviours, conflicts among users, and high cost associated with frequent desludging. However, opportunities for improvement included users&rsquo; preference for shared toilets due to enjoyed benefits, existing facility management practices, and mutual understanding among users (tenants and landlords). Interventions and policy guidelines to influence behaviour change of shared sanitation users are proposed and are intended to be delivered by local government and users

Impact of the ban on illegal mining activities on raw water quality: a case-study of Konongo Water Treatment Plant, Ashanti Region of Ghana

The Government of Ghana prohibited Artisanal and Small-Scale Mining (ASM) operations from 2017 to 2018 as part of its strategy to address the socio-environmental issues caused by illegal mining activities, also referred to as “galamsey” operations. This study assessed the trend in the water quality of raw water abstracted at the Konongo Water Treatment Plant (WTP) for treatment before and after implementing the ban on “galamsey” operations. The main source of raw water for the Konongo WTP is the Anuru River. Secondary data on physicochemical water quality from 2006 to 2019 was sourced from the Konongo WTP and the Ashanti Regional Water Quality Assurance Unit of Ghana Water Company Limited (GWCL). Mann-Kendall seasonality test was used to determine trends in the water quality data using XLSTAT statistical tool. The results showed a statistically significant (5% level of significance) upward trend in colour, turbidity, temperature, total iron, and sulphate before the ban on “galamsey” activities. There was statistically significant evidence of a downward trend in total hardness, calcium hardness, turbidity, total alkalinity, and chloride after the ban on “galamsey” operations

Traditional agroecological knowledge and practices: The drivers and opportunities for adaptation actions in the northern region of Ghana

Agroecological practices are promoted as a more proactive approach than conventional agriculture to achieving a collective global response to climate change and variability while building robust and resilient agricultural systems to meet food needs and protect the integrity of ecosystems. There is relatively limited evidence on the key traditional agroecological knowledge and practices adopted by smallholder farmers, the factors that influence smallholder farmers’ decision to adopt these practices, and the opportunities it presents for building resilient agricultural systems. Using a multi-scale mixed method approach, we conducted key informant interviews (n ​= ​12), focus group discussions (n ​= ​5), and questionnaire surveys (N ​= ​220) to explore the traditional agroecological knowledge and practices, the influencing factors, and the opportunities smallholder farmers presented for achieving resilient agricultural systems. Our findings suggest that smallholder farmers employ a suite of traditional agroecological knowledge and practices to enhance food security, combat climate change, and build resilient agricultural systems. The most important traditional agroecological knowledge and practices in the study area comprise cultivating leguminous crops, mixed crop-livestock systems, and crop rotation, with Relative Importance Index (RII) values of 0.710, 0.708, and 0.695, respectively. It is reported that the choice of these practices by smallholder farmers is influenced by their own farming experience, access to market, access to local resources, information, and expertise, and the perceived risk of climate change. Moreover, the results further show that improving household food security and nutrition, improving soil quality, control of pest and disease infestation, and support from Non-Governmental Organizations (NGOs) and local authorities are opportunities for smallholder farmers in adopting traditional agroecological knowledge and practices for achieving resilient agricultural systems. The findings call into question the need for stakeholders and policy-makers at all levels to develop capacity and increase the awareness of traditional agroecological knowledge and practices as mechanisms to ensure resilient agricultural systems for sustainable food security