Abstract

Dangerous and unhealthy sanitation practices, attitudes, and beliefs significantly contribute to adverse public health outcomes in low-income peri-urban communities of developing countries. This research explores sanitation practices and attitudes of the Kotoko community in Kumasi (Ghana) through household survey triangulated by in-depth and key-informant interviews and transect walks. In 67 households lived 2,226 people with average household and family sizes of 33 and four respectively. The ‘sanitation facilities’ used in the research community were broadly grouped into community, private, and open (or inappropriate) defecation. The results showed that two-thirds of respondents reportedly defecated in the community pour-flush (PF) latrine, while 9% of respondents were open defecators, and the rest defecated in private (either own or neighbor’s). Among the two-thirds of respondents who used the community PF latrine, 56% (a larger majority men) were dissatisfied with its condition on grounds of poor maintenance and queuing, while 8% attributed the dissatisfaction to the distance of the facility from their homes (proximity concerns). These results also provided an initial indication for community sanitation improvement support. The majority (83%) of the open defecators were men and all were willing to participate in community sanitation projects. The research community sanitation expenditure was categorized into low (0 – Ghȼ4.9), medium (Ghȼ5.0 – Ghȼ9.9), and high (Ghȼ10.0 – Ghȼ14.9) payment bands and 61%, 29%, and 10% of respondents respectively paid within these bands – giving an average expenditure per capita per month as Ghȼ4.95 (USD3.01). There was no evidence to suggest that either willingness to pay and use a sanitation facility was age-sensitive, or willingness to participate in community sanitation projects was gender-sensitive in the research community when Pearson chi-square (χ2) non-parametric tests were conducted. Regular facility cleaning (15%) and pit emptying (15%) were significant reported operation and maintenance practices at the community facility. The research findings indicated potential overuse and poor maintenance of the community PF latrine, suggesting inadequate sanitation provision. There was however a high sense of community participation spirit in sanitation projects. Improved maintenance of the community PF latrine, and either the construction of an additional latrine or expansion of the existing one are recommended.

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