Bridging Troubled Waters:

A Quantitative Analysis of Environmental Equity in Accra,

Ghana

A thesis presented by

Heather Carmichael

to

The Committee on Degrees in Environmental Science and Public Policy

in partial fulfillment of the requirements

for a degree with honors
of Bachelor of Arts

Harvard College
Cambridge, Massachusetts

March 2009
Acknowledgements

I met Professor Majid Ezzati during my sophomore year at Harvard,

when he provided me with my first opportunity to travel to Accra, to do
summer research on urban air pollution with a small team from the School of
Public Health. I could not have been more fortunate, as it is hard to imagine
that there is any researcher at Harvard who is more eager to work with
undergraduates or who places so much value on his students’ ideas and
efforts. Professor Ezzati often reminds his students that lofty aspirations of
“saving the world” mean nothing unless we are first willing to learn
something about its problems. If nothing else, I hope that this thesis makes
evident my commitment to such learning and my great debt to Professor
Ezzati for providing a model of how to go about it.

For the development of my quantitative skills, I have to thank first and

foremost Professor Gary King, for the grounding he provided me in his
methodology class as well as several helpful conversations on the methods
employed in this thesis. For shaping my ideas and encouraging my interest
in environmental risks in the urban environment, I am grateful to Professor
Jennifer Leaning and my experience in her junior seminar. Professor Michael
Herron is to thank for introducing me to the world of Bayesian statistics, and
Professor Sumeeta Srinivasan for furthering my GIS skills.

I am overwhelmingly grateful to the Harvard University Center for the

Environment, which provided the vast majority of funding for both my
summer trips to Accra, as well as the Harvard College Research Program for
funding testing equipment used in my thesis research. The Center for
Geographic Analysis was kind enough to provide me with a GPS, as well as
help with the initial stages of data analysis. This research also would not
have been possible without help from the University of Ghana and the
Harvard Initiative for Global Health.

I have many good friends and colleagues to thank here at Harvard.

First among them is Ari Friedman, who was a constant source of R code, puns,
and helpful advice. Kathie Dionisio played an equally important role in
mentoring me during my first summer in Accra, and probably knows more
about Accra than any other obruni on the planet. I also want to thank Michael
Rooney for and David Bartels, fellow researchers, for their companionship in
Cambridge and Accra. Several people also played a key role in the final
stages of editing, particularly Derek Wetzel.

My research would not have been possible without the help of many
people in Accra as well. I have to thank our field assistants—Tete, Laye,
Nazar, Abu, and Kilu—for assisting me around Nima and Jamestown, and for
lively discussions about local and world politics. My second trip to Accra
would not have been successful without the help of Allison Hughes and Nana
Prempeh, who offered both advice and company on numerous occasions. I
would not have made it through the summer, or indeed, out of the airport, if
it were not for Raphael and Comfort Arku, who came to rescue me whenever
anything went wrong, even in the midst of their honeymoon. Finally, I

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particularly have to thank Adam Abdul Fatah and his wife, Hawa, for their
generosity and hospitality, as well as their insight and inspiration, and for
lending me their baby daughter, Amirat, when I got lonely.

No thesis makes it to completion without the slew of friends who make

sure the author survives the process of writing it; in my case, particular
thanks goes to Michael Hersher, Alison Ravenscraft, Jay Miller, Gordy Powers,
Nicole Irwin, Hanna Retallack, Sezen Unluonen, Leslie Moclock and Eric
Sefton. I also especially thank my thesis lunch buddies, Spring Greeney, Jo
Henderson-Frost, and Nora Sluzas, for many helpful, if not entirely thesis-
related, conversations.

Finally, and most importantly, I have to thank my family. Without them

I would never have made it this far in the first place.

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Abstract

It has been established that environmental risks have substantial impacts on

human health and contribute substantially to the global burden of disease. However,

much of the research that has been done on environmental risks and interventions in the

developing world has focused on rural regions. Meanwhile, urban areas in poor countries

are experiencing rapid growth; while this expansion presents challenges to developing

infrastructure, it also generates the opportunity to make use of economies of scale in

providing services such as water supply, sanitation, and waste removal. Focusing on the

city of Accra, Ghana, my thesis moves beyond the study of risks in the household

environment and considers the neighborhood effects that occur in areas of concentrated

poverty. Because environmental inequity is often masked by aggregate statistics in urban

areas, my thesis also seeks to quantify the magnitude of environmental disparities within

the city by comparing four neighborhoods of varied socioeconomic status. I consider in

particular the problems of littered solid waste, open drainage systems, and household

water quality in a quantitative analysis of original data, showing that these risks can be

researched and assessed in resource-poor settings at relatively little cost. My thesis also

serves as a body of empirical evidence that could be used to promote policies to improve

urban slums of Accra and other cities in sub-Saharan Africa.

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Table of Contents

Chapter 1 : Introduction...................................................................................................1
Chapter 2 : An Introduction to Accra and the Study Areas.........................................11
Chapter 3 : Datasets and Methods of Data Collection.................................................20
Chapter 4 : Water, Hygiene and Sanitation in the Greater Accra Metropolitan Area
Census and Other Household Surveys ..........................................................................30
Chapter 5 : The Spatial Distribution of Littered Solid Waste.....................................47
Chapter 6 : Liquid Waste and Roadside Drainage Gutters ........................................64
Chapter 7 : Household Drinking Water—Source versus Consumption.....................76
Chapter 8 : Discussion, Conclusions, and Suggestions for Future Policy...................94
Works Cited...................................................................................................................106
Appendix A....................................................................................................................107
Appendix B....................................................................................................................108

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List of Figures and Tables

Figures

Figure 2-1: Beach area (top) and residential street (bottom) in Jamestown..............16
Figure 2-2: Rooftop view (top) and public waste collection site (bottom) in Nima.. .17
Figure 2-3: Residential area (top) and the Ring Road (bottom) in Asylum Down... .18
Figure 2-4: Developing area along the walking path (top) and gated houses in East
Legon (bottom).................................................................................................................19
Figure 3-5: Water collected from a public tap in Jamestown and stored outside a
house in a plastic barrel...................................................................................................24
Figure 3-6: Metal barrels used to store water in the courtyard of a household
compound in Nima...........................................................................................................24
Figure 3-7: An example of a highly polluted consumption sample collected from a
household in Jamestown. E. coli colonies appear blue or purple, while other
coliforms form pink colonies...........................................................................................25
Figure 3-8: Testing for E. coli and total coliforms using Coliscan® Easygel® system
—incubation at room temperature................................................................................25
Figure 3-9: Map of study areas and walking paths showing road type and surface,
as well their general location in the city (courtesy of Ari Friedman)..........................27
Figure 3-10: Partially covered cement gutter in East Legon with no trash and slow
flowing water (left) and clogged open gutter in Nima with stagnant water flow
(right). ..............................................................................................................................29
Figure 4-11: Population density in the Greater Accra Metropolitan Area (boxes show
the approximate locations of the study areas)...............................................................32
Figure 4-12: Persons per bedroom for households in the Greater Accra Metropolitan
Area, aggregated by enumeration area..........................................................................32
Figure 4-13: Water sources by EA in the Greater Accra Metropolitan Area.............34
Figure 4-14: Water sources in the four neighborhoods using data from the 2000
census (left) and the 2007 household surveys (right)....................................................35
Figure 4-15: Household methods of solid waste disposal include (clockwise from top
left) disposal at public collection sites, private collection of solid waste, illegal
dumping (for example, into open drainage gutters) and burning of household trash.
...........................................................................................................................................39
Figure 4-16: Household methods of solid waste disposal by EA in the Greater Accra
Metropolitan Area............................................................................................................40
Figure 4-17: Methods of solid waste disposal in the four neighborhoods, according to
the 2000 census (left) and the 2007 household surveys (right).....................................41
Figure 4-18: Liquid waste disposal methods by EA in the Greater Accra
Metropolitan Area............................................................................................................43
Figure 4-19: Liquid waste disposal methods in the four neighborhoods, according to
the 2000 census (left) and the 2007 household surveys (right).....................................45
Figure 4-20: Toilet facilities in the four neighborhoods, according to the 2000 census
(left) and the 2007 household surveys (right)................................................................46

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Figure 5-21: "Sachet" water is a common commercial source of drinking water in
Accra (left). The plastic sachet then becomes a common source of littered waste
(right)................................................................................................................................49
Figure 5-22: The spatial distribution of plastic waste in the four study areas. Only
Asylum Down and Jamestown show significant spatial autocorrelation....................52
Figure 5-23: The spatial distribution of food waste in the four study areas. Only
Nima shows significant spatial autocorrelation............................................................53
Figure 5-24: The spatial distribution of paper waste in the four study areas. No
neighborhoods showed significant spatial autocorrelation..........................................54
Figure 5-25: Map depicting the littered waste data collection points in Asylum
Down, along with the population density raster. The red circles represent buffer
zones (50 meter radius) for which an average population density was calculated....57
Figure 5-26: Histograms of this test statistic for replicate datasets sampled from the
model. Lines in red show the test statistics for the actual dataset..............................62
Figure 6-27: Level of trash in open gutters summarized for the four neighborhoods.
...........................................................................................................................................66
Figure 6-28: Level of littered waste in gutters along the walking paths for the four
study areas........................................................................................................................67
Figure 6-29: Stagnant waters provide breeding grounds for mosquitoes and other
pests (left). Shallow gutter with high flood risk in Jamestown (right).......................68
Figure 6-30: Classification of water flow in gutters along the walking paths for the
four study areas................................................................................................................71
Figure 6-31: Measure of flood risk for gutters along the walking paths for the four
study areas........................................................................................................................72
Figure 6-32: Comparison of trash level to water flow for all measured gutters
(pooled across neighborhoods).......................................................................................74
Figure 7-33: Classes of coliform bacteria used as indication of biological
contamination in water (Source: Washington State Department of Health, 2007).. .82

Tables
Table 4-1: Mean population densities for EAs in each locality (standard deviations
shown in parentheses). ...................................................................................................31
Table 4-2: Mean number of persons per bedroom for households in each
neighborhood for the 10% household sample (standard deviations shown in
parentheses)......................................................................................................................31
Table 5-3: Mean level of different waste types by neighborhood (ranges shown in
parentheses)......................................................................................................................48
Table 5-4: Regression of log1plastic on neighborhood.................................................50
Table 5-5: Moran's I values for each neighborhood for different types of littered
waste. Data demonstrating high levels of spatial autocorrelation (unlikely to be
random) are marked by asterisks...................................................................................51
Table 5-6: Results for OLS regression of log1plastic on road capacity and surface..57
Table 5-7: OLS regressions of log1plastic on two measures of population density....58

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Table 5-8: Results of the OLS regression of log1plastic on the percentage of the
population using a public dumpsite for solid waste collection.....................................59
Table 5-9: Summaries of posterior densities (mean and 95% confidence interval) for
important estimated parameters....................................................................................60
Table 6-10: Summary of important characteristics of gutter water in the four
neighborhoods..................................................................................................................70
Table 6-11: Average width and depth of gutters in the four neighborhoods (in
centimeters)......................................................................................................................70
Table 6-12: Flood risk of gutters with specified characteristics, namely, level of
littered waste (left) and water flow (right).....................................................................75
Table 7-13: Piped sources used by sampled households within each neighborhood. 78
Table 7-14: Of households that store drinking water prior to consumption,
percentages using various containers for water storage. ............................................79
Table 7-15: Location of the storage container within the home in each neighborhood
(as a percentage of households that store drinking water prior to consumption). ...79
Table 7-16: Percentage of households demonstrating particular hygiene behaviors in
the household prior to consumption from piped sources. ..........................................80
Table 7-17: Comparisons of E. coli contamination in piped samples, at the source
and at the point of consumption. ...................................................................................85
Table 7-18: Comparisons of total coliforms in piped samples, at the source and at
the point of consumption.................................................................................................85
Table 7-19: Difference in E. coli contamination between consumption samples and
source samples for all households with piped water sources, by source type.............88
Table 7-20: Difference in total coliform contamination between consumption
samples and source samples for all households with piped water sources, by source
type....................................................................................................................................89
7-21: Mean differences in E. coli and total coliform contamination between
consumption samples and source samples for all households with piped water
sources, by storage location. Numbers in parentheses include TNTC samples by
approximating TNTC counts at the minimum 200 cfus/5mL......................................90
7-22: Mean differences in E. coli and total coliform contamination between
consumption samples and source samples for all households with piped water
sources, by storage container type. Numbers in parentheses include TNTC samples
by approximating TNTC counts at the minimum 200 cfus/5mL................................92

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Chapter 1: Introduction

A Changing Global Demographic

In 2007 the global urban population exceeded the rural population for the first

time in history.1 Trends suggest that population growth in the next 30 years will occur

almost entirely in the urban areas of low- and middle-income countries (LMIC).2 The

rapid rates of growth in these urban areas are due both to high rates of rural-to-urban

migration and high urban birth rates. As cities struggle to cope with rapid growth and

development, infrastructure often lags far behind what is needed to manage pollution and

wastes.

One outcome of rapid urbanization in the developing world has been the

proliferation of city slums. Nearly one sixth of the global population lives in slums,

defined as areas where the population lacks security of tenure, adequate housing, safe

drinking water and sanitation.3 Almost four billion people are expected to live in slums

by 2030. In developing countries, the proportion of the urban population who live in

slums is currently estimated at 43%; in the least-developed countries, slum-dwellers

comprise 78% of the population in urban areas.4

Historically, governments have often seen urbanization as a problem, not an

opportunity, and therefore attempted to accelerate rural development as the primary focus

of poverty reduction.5 In a 1987 survey of 116 developing countries, 90 countries

indicated that they had initiated policies to slow urban growth by reducing rural-to-urban

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4
5

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migration.6 It is thought that by creating better opportunities for rural populations,

countries can discourage the influx of rural migrants into urban centers, and thus solve

the “problem” of urbanization.7 This perspective can foster a misconception of the urban

poor as transient populations that present a merely temporary problem, one that needs not

be immediately rectified.8 In failing to acknowledge the permanence of those living in

urban poverty, government officials also neglect to formalize patterns of settlement for

rural migrants as they flock to urban areas. The urban poor are thus a marginalized

population excluded from many aspects of social development and welfare including

health care, transportation, livelihood opportunities, and political expression.9

Urbanization and the Environment: A Troubling Lack of Data

In the study of economic development, urban bias is a common and well-

understood concept, established by Michael Lipton (1976).10 Urban bias refers to the

tendency of city-dwellers, who live in centers of political, economic, and social activity,

to have greater access to policy-makers and government than their rural counterparts. The

corollary to this is the notion that urban poverty ought to be less of a concern when facing

poverty as a whole, and that the majority of the focus in development should be on the

seemingly greater and more pervasive problem of the rural poor.

However, ironically, the assumption of an urban bias may have resulted in greater

attention to means of improving the lives of the rural poor in developing countries, at the

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7
8

9
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expense of research focused on the living conditions of their urban brethren. Saumitra

Jha has described this rural bias in the following way:

If it is in fact the poorest migrants that gain from improved access to decision makers and
services by moving to the city, then urbanization, rather than being a strain on resources
that is to be discouraged, may in fact provide a means to better governance and poverty
alleviation. Unfortunately, due to an arguably strong “rural bias” in development data
and inquiry, little quantitative evidence is available either on the strategies of network
formation or on the actual political networks of the urban poor.11

Thus, it remains unclear whether the urban poor actually benefit from the urban bias in

development, and this lack of clarity is in part due to the imbalance of research and

initiatives in favor of the rural setting.

Although Jha focuses on the lack of research that exists in the social and political

realm, this rural bias is also evident in the study of environmental risks and intervention

methods. While research exists on the associations of environmental risks with poverty

in the developing world, urban settings have generally received less attention than rural

ones. A systematic review of the literature on interventions in water, sanitation, and

hygiene in the developing world, conducted in 2005, considered all studies in the field

published prior to June, 2003. Of a total of 38 studies selected for review, only 11 were

conducted in urban or peri-urban areas, while 22 studies focused specifically on rural

areas (the locations of the other 6 studies were unstated). Of the 24 studies deemed to be

of “good” quality, only 3 were in urban areas and 3 in peri-urban areas, while 14 had

been undertaken in rural settings.12 While the quality and quantity of research on

environmental risks in urban areas is certainly improving13, there is still much progress to

be made.

11

12
13

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 The environmental risk and the physical deprivation experienced by urban slum

residents can be staggering, with many health risks at levels substantially higher than

those considered safe or seen in other areas of the city. Inadequate access to safe water

influences the spread of disease via water-borne pathogens, and water scarcity also

spreads disease due to poor hygiene. Inadequate sanitation infrastructure contaminates

the neighborhood and household environment, and in turn can contaminate water sources.

Inadequate waste removal exacerbates disease by providing breeding grounds for flies

and other pests, and littered waste also clogs drainage systems, which then act as

breeding grounds for mosquitoes that spread malaria and dengue. Poor structural quality

of housing leads to higher risk for physical injury and overcrowding facilitates the rapid

spread of infectious disease.14

The environmental risks described above indicate a need for more detailed

empirical study in the urban developing world. This research needs to extend beyond the

study of the household environment, to the neighborhood effects that occur in areas of

concentrated poverty. Thus, one goal of this thesis is to examine closely both

neighborhood- and household-level environmental risks in the urban setting.

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The Underestimation of Urban Poverty: Definitions and Discrepancies

Studies on urban poverty can easily underestimate its pervasiveness and its

implications. This is in part because average urban incomes exceed average rural

incomes by a significant margin, which is all too often cited as a reason to divert focus

away from the urban poor. The UN Millennium Project Report on Improving the Lives

of Slum Dwellers states: “The conventional wisdom is that urban areas are better off than

rural areas and that urban slum dwellers live better lives than their rural counterparts.”15

This underestimation of poverty in the city is partially due to a lack of adjustment for cost

of living. Although the urban poor are on average wealthier than the rural poor, their

earnings often fail to cover even the most basic necessities when living in the city.

Definitions of lack of access to safe drinking water, sanitation, and shelter are also

inadequate and may misrepresent the experiences of the urban poor. While many urban

residents meet the definitions of having access to “improved provision” of water and

sanitation, these facilities may be shared by hundreds of people, greatly increasing the

risks of contamination and exposure. Similarly, proximity to infrastructure such as

hospitals or water sources does not ensure that poorer residents will have access to these

amenities.16

Finally, when considering the urban poor there is also a problem of aggregate

statistics, which obscure the huge disparities that often exist in the city. Middle and

upper class households are also concentrated in urban areas, and can obscure the

differences between rural and urban poverty. Under-five mortality rates in informal

settlements in Nairobi, for instance, are more than twice the city’s average, while these

15
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informal settlements comprise nearly half the city’s population.17 It is unclear whether

the urban bias extends to the urban poor, who may be just as distanced as the rural

population from formal government and access to policymakers who live just next door.

Although the meaning and scope of the term environmental equity remains vague,

the United States Environmental Protection Agency defines it as “the equal protection

from environmental hazards of individuals, groups, or communities regardless of race,

ethnicity, or economic status.”18 The study of environmental equity in developing world

cities has been limited, although marked differences exist in the living conditions and

health outcomes of urban dwellers. Another goal of this thesis is to explore

environmental differences and disparities in the urban setting of the developing world.

Environmental Risk Factors for Health

It has been demonstrated that environmental risks have substantial impacts on

human health, accounting for close to one-fifth of the burden of disease in developing

countries (a conservative estimate).19 Among the most important environmental risk

factors in the developing world are inadequate water, sanitation, and hygiene (WSH),

indoor air pollution from solid fuels, urban ambient air pollution, and vector borne

diseases such as malaria.20 In urban areas, overcrowding and widespread malnutrition

make populations even more vulnerable to the spread of infectious disease.

Reducing environmental risks also presents a valuable opportunity to improve

health outcomes for populations in developing countries. It has been estimated that 4.79

million children under the age of five years died in sub-Saharan Africa in 2004, an
17
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estimated annual child mortality of 39.1 per 1000 children.21 Among other things, the

Millennium Development Goals (MDGs) seek to reduce child mortality worldwide by

two-thirds. However, one study has estimated that 50% of the gap towards meeting this

child mortality goal in sub-Saharan Africa could be reached if the three nutritional and

environmental MDGs—improving child nutrition, provision of adequate water and

sanitation, and reduction in the use of solid fuels—were achieved for all households with

children.22 Thus, reducing exposure to environmental risks is a potential strategy to make

vast strides in improving human health.

However, exposure to environmental risks is determined by a complex web of

interactions between technological, environmental, and behavioral factors. For example,

the environmental risk factor of indoor air pollution can be influenced, among other

things, by the fuel or stove types used by a household, the location of vendors for a given

fuel type, the amount of time that the stove is on, or the amount of time spent near the

stove.23 This can make causality, as well as the health effects of individual interventions,

difficult to establish.

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Water, Sanitation and Hygiene (WSH)

Adequate water, sanitation and hygiene (WSH) have been identified as the key

environmental risk factors for diarrheal diseases, which contribute heavily to the burden

of disease in developing countries. Diarrheal diseases are estimated to cause 3.3 million

deaths globally each year and are responsible for more than one-quarter of childhood

mortality every year.24 The majority of diarrheal disease is caused by infectious

pathogens such as viruses, bacteria, protozoa and parasitic worms that are transmitted via

fecal matter excreted by the human host. Thus, poor WSH contributes to the spread of

diarrheal disease by facilitating transmission between human hosts. In addition to

diarrhea, poor WSH can increase the risk of other diseases such as schistosomiasis,

trachoma, ascariasis, trichuriasis, and hookworm, and also contributes to the risk of

diseases such as typhoid, malaria, dengue, yellow fever, hepatitis A and hepatitis E.25

It should be noted that while a large portion of infectious diarrheal disease is

water-borne (transmitted via drinking water containing pathogens), water-washed disease

also plays a substantial role (transmitted via hands or food due to lack of water and

adequate sanitation).26 Thus, WSH can be defined broadly to encompass many factors

including ingestion of contaminated water, lack of water, poor hygiene practices in the

home and neighborhood, contact with unsafe water in agriculture and inadequate

management of water resources and water systems (such as drainage gutters).27 Chapter

7 of this thesis focuses on water-borne transmission, considering the effects of

environmental risk factors on the level of fecal-oral contamination in household drinking

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water. Chapters 5 and 6 focus on neighborhood gutter systems and neighborhood solid

waste management, which can influence the risk of water-washed disease.

Risk can be influenced by factors at the household level or in the surrounding area

—household vicinity—in which case they are generally behavioral. Alternately, WSH

can be influenced at the broader neighborhood level by infrastructure and technology. At

the infrastructural level, WSH can be affected by the availability and type of water

sources, the quantity of water available, and the sewage and waste disposal

infrastructures within the neighborhood. WSH can also be influenced by technological

and behavioral choices at the household level, such as the household source of water and

storage method, type of latrine, and the household or community techniques for waste

disposal. Additional technological factors include point of use decontamination for water

(such as boiling or filtration), and food and hand washing techniques (such as soap).

Finally, WSH can be affected by behavioral factors such as hygiene, methods of water

transportation and storage, and waste disposal methods.28 This hierarchy is summarized

below.

Household Vicinity Household

Neighborhood Effects Effects
Effects -population -type of water Drinking
-distribution density/crowding source
-solid/liquid waste
Water
infrastructure -storage
-solid/liquid waste disposal methods methods
Outcome
infrastructure -toilet facilities -purification
-water sources/distance methods

Outline of the Thesis

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 The interaction between urbanization, poverty and the environment requires

further inspection. I designed this study to assess some of the differences in the

distribution of neighborhood and household level environmental risk between

neighborhoods of varied socioeconomic status. In particular, this study considers water,

hygiene and sanitation, while omitting the equally important problems of indoor and

outdoor air pollution.

The second chapter of this thesis describes some of the specifics of the Accra

metropolis, as well as the four neighborhoods chosen for the study. In the third chapter, I

describe the methods used in data collection for this thesis. The fourth chapter uses data

available on these areas from the Accra census as well as a much smaller but more recent

set of household surveys done in the four neighborhoods to explore demographic trends

in the four neighborhoods as well as drinking water sources, methods of solid and liquid

waste disposal, and sanitation facilities. The fifth, sixth, and seventh chapters present the

results of original data I collected in Accra during the summer of 2008. In the fifth

chapter, I focus on the spatial distribution of littered waste in the four neighborhoods.

The sixth chapter analyzes the distributions of open drainage gutters that line the streets

of Accra, intended for storm water runoff, but generally used for liquid waste disposal by

many city residents. The seventh chapter considers household drinking water quality,

hygiene and sanitation, including an analysis of samples that were tested for E. coli and

other coliforms. The final chapter will conclude and include suggestions for policy in the

future.

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Chapter 2: An Introduction to Accra and the Study Areas

Choice of Accra as a Study Location

Accra is, in many ways, an ideal location for the study of urbanization in the

developing world and its associated health risks. Similarities in urban structure and

development, poverty, and past colonial history make Accra fairly representative of other

cities in coastal West Africa.29 Accra is characterized by a sprawling urban area and

uneven infrastructure due to the incomplete implementation of development plans post-

independence, which has led to unplanned growth and the proliferation of slum

communities. UN Habitat estimates that 66% of the city’s population lives in urban

slums.30

While the physical and demographic characteristics of Accra facilitate

generalization to other parts of sub-Saharan Africa, the city is unique due to the quantity

of data available on the environment, poverty, and health. Thus, Accra is somewhat of an

exception to the rural bias in research on environmental risk discussed in the previous

chapter. Several important studies and surveys should be mentioned here. The 2000

National Population and Housing Census collected information on water and sanitation in

the household environment at a high level of spatial detail. The Stockholm Environment

Institute (SEI) conducted a study of household environments in three developing world

cities (Accra, Jakarta, and Sao Paulo) in 1991, including citywide surveys of 1000

households in Accra. Professor Jacob Songsore of the University of Ghana has published

multiple works on the environmental health situation in Accra, including a study of

29
30

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important environmental health indicators in all residential areas. These studies assessed

water, sanitation, pests, sullage and drainage, food contamination, hygiene, solid waste,

housing problems, and indoor and outdoor air pollution at the neighborhood level.31

Demographic and Environmental Characteristics

In the 2000 census, the Accra Metropolitan Area had a total population of

1,658,937. Based on an annual growth rate of 4.4% in the Greater Accra Region, the

expected population of the city in 2008 was approximately 2.3 million.32 This rapid

growth, which continues to the present day, is largely due to rural-urban migration, as the

total fertility rate in the metropolitan area, at 2.2 children per woman per lifetime, is the

lowest in the country.33 Indeed, the growth rate for this region far outpaces the national

average of 2.7% per year.34 Other estimates indicate that the floating population

[homeless and those without permanent residences] in the city could be as high as half a

million daily, with nearly half this population remaining in the city overnight.35 Forty-

eight percent of Accra’s population is below the poverty line and the city experiences

acute problems of sanitation, waste management and pollution coupled with this rapid

urban expansion.36 Data from the 2000 census indicated that 73.9% of households in

Accra did not have a toilet with a sewer connection, 56.3% had no piped water in the

house, and 47.8% had more than three people per room.37

31

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35

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 The five most reported diseases at outpatient facilities in Accra indicate the

importance of environmental factors in determining health outcomes; according to

Songsore et. al. the health problems in the city are primarily “preventable and

communicable diseases, diseases attributable to poor environmental sanitation, ignorance,

and poverty.”38 Malaria is the most common, followed by upper respiratory tract

infections, diarrheal diseases, skin diseases, accidents, and intestinal worms.

Within the city, large disparities exist in the health and environmental conditions

of subpopulations of different socioeconomic status. Five-fold differences in mortality

rates have been found between poor and wealthy neighborhoods.39 Household living

conditions are clearly differentiated between socioeconomic classes as well. A 1993

study by Songsore et. al. of 1000 households in Accra found that while only 10% of

households in the wealthiest quintile had to fetch water from outside their household

compound, nearly 80% of households in the poorest quintile did. While 71.7% of

households in the poorest quintile used pit latrines, 77.3% of households in the wealthiest

quintile had access to a flush toilet. Similarly, 68.8% of the poorest households shared a

toilet facility with more than ten other households, while 64.6% of the wealthiest

households had a private toilet.40

In particular, my research in Accra focused on four neighborhoods within Accra

of varying socioeconomic status. Two of these communities, Jamestown and Nima, can

be classified as urban slums. Asylum Down is a mixed-income neighborhood in the heart

of Accra, while East Legon is an area of relative affluence on the outskirts of the city.

38

39
40

2
Jamestown and Usshertown

The study area in Jamestown and Usshertown is densely crowded with a

population of 13,617 in Jamestown and 22,140 in Usshertown, according to the 2000

census. The study area includes both neighborhoods, but will henceforth be referred to

as Jamestown only. Jamestown is located along the coastline in the old colonial area of

Accra, and many of the older colonial buildings have been preserved and now house

multiple households. The primary ethnicity in this study area is Ga, and the population is

for the most part poor and uneducated. The study area includes the main road that passes

from central Accra along the coast to the Korle-Bu area, as well as a large area along the

beach with a sizable squatting settlement and large boat yard. It is bordered on the south

by the ocean and on the west by the highly-polluted Korle Lagoon.

Nima

In Nima, the population according to the 2000 census was 69,044. Located in the

central part of the city, Nima has a large Muslim population of Hausa origins, and is

considered to be one of the most deprived slums in Accra. It is adjacent to the

neighboring slum areas of Mamobi (population 49,812) and New Town (population

45,130). The study area enjoys a mix of residential and commercial use, with a large

market place located to the east of the main road. The Al-Hamdu Gutter, one of the main

open drainage gutters for the city, passes along the western border of the study area, and

the land has a substantial gradient going down towards this drain.

Asylum Down

2
 Asylum Down, with a population of 9,363 according to the census, is located in

the central part of the city and has a mix of residential and commercial areas, as well as a

mix of ethnicities and socioeconomic statuses. Poorer populations live in areas along the

main gutter that are prone to severe flooding during periods of heavy rain. The study area

also includes the Central Ring Road, one of the larger highways in the city, which is

bordered by a number of multi-story office buildings, hotels and other businesses.

East Legon

The population of East Legon was 7,681 at the time of the 2000 census; however,

the area has grown substantially since then. East Legon is located near the University of

Ghana on the periphery of the city. The area is relatively affluent and largely residential,

with many single-family homes on fenced-off properties. However, it is also recently

developed, and many areas lack some of the infrastructure found in other parts of the city,

such as paved roads and sewage systems. Also, the community includes pockets of

poorer residents, many squatting on vacant lots or in unfinished houses.

2
 Figure 2-1: Beach area (top) and residential street (bottom) in Jamestown.

2
 Figure 2-2: Rooftop view (top) and public waste collection site (bottom) in Nima.

2
 Figure 2-3: Residential area (top) and the Ring Road (bottom) in Asylum Down.

2
Figure 2-4: Developing area along the walking path (top) and gated houses in East Legon (bottom).

2
Chapter 3: Datasets and Methods of Data Collection

This chapter summarizes briefly the data used for analysis in this thesis, including

three original datasets that I collected in Accra during the summer of 2008 with the help

of a small team of research assistants.

Household Data

Ghana National Census (Ghana Statistical Services, 2000)

The 2000 Population and Housing Census was the fourth population census

undertaken in Ghana since independence and the most recent since 1984. The census was

enumerated on a household-by-household basis in March and April, 2000, with special

arrangements made for the floating population. The census was enumerated at the level

of the individual, but data were also collected for households. A household is considered

by the GSS to be “a person or group of persons who live together, in the same house or

compound, share the same housekeeping arrangements and are catered for as one unit.”41

The smallest statistical unit of the census is the enumeration area (EA), a

geographic area with clear physical boundaries that is enumerated by one census official.

There were 26,710 enumeration areas in the country, and 1,724 in the Greater Accra

Metropolitan Area (GAMA). The average population of each EA was 750, making the

EA similar in size to U.S. census blocks.42 Another important geographic unit in the

census is the locality, which is defined by the Ghana Statistical Services as a “nucleated

and physically distinct population cluster in which the inhabitants live in neighboring
41
42

2
living quarters and which has a name or locally recognized status.”43 In the GAMA,

localities are what might be referred to more colloquially as neighborhoods or

communities.

I have access to a 10% random sample of the census for the entire Greater Accra

Metropolitan Area in 2000, courtesy of Professor Allan Hill. This sample includes

information on liquid and solid waste disposal methods, toilet and bathing facilities, and

water sources for a random sample of 10% of households in the GAMA. A rough

estimate of population density can also be obtained by dividing the total population in

each EA by its area.

Accra Household Air Pollution Surveys (Ezzati et. al., 2007)

The primary focus of these surveys was to gather information related to household

use of solid fuels, household exposure to indoor air pollution, and respiratory disease.

However, some survey questions were directed more generally toward the household

environment, and pertain to water, hygiene and sanitation. As in the 2000 census,

respondents were asked about their water sources, toilet facilities, and methods of

disposal for solid and liquid waste. Although the sampled households represent a much

smaller dataset than is available through the census, with only 18-20 households per

neighborhood, the data are more recent, and may provide clues as to how the household

environment is changing in these areas of Accra. This survey was approved by the

Institutional Review Board (IRB) of the Harvard School of Public Health and the results

of the survey were provided to me courtesy of Professor Majid Ezzati.

43

2
Household Water Quality and Water Storage (Original Dataset, 2008)

I collected samples of water in a total of 59 households in the four neighborhoods

described. These households represent a substantial majority of households surveyed in

the air pollution studies described above. Two 12 mL samples were taken in each

household; one is denoted the consumption sample, and was taken one at the point of

consumption (as it would be consumed by a household member) and was taken from the

source (the tap or location from which the household fetches water). If the household’s

source was commercial (i.e. bottled or sachet water) only one sample was taken. The

household head was asked to identify his or her household’s primary source of drinking

water. Drinking water was defined as water that is used for direct consumption, and not

used for bathing or cooking. Specifically, the household head was asked to provide a

sample of water as members of the household would consume it.

The household’s primary source of drinking water was categorized as one of the

following:

1. Indoor pipe – Water flows into the household building by pipe.

2. Pipe in yard – Water flows from a pipe within the household
compound/yard.
3. Public tap – Water from a source outside the household compound.
4. Tanker Truck – Water obtained from a tanker truck.
5. Bagged – Water bought in unsealed plastic bags from a vendor.
6. Sachet – Water bought in sealed plastic sachets from a vendor.
7. Bottled – Water bought in sealed plastic bottles from a vendor
8. Rainwater – Water collected during precipitation
9. Other

Additionally, the source was classified as being private (only for the household or

surrounding compound) or as shared (used by multiple compounds or sold to the public).

The household head was also asked to identify any alternative sources of drinking water

used by the household.

2
 I then observed the following characteristics of the source and storage of the

consumption sample:

1. Storage Container Type: Described as plastic bin/barrel, metal

bin/barrel, polytank, plastic bottle, or other.
2. Storage Location: Described as indoor (inside building but not
refrigerated), outdoor (outside household building or in compound),
refrigerator, or other.
3. Storage Time: Number of days stored, if known.
4. Wash: Whether the subject washes or rinses hands prior to retrieving
water.
5. Filter: Whether the water is filtered prior to consumption.
6. Boil: Whether the water is boiled prior to consumption.
7. Brand: For bottled/sachet water only, the company providing the
water.

5mL of each sample was tested in field conditions for E. coli and total coliforms,

indicators of fecal contamination, using the Coliscan® Easygel® system.44 Results are

presented in colony-forming units per 5mL (cfus/5mL). These data are right-censored, as

E. coli and total coliform counts greater than 200 cfus/5mL were denoted too numerous

to count (TNTC). A more detailed description of the testing methods and protocol can be

found in Appendix A.

44
Micrology Laboratories, LLC (Goshen, IN).

2
Figure 3-5: Water collected from a public tap in Jamestown and stored outside a house in a plastic
barrel.

Figure 3-6: Metal barrels used to store water in the courtyard of a household compound in Nima.

2
Figure 3-7: An example of a highly polluted consumption sample collected from a household in
Jamestown. E. coli colonies appear blue or purple, while other coliforms form pink colonies.

Figure 3-8: Testing for E. coli and total coliforms using Coliscan® Easygel® system—incubation at
room temperature.

2
Neighborhood Data

Neighborhood Solid Waste Management (Original Dataset, 2008)

Within each neighborhood, I took measurements along a predetermined 6-7 km

“walking path” used in previous studies for urban air pollution research. Each path

traverses the neighborhood in a crisscrossed pattern and covers a representative variety of

road capacities and surfaces, which have been classified and recorded in previous studies

(Figure 3-5). Along the walking paths, I took a survey of the level of litter and trash,

stopping approximately every 80 meters. This amounted to 100-120 points per

neighborhood over the course of two days’ measurement in each neighborhood.

Alternating points were sampled on each day. The following parameters were measured

within a radius of 5 meters, not including any trash or waste that was within a gutter, or

within a household/individual waste container (if the number of items in a given count

exceeded 100, the level of waste was estimated from a smaller area count):

1. Location: Spatial coordinates recorded using GPS, averaged over 30

seconds.
2. Time: Recorded GPS time.
3. Plastic: A count of all plastic waste. One unit is defined as approximately
the size of a plastic water sachet.
4. Food: A count of all food waste (e.g. corn cobs, orange peels, coconut
husks, pineapple husks, etc). One unit is defined as approximately the size
of a fist.
5. Metal: A count of all metal waste. One unit is defined as approximately the
size of a (flattened) can.
6. Plant/wood: A count of all plant and wood waste. One unit is defined as
the size of a palm frond/large branch.
7. Paper: Count all paper, cardboard, and newspaper waste. One unit is
defined as the size of a sheet of paper.
8. Other: Notes for any other significant trash or waste, or waste that is in
containers.

2
Figure 3-9: Map of study areas and walking paths showing road type and surface, as well their
general location in the city (courtesy of Ari Friedman).

2
Although the data were not analyzed in this study, I also located and marked all public

toilets, bathing facilities, and public rubbish dumpsites or collection points within each

neighborhood area.

Classification of Open Gutters (Original Dataset, 2008)

I also classified and recorded the location of all the gutters along the walking

paths. Each segment of gutter was classified according to its structure, size, and the

amount of water and trash in it. Each section of the walking path for each neighborhood

was described according to the following parameters, using a waypoint to mark its start:

1. ID: Recorded both with GPS waypoint and other attributes (below)
2. Location: Recorded using GPS waypoint
3. Altitude: Recorded using GPS waypoint
4. Time: Recorded GPS time
5. Approximate Location: A brief description of the waypoint location.
6. Type: Each segment of the walking path was classified as having no gutter
or as having a gutter
7. Side of road (L or R): When gutters are on both sides of the roadway used,
the right side was classified. If there was no gutter on the right side the left
side was classified.
8. Opposite: The opposite side of the path was classified as having no gutter
or as having a gutter.

Only gutters running parallel to the path were classified, unless the width of the

gutter crossed was greater than 1 meter. Isolated gutters less than 3 meters long were not

recorded. All gutters were also classified according to the following variables:

1. Cover: Open gutter or partially-covered gutter.

2. Construction: Cement, partially broken, or dirt (unstructured).
3. Width: Width of gutter in meters.
4. Depth: Depth of gutter in meters.
5. Water width: Width of water flow in meters (approximate).
6. Water depth: Water flow depth in meters (approximate).
7. Water flow: Speed of water flow was described as dry, stagnant, slow
flow, or fast flow.

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 8. Trash: The quantity of solid waste in the gutter was classified as none, low
(<10 % estimated coverage), medium (<40 % estimated coverage), high (<
70 % coverage), or clogged (>70 % coverage)
9. Turbidity: Transparent or opaque.
10. Color

Figure 3-10: Partially covered cement gutter in East Legon with no trash and slow flowing water
(left) and clogged open gutter in Nima with stagnant water flow (right).

Other Research

I also visited important agencies within Accra to learn about sanitation and water

issues from a more qualitative perspective. I visited the National Water Research

Institute, as well as the Ghana Water Company (GWCL), which handles the distribution

of water throughout the city. I also met with an official at the Ministry of Local

Government (Sanitation Division). I attended meetings of some local organizations such

as the Federation of Youth Clubs (FYC) in Nima, which has been actively campaigning

for the construction and improvement of the major gutter that runs through the

neighborhood. In addition, I took every opportunity to discuss my research topic with

local field assistants in the neighborhoods.

2
Chapter 4: Water, Hygiene and Sanitation in the Greater
Accra Metropolitan Area Census and Other Household
Surveys

This chapter uses household-level data from the 2000 National Census and from

household surveys conducted in 2007 to examine disparities in environmental conditions

in the Accra Metropolitan Area. I first consider indicators of household and

neighborhood crowding in the four neighborhoods, before turning to household indicators

of environmental risk. Importantly, I look at differences in household water sources,

methods of solid and liquid waste disposal, and toilet facilities.

Population Density and Persons per Bedroom

Population density is one potential demographic variable that could explain

neighborhood differences in environmental risks. Areas with high population density

may generate higher levels of littered waste, or may have more acute problems of sullage

and drainage. Crowding can also directly impact the spread of communicable disease by

increasing the probability of exposure to infectious pathogens.

The map of population density for the Greater Accra Metropolitan Area (Figure

4-1) highlights that the majority of the urban population is concentrated in urban slums

like Nima and Jamestown. I compared relative population densities in each

neighborhood using the mean population density of enumeration areas in that locality as

found in the 2000 census; Table 4-1 below summarizes these results. In particular, the

EA-level population densities in Nima and Jamestown are more than five times greater

than those of Asylum Down, and are almost fifteen times greater than the densities in

2
East Legon. While population densities in Jamestown and Nima are nearly identical, the

variation between EAs in Nima is much greater than in Jamestown, indicating that

Nima’s population is spread more heterogeneously throughout the neighborhood.

Neighborhood Number of EAs Population per hectare

Jamestown 73 671.7 (395.8)
Nima 63 671.4 (665.4)
Asylum Down 32 94.4 (80.6)
East Legon 12 45.5 (73.9)
Table 4-1: Mean population densities for EAs in each locality (standard deviations shown in
parentheses).

While population density better approximates neighborhood-level concentrations

of populations, the number of persons per bedroom is an indicator of crowding at the

household level. Differences in persons per bedroom (Figure 4-2) are less pronounced

across the Greater Accra Metropolitan Area than are differences in population density.

Similarly, the differences between the study neighborhoods are not as dramatic for this

measure (Table 4-2); while households in Nima and Jamestown, on average, have more

persons per bedroom than do households in Asylum Down or East Legon, the differences

are relatively small. Notably, while the population density in Asylum Down is twice that

of East Legon, households in Asylum Down are less crowded than those in East Legon.

This reflects the different patterns of land use in each community; while nearly all land in

Nima and Jamestown is residential and built on, portions of land in Asylum Down are

commercial, and much of East Legon is open or used for agriculture.

Neighborhood Persons per bedroom

Jamestown 3.25 (2.49)
Nima 3.88 (2.58)
Asylum Down 2.81 (2.13)
East Legon 3.10 (2.46)
Table 4-2: Mean number of persons per bedroom for households in each neighborhood for the 10%
household sample (standard deviations shown in parentheses).

2
Figure 4-11: Population density in the Greater Accra Metropolitan Area (boxes show the
approximate locations of the study areas).

Figure 4-12: Persons per bedroom for households in the Greater Accra Metropolitan Area,
aggregated by enumeration area.

Sources of Household Water

Accra experiences problems of acute water stress due to the rapid expansion of

the city with little complementary development in the piped water supply for developing

areas. Additionally, the piping distribution system in some parts of the city is more than

2
thirty years old and suffers from deteriorating quality.45 Almost without exception,

households that I visited in Accra described some inconsistency in their supply of water.

In wealthier areas, households generally have indoor piping and store water in large,

sealed “polytanks” for when there is water outage. In poorer areas, most households use

a communal source of water—either a public tap or a tap in the yard of the household

compound—and store water in open barrels inside or outside the home.

Songsore has shown that households in Accra relying on communal sources

outside the home have, on average, higher diarrheal prevalence for children under the age

of six than do households with indoor piping. Similarly, households that must store water

or have interrupted water supply have significantly increased risk (4.3 and 3.1

approximate relative risk, respectively) for diarrheal diseases in children under the age of

six.46

Both the 2000 census and the 2007 household surveys conducted by Harvard

researchers show clearly differentiated patterns of water sources for households across

neighborhoods. The results from the 2000 census show that the majority of households

in Nima (n = 1534) and Jamestown (n = 917) use pipes outside their home as their main

supply of water. Households in Asylum Down (n = 439), on the other hand, generally

had an inside pipe, with a smaller minority using outside pipes. In East Legon (n = 271),

the results were mixed, with relatively similar numbers of households using outdoor and

indoor pipes. Only a small fraction of the population in each neighborhood used other

sources of water, such as tanker trucks, wells, boreholes, and rivers.

45
46

2
Figure 4-13: Water sources by EA in the Greater Accra Metropolitan Area.47

47
Note: Drinking water sources are evaluated at the household level. The following options are listed:
outside pipe, indoor pipe, tanker supply, borehole, spring/rain water, river/stream, dugout, other. For clarity,
enumeration area boundaries are not shown. The bottom frame (alternative methods) includes households
that use a source that is not pipe-borne.

2
 The results of the 2007 household surveys were quite different; this can be

attributed to a number of factors. First, this survey represented a much smaller sample of

households in each neighborhood. Second, households were asked specifically about

sources of drinking water in this survey, which is often distinguished in source from

water for other purposes such as cooking, bathing, and cleaning. Also, households were

given a broader selection of response options on this survey that included commercial

sources of water such as water sachets and bottled water. Households were allowed to

list multiple water sources on the later survey, but only one on the census. Households

may also have different conceptions of the definitions of different water sources; a tap

that is in the yard of the family compound but is shared by several households in the

vicinity may be considered by the household to be an “indoor” pipe. Finally, and

importantly, sources of water could have changed significantly in the intervening years

between the census and the survey.

Figure 4-14: Water sources in the four neighborhoods using data from the 2000 census (left) and the
2007 household surveys (right).

2
 The 2007 survey gives insight into sources of drinking water in the four

neighborhoods in particular. In Nima, households with one water source (n = 14)

primarily listed a public tap as their water source (57%), followed by water piped into the

yard (21%), and lastly water piped into the dwelling (14%). Households with two

sources (n = 7), almost without exception, used a combination of water piped into the

yard and water piped into the dwelling.

In Jamestown, public taps (43%) and water piped into the yard (43%) were the

most common sources of drinking water for households with one primary source (n =

14), with a minority using water piped into the dwelling (14%). Households with two

sources (n = 7) most frequently used both sachet water and water from a piped source,

usually a public tap.

In Asylum Down, the sources used were much more varied. Of those households

using one water source (n = 11), there was a more even distribution of sources: sachet

water (36%), piped into dwelling (27%), public tap (18%), bottled water (9%) and piped

into yard (9%). For households with two sources (n = 9), all households used a

combination of sachet water and a piped source. For most multi-source households, this

second source was either piped into the yard (66%) or piped into the dwelling (22%).

East Legon displayed a very different profile of drinking water sources.

Households with only one source (n = 8) used either water piped into the dwelling (38%),

bottled water (25%), sachet water (25%), or water piped into the yard (13%).

Households with more than one source (n = 10) used, almost without exception, a

combination of sachet water and an alternative source. This alternative source was most

often water piped into the dwelling (50%) or bottled water (30%).

2
 Importantly, it appears that in some neighborhoods, particularly in Asylum Down

and Jamestown, households may supplement an existing piped source with water from

commercial sources, primarily sachet water. This phenomenon was not reflected in the

census data, both because the census did not specify water from commercial sources on

their survey, and because households could not list multiple water sources. Thus, it is

impossible to determine from these data if the relatively common use of commercial

sources is a recent development in Accra or to discern city-wide patterns in commercial

water usage.

Household Solid Waste Disposal

Household solid waste disposal methods in Accra were found to be both diverse

and spatially clustered. Households strategies include depositing waste at public

dumpsites (61.3 % of all households), having trash collected (20.4 %), burning trash (6.6

%), burying trash (3.0 %), and dumping trash elsewhere (5.6 %). Mapping these

strategies by EA highlights that solid waste disposal methods varied by geographic

location (see Figure 4-6). The more central and densely populated slum areas, including

Nima and Jamestown, generally relied on public containers to dispose of solid waste.

Areas in the central part of the municipality, including Asylum Down, were serviced

primarily by private waste collection. Areas on the periphery of the urban metropolis,

such as East Legon, regardless of socioeconomic status, tended to use alternative methods

such as burning or burying trash.

2
2
Figure 4-15: Household methods of solid waste disposal include (clockwise from top left) disposal at
public collection sites, private collection of solid waste, illegal dumping (for example, into open
drainage gutters) and burning of household trash.

The results of the 2007 surveys show similarly differentiated patterns of solid

waste disposal. The majority of households surveyed in Nima and Jamestown used

public dumpsites, while all households in Asylum Down reported that their waste was

collected. East Legon demonstrated a variety of waste disposal methods in both surveys,

with the majority of households using waste collection, but with significant minorities

using all four other methods of waste disposal.

2
Figure 4-16: Household methods of solid waste disposal by EA in the Greater Accra Metropolitan
Area.48

48
Note: Solid waste disposal methods are evaluated at the household level. The following options are
listed: public dumpsite, collected, burned by household, dumped elsewhere, buried by household, or other.
For clarity, enumeration area boundaries are not shown. The bottom frame (alternative methods) includes
households that bury or burn trash, or dump their trash elsewhere.

2
Figure 4-17: Methods of solid waste disposal in the four neighborhoods, according to the 2000 census
(left) and the 2007 household surveys (right).

Notably, the percentage of households serviced by waste collection appears to

have increased substantially in East Legon during the intervening years between the two

surveys, likely due to rapidly developing infrastructure in this relatively wealthy

neighborhood. Once again the survey shows that, particularly in East Legon, multiple

methods of waste disposal were used by some households; in particular, while waste

collection was used by many households, the same households also used alternative

methods such as burning or burying trash.

Household Liquid Waste Disposal and Toilet Facilities

Household methods of liquid waste that were assessed in the 2000 census in

Accra included disposal via sewage system (12.4% of households), waste thrown on

street (16.3%), waste thrown in gutter (51.9%), waste thrown in the household compound

(16.3%), and other (0.7%). Thus, a remarkably small number of houses were serviced by

2
a sewage system as of 2000, and the majority of households instead relied on open gutters

that run alongside most city streets. These gutter systems, intended to manage rainwater

runoff during the rainy season, feed into larger “drains” across the city that eventually

deposit their contents directly into the Atlantic Ocean.

The toilet facilities used by households also reflect this lack of sewage systems in

most of the city. Only 22.1% of houses reported using a flush toilet located in their

house, while 9.1% of households said they used a flush toilet located in another house.

Meanwhile, 32.2% of households relied on public toilets. The remaining households

used traditional pit toilets (6.1%), Kumasi Ventilated Improved Pits (11.5%), a

bucket/pan (12.4%) or had no facilities (4.0%).

A useful comparison by which to consider the effects of a city-wide sanitation

project is the case of Salvador, Brazil, a city similar in size to Accra. In 1997, an

intervention was planned for the city which aimed to increase the sewerage coverage

from 26% to 80% of households. The effects of the intervention were assessed using two

longitudinal studies of diarrheal morbidity in children under three years of age, one prior

to the intervention and one after its completion. The researchers found that diarrheal

prevalence was reduced by 21% (95% CI 18-25%), and that after adjustment for baseline

sewerage coverage and confounding variables, an overall reduction of 22% (19-26%) was

found. In areas where initial prevalence was highest, declines of more than 40% (39-

46%) in prevalence were estimated after adjustment.49

49

2
Figure 4-18: Liquid waste disposal methods by EA in the Greater Accra Metropolitan Area.50

50
Note: Liquid waste disposal methods are evaluated at the household level. The following options are
listed: sewerage system, dumped in gutter, dumped in compound, dumped in street, or other. For clarity,
enumeration area boundaries are not shown. The bottom frame (alternative methods) includes households
that dump liquid waste in the street or in their compound.

2
 Analysis of the census data indicates that construction of sewage systems in Accra

has been limited to wealthier areas of the central city such as Cantonments, Airport

Residential, and, to an extent, Asylum Down. Within the city, and particularly in poorer

areas, most households disposed of waste into open drainage gutters. Alternative

methods, such as dumping in the compound or street, were used in the peripheral areas of

the city which lack infrastructural developments such as the construction of gutters or a

sewage system.

Both the census data and the 2007 survey reflect the prominence of dumping in

gutters as a primary method of liquid waste disposal in Accra, particularly in poorer areas

such and Nima and Jamestown. The fact that none of the households in Asylum Down

sampled in the 2007 survey indicated that they used a sewer for liquid waste disposal is

likely due to the small sample size in this survey as well as the heterogeneous nature of

sewer coverage in Asylum Down. The EAs in Asylum Down where households were

sampled in the 2007 survey did not include EAs with high levels of sewer coverage,

although parts of the area did, as the census indicated, have relatively high numbers of

households connected to sewer systems. Similarly, the apparent increase in the number

of households with sewer systems in East Legon and decrease in households dumping in

their compound between the 2000 census and the 2007 survey could reflect either the

infrastructural development of this area in these years or the fact that these households

represent only a small sample from a few EAs within the locality.

2
Figure 4-19: Liquid waste disposal methods in the four neighborhoods, according to the 2000 census
(left) and the 2007 household surveys (right).

Toilet facilities in the 2000 census were also highly differentiated by

neighborhood (Figure 4-10); the vast majority of households in Nima and Jamestown

relied on public facilities and more households had access to flush facilities in Asylum

Down and East Legon. In these wealthier neighborhoods, the surveys conducted in 2007

show increases in the percentage of households with access to a flush toilet, particularly

in East Legon, although this may be due to limited sampling. Notably, it does not appear

that any improvements have been made in either Jamestown or Nima, where all but a

small portion of households continued to rely on public toilets or alternative facilities

such as traditional pit toilets, KVIPs, and bucket/pan systems.

2
Figure 4-20: Toilet facilities in the four neighborhoods, according to the 2000 census (left) and the
2007 household surveys (right).

2
Chapter 5: The Spatial Distribution of Littered Solid Waste

The lack of capacity for solid waste management is a common problem in

developing cities. Waste is generated in smaller quantities in the developing world than

in the developed world, and within developing cities poorer residents produce less

waste.51 Despite lower waste generation, there is often more littered waste in developing

cities, especially in poorer neighborhoods, because the infrastructure for waste removal is

limited.52 Poor households may have to resort to less effective alternatives, such as

burning or burying waste, or illegal dumping in public areas.

Littered waste exacerbates disease—providing breeding grounds for flies and

other pests, clogging drainage systems, and creating cesspools which then act as breeding

grounds for mosquitoes that spread malaria and dengue.53 This study examines some of

the spatial patterns of littered waste in Accra, using original data collected in July and

August of 2008, described in Chapter 3. In particular, spatial techniques and a Bayesian

hierarchical model are used to estimate effects at the enumeration area (EA) and

neighborhood level.

Inter-Neighborhood Variation in Littered Waste

Plastic waste was by far the most common form of waste found in this study,

followed by paper and food waste items. By observation, the most common form of

littered plastic waste was the plastic water sachet, a common commercial source of

drinking water throughout the city (Figure 5-1). The density of plastic waste was higher
51

52
53

2
in the slum areas of Nima and Jamestown, and higher in East Legon than in Asylum

Down. Littered food waste was most common in Nima, which has a large open market,

and was more common in both slum communities than in either East Legon or Asylum

Down. Similarly, paper waste was less common in the wealthier communities. Metal

waste and wood/plant waste were more evenly distributed between the four

neighborhoods (see Table 5-1).

Table 5-3: Mean level of different waste types by neighborhood (ranges shown in parentheses).

Because of the ubiquity of littered plastic waste, it is the primary form of waste

considered in the following analysis. Additionally, plastic waste has a lifetime of

millions of years, implying that it will remain in the environment perpetually unless

otherwise removed; while many other forms of littered waste, such as food and paper

products, also pose health risks to a community, these products will eventually

biodegrade. The use of plastic products on a large scale is also relatively new

phenomenon within the city of Accra, at least in part due to rising use of items such as

plastic water sachets and plastic bags.

2
Figure 5-21: "Sachet" water is a common commercial source of drinking water in Accra (left). The
plastic sachet then becomes a common source of littered waste (right).

The distribution of plastic waste in the neighborhoods was roughly lognormal.54

Thus, in order to do regression analysis, the variable was first log-transformed. Because

a value of zero is possible for plastic waste, the variable was transformed as follows:

This transformed variable was then regressed against a dummy variable for

neighborhood, yielding the results presented in Table 5-2. Because this is a log-linear

regression55 the coefficients can be roughly interpreted as percent change in comparison

to the reference category (Asylum Down). Thus, both slum areas of Nima and

Jamestown have, on average, 78% and 88% more littered plastic waste than Asylum

Down, and these differences are significant at the 1% level. East Legon, on the other

hand, has 28% more littered plastic waste on average, but this difference was not

significant at the 5% level.

54
A lognormal distribution refers to the probability distribution of a random variable that is the logarithm of
a normally distributed random variable.
55
Similarly, a log-linear regression is the regression of a log-transformed dependant variable on an
untransformed (linear) independent variable.

2
Table 5-4: Regression of log1plastic on neighborhood.

Intra-Neighborhood Variation in Littered Waste

There was also variance in the amount of plastic waste found at different points

within each neighborhood. In order to explore possible explanations for variations in

plastic waste within each neighborhood, the littered waste data was mapped using the

GIS software ArcMap.56 The data were then analyzed for spatial clustering, to see if any

notable patterns emerged. In particular, Moran’s I—a statistical measure of spatial

clustering, or autocorrelation—was calculated for three types of waste (plastic, food, and

paper) in each neighborhood. Values close to zero indicate that the data are most likely

random. Positive spatial autocorrelation values indicate that data are clustered in patterns

unlikely to be due to random chance; that is, if a particular collection point has high

levels of waste, points nearby are also likely to have high levels of waste, and visa-versa.

Negative spatial autocorrelation values indicate that neighboring data points are different

in patterns unlikely to be due to random chance, or that a point with high levels of waste

is likely to be surrounded by points with low levels of waste.

For plastic waste, there was significant clustering in Jamestown and Asylum

Down. Possible explanations for spatial clustering in Jamestown include high levels of

plastic waste found in the southernmost part of the neighborhood, which is along a beach
56

2
with an illegal dumpsite. In Asylum Down, very low levels of waste are found in the

commercial area along the Central Ring Road, where cleanup of littered waste occurs on

a daily basis. Conversely, high levels are found in the poorer central part of the area,

along the main drainage gutter. This could explain the spatial autocorrelation found in

Asylum Down. Finally, in Nima, spatial autocorrelation was detected for littered food

waste. From the map, it appears that most food waste was found either in the market area

along the main road or alongside the gutter that borders the western edge of the study

area. No neighborhoods demonstrated negative spatial autocorrelation for any waste

type. However, aside from the aforementioned exceptions, no waste types demonstrated

spatial autocorrelation in any of the other neighborhoods.

Plastic Food Paper

Jamestown 0.32*** 0.06 -0.04
Nima 0.02 0.14** 0.06
Asylum Down 0.26*** 0.06 0.05
East Legon 0.02 0.12 -0.06
Table 5-5: Moran's I values for each neighborhood for different types of littered waste. Data
demonstrating high levels of spatial autocorrelation (unlikely to be random) are marked by asterisks.

2
Figure 5-22: The spatial distribution of plastic waste in the four study areas. Only Asylum Down and
Jamestown show significant spatial autocorrelation.

2
Figure 5-23: The spatial distribution of food waste in the four study areas. Only Nima shows
significant spatial autocorrelation.

2
Figure 5-24: The spatial distribution of paper waste in the four study areas. No neighborhoods
showed significant spatial autocorrelation.

2
GIS Analysis

It is possible that both inter- and intra- neighborhood variation in plastic waste can

be associated with demographic or other characteristics of the surrounding area, such

road surface and capacity, methods used by households for solid waste disposal or

population density. The littered waste measurements were conducted along walking

paths constructed to cover each neighborhood spatially and also to traverse a variety of

road capacities (i.e. alley, secondary and primary roads) and road surfaces (paved or dirt).

While less likely to explain differences between neighborhoods, road capacity could

possibly explain within-neighborhood variations in levels of littered waste. Methods

used for household solid waste disposal, which vary both within and between

neighborhoods (see Chapter 4), represent another mechanism that could explain variation

in littered waste, as some methods may lead to more effective collection of waste from

the neighborhoods. Another possible explanation for the differences in littered waste

within and between neighborhoods is population density. The population density in the

slum areas of Nima and Jamestown is much higher than the density in East Legon, while

Asylum Down has a medium level of population density.

In order to analyze the spatial relationships between the littered waste data and

other demographic and environmental variables such as population density, road type,

and solid waste disposal methods, I created an overlay of relevant datasets in ArcMap.57

57
I accomplished this by joining a shapefile of all EAs in the Greater Accra Metropolitan Area (provided
courtesy of Allan Hill, Harvard School of Public Health) with a table of relevant census data, including
solid waste disposal and population density summarized for each EA. I then added a shapefile of the road
classifications along the walking path and the original trash dataset to the same data frame (provided
courtesy of Majid Ezzati, Harvard School of Public Health).

2
 I used a spatial join58 to associate each trash data collection point with the relevant

EA-level data. This allowed me to associate each point of littered waste data with the

population density and the proportion of the population using a public dumpsite for solid

waste disposal for the EA in which it was located. Additionally, I used a spatial join to

associate each littered waste data point with the road type and surface at that location.

The table created from these spatial joins contains information on geographic location,

quantities of littered waste recorded, road type and surface, population density, and solid

waste disposal methods. This table was exported for further analysis using the R

statistical computing program.59

As the littered waste data points were taken along roadsides, the data points are

often found at the intersection of multiple EAs with different population densities,

begging the question of which EA information is most appropriate to use. Thus, I created

a more “smoothed” measure of population density at the data collection point by

calculating an area-weighted average of the population density for EAs within a certain

distance of the measure point;60 this method should address these discontinuities. The

“smoothed” population densities were then joined with the littered waste dataset.

58
A spatial join creates a table in which fields from one layer's attribute table are appended to another
layer's attribute table based on the relative locations of the features in the two layers. In this case, the data
attributed to the EA in which the trash data collection point is located is appended, as well as the road
classification for the nearest segment of the walking path.
59

60
In order to accomplish this calculation, the census shape file was converted to a raster, with population
density as the variable. A 50-meter buffer zone was defined around each littered waste data point. In these
buffers, zonal statistics were computed to find the mean population density within the buffer (see Figure
5-5).

2
Figure 5-25: Map depicting the littered waste data collection points in Asylum Down, along with the
population density raster. The red circles represent buffer zones (50 meter radius) for which an
average population density was calculated.

Correlation with Demographic and Infrastructural Variables

In general, it appears that the proposed neighborhood characteristics do little to

explain variations in littered waste within neighborhoods. For road capacity and surface,

only the coefficient for Divided Multi-Lane roads was significant at the 5% level.

However, the only road with this classification was the Central Ring Road in Asylum

Down, which had demonstrably low quantities of trash, as explained above. Thus, the

quantity of trash does not appear to vary significantly by road type.

Table 5-6: Results for OLS regression of log1plastic on road capacity and surface.

2
 While the coefficient on population density is very small in this regression, it can

be roughly interpreted as a 23% increase in the amount of waste between the 25% and the

75% percentiles (roughly 1 person per hectare and 430 persons per hectare, respectively)

for the dataset. While the effect of population density is statistically significant,

substantial unexplained variation in plastic littered waste remains (R2 = 0.03). The

smoothed population density created little change in the results for this regression. The

coefficient can be roughly interpreted as a 32% increase in the amount of waste between

the 25% quartile (roughly 3 persons per hectare) and the 75% quartile (roughly 463

persons per hectare).

Table 5-7: OLS regressions of log1plastic on two measures of population density.

Results for the regression on the percent households using a public dumpsite as

their method of solid waste disposal showed that the amount of waste increases when a

higher percentage of the population uses public dumpsites for waste collection. The

coefficient can be roughly interpreted as a 57% increase in the amount of waste between

the 25% quartile (13% of the population using public dumpsite) and the 75% quartile

(92% using a public dumpsite). The R2 for this regression was also low (0.06). When

population density was included in this regression (results not shown), the coefficient for

public dump decreased slightly, but remained significant at the 5 % level, while the

2
coefficient on population density was not significant. This makes sense, as these

variables are highly collinear (r = 0.67, p < 2.2e-16).

Table 5-8: Results of the OLS regression of log1plastic on the percentage of the population using a
public dumpsite for solid waste collection.

Bayesian Hierarchical Regression

There was significant variance in the amount of plastic waste found at different

points within each neighborhood. However, the hypothesized explanatory variables

occur at different levels of analysis—road surface and capacity are unique to a specific

data collection point, while the collection points are clustered within different EAs. Each

EA, in turn, has a population density and percentage using public waste collection, which

could also explain the level of plastic waste. Finally, the data collection points are

clustered within four neighborhoods.

Thus, I chose to model the data using a hierarchical (multi-level) model. This

allows for gains in efficiency (because we are pooling across a larger dataset), but less

concern for bias if the variation between clusters (in this case EAs) is large. Bayesian

methods are ideal for this analysis, because they allow for the estimation of a relatively

large set of parameters with a relatively small dataset, without any computational

shortcuts or approximations. Thus, we can completely characterize the joint distribution

of all model parameters for the hierarchical model.

The model assumes that the dependent variable is distributed normal with linear

mean:

2
Thus, there are two independent categorical variables here, road surface and road

capacity, for a total of 10 parameters to be estimated. Here, βj is the EA-level effect. We

assume further that:

There are two additional parameters to be estimated at the EA level: the

population density and the percentage of households using public waste collection. I

assumed vague normal priors on the slopes and gamma priors on precisions. Parameters

in this model were estimated using the JAGS program in conjunction with the R

statistical program.61

Table 5-9: Summaries of posterior densities (mean and 95% confidence interval) for important
estimated parameters.

61
This program uses a Gibbs sampler approach to create Markov Chain Monte Carlo (MCMC) simulations
that approximate the posterior densities. The chains were run for 50,000 iterations and trace plots were
used to diagnose convergence (all chains converged).

2
 With the exception of public collection of waste, all estimated parameters have

confidence bounds that include zero. The mean of the posterior distribution for public

collection is approximately 0.50. Because this is again a log-linear regression, the

coefficients can be roughly interpreted as percent change. Thus, the coefficient can be

roughly interpreted as a 40 % increase in the amount of waste between the 25% quartile

(13% of the population using public dumpsite) and the 75% quartile (92% using a public

dumpsite). All of the coefficients at the lowest level of the hierarchy, which includes road

surface and capacity, have much smaller means and confidence intervals that contain

zero; thus, there are no predictive variables at this level.

A test statistic approach was used to determine if the model adequately

characterizes the differences between the four neighborhoods. This involves estimating

replicate datasets using the posteriors of the estimated parameters. If there are additional

differences at the neighborhood level that are not explained by the model estimated, we

would expect that the neighborhood means for the dataset would differ substantially from

the replicate datasets. Thus, the test statistics used were the mean of the independent

variable for each of the four neighborhoods. As can be seen below, the sample means do

not differ substantially from the distributions of the test statistics for the replicate

datasets. Thus, we can conclude that there is not a need for an additional level of

hierarchy (“neighborhood effect”) in the model.

2
Figure 5-26: Histograms of this test statistic for replicate datasets sampled from the model. Lines in
red show the test statistics for the actual dataset.

Summary

It appears that patterns of littered plastic waste are not easily explained at a high

level of spatial resolution. While significant differences existed between the four study

areas, with much higher levels of waste in the two slum areas, patterns within each

neighborhood were generally difficult to explain. However, a higher percentage of

households using public collection for solid waste management was predictive of higher

levels of littered plastic waste. This variable seems to adequately model differences

2
between the four neighborhoods, without the need for an additional “neighborhood

effect”.

Within neighborhoods, however, these demographic variables did not adequately

explain the spatial patterns of littered waste. Road capacity and surface were also unable

to explain within-neighborhood variation. An alternative explanation is that larger

neighborhood features such as market places, drainage gutters, and major roadways can

explain clustering and variation within neighborhoods, but this hypothesis remains to be

tested.

2
Chapter 6: Liquid Waste and Roadside Drainage Gutters

This chapter includes a spatial analysis of an original dataset that considers the

characteristics of roadside drainage gutters in Accra, used indiscriminately by many

residents for the disposal of liquid wastes and other refuse.

Spatial Methods and Data Analysis

Each unit of data in this survey represents the beginning of a segment of the path

and the associated information pertaining to the gutter characteristics along that segment.

The walking paths were recorded using a GPS with sub-meter accuracy; the data were

then processed and smoothed to remove error associated with poor satellite signal when

the path was measured. The gutter data, on the other hand, were collected using a GPS

with an error of up to a few meters; therefore, while the locations recorded fall quite close

to the path, there is not an exact spatial match between the gutter data and the pre-

recorded path. The goal of the data processing procedure was to associate each gutter

data point with the closest point along the path, and then to calculate the length of the

path segment between gutter data points.62 These path segments were then used to

create maps displaying the various gutter characteristics along the path (Figures 6-2, 6-4,

and 6-5) and calculate relevant statistics for each neighborhood. The measurement error

62
Because the walking paths have points of overlap and intersection, it was also important to ensure that
each point of data collection was associated with the correct segment of the path in the correct order. To
accomplish this, each walking path was divided into two to three “analytic segments”, designed so that
each segment did not overlap itself or have any crossings. The gutter data were divided into these analytic
segments as well, so that the closest point on the path by distance could be associated with the appropriate
point on the walking path. ArcMap was then used to spatially join the datasets by associating the closest
point along the path with the gutter data. Thus, the gutter data points were effectively “snapped” to the
closest location along the path.

2
in the spatial data for the gutter measurement points—as well as the process used to

associate this data with the pre-recorded path—should not have produced any significant

bias in the results of this analysis.

Statistics in this chapter, unless otherwise noted, are expressed as the total length

of gutter displaying a given characteristic, or set of characteristics, as a percentage of the

total walking path length with gutters. (For example, the statement that 62.3% of gutters

in Jamestown had stagnant water means that, of the approximately 4.1 km of walking

path in Jamestown that has gutters, about 2.6 km of those gutters had stagnant water.) It

is important to note that gutter sampling was neither random nor complete, as the walking

path represents only a small subset of all roads and alleys within each neighborhood.

However, the walking paths are representative of all areas within the neighborhood; each

path covers a variety of road types within the neighborhood and traverses the entire study

area. Although both Aslyum Down and Nima contain portions of large, city-wide

drainage gutters, the analysis presented was robust to the exclusion of these larger gutters

from the sample, indicating that these gutters did not have a large influence on the results

of this chapter (data not presented).

Prevalence of Littered Waste in Open Gutters

The amount of littered waste found in the drainage gutters was estimated as a

percent coverage of the gutter, and classified in five categories: none, low (less than 10%

estimated coverage), medium (10-40% coverage), high (40-70% coverage), and clogged

(greater than 70% coverage). Overall, most gutters along the paths had low (38.5%) or

2
medium (28.2%) trash coverage. Fewer gutters were clogged (12.9%) or demonstrated

high levels of waste (11.8%). Only a small portion of gutters had no trash (7.5%).

Stratified by neighborhood, there appears to be an association between the levels

of littered waste in open drainage gutters and the socioeconomic status of that

neighborhood. The data show that more gutters which are clogged or have high levels of

waste are found in the slum communities of Nima (42.6%) and Jamestown (36.3%). The

clogged gutters in Nima were concentrated along the main road through the marketplace,

which is heavily littered with trash and comprises a large portion of the walking path.

Overall, East Legon had the lowest levels of waste in open drainage gutters, with the

majority (65.5%) of gutters in this neighborhood having low levels of trash or no trash at

all. Asylum Down also had a majority of gutters with low or no trash (54.0%), but a

slightly higher proportion of gutters had medium levels of trash in this neighborhood.

The results are summarized in Figure 6-1.

Figure 6-27: Level of trash in open gutters summarized for the four neighborhoods.

2
Figure 6-28: Level of littered waste in gutters along the walking paths for the four study areas.

2
Water Quality and Flood Risk

Stagnant waters can act as a proxy measure for mosquito and other vector

breeding sites, which in turn increase the risk of diseases like malaria. It is not unusual to

find visible larvae in these stagnant gutters (see Figure 6-3). Thus, malaria is another risk

associated with water, sanitation and hygiene, although through pathways independent

from fecal-oral contamination.

Figure 6-29: Stagnant waters provide breeding grounds for mosquitoes and other pests (left).
Shallow gutter with high flood risk in Jamestown (right).

A large portion of gutters in all neighborhoods (43.0%) were characterized by

stagnant waters, with roughly equal portions having slow flow (19.4%), fast flow (17.4%)

and no water (20.1%). The proportion of gutters with stagnant waters differed across the

four neighborhoods, and was notably high in Jamestown (62.3%). Aslyum Down had the

lowest proportion of gutters with stagnant water flow (35.0%), and East Legon and Nima

had intermediate levels (39.6% and 42.6% respectively). One explanation for why Nima

had relatively few gutters with stagnant waters is due to the steep gradient on the western

2
side of the neighborhood; while gutters on the flat, eastern portion of the neighborhood

near the market place tended to have stagnant waters, the gutters on the steep hill near the

main drainage gutter all had relatively fast flow.

Turbidity of water is a second important characteristic; in this study, gutter water

was classified as either transparent or opaque. While not a direct indicator of a health

risk, turbidity provides some indication of the use of open gutters for functions other than

their intended purpose of rainwater drainage from road surfaces. Gutters with opaque

waters in Accra are most frequently filled with grey, greenish, or white waters. Thus the

opacity of water in gutters can often be inferred as a sign of households disposing of

sullied water used for washing and cleaning in the gutter system. Indeed, during

measurement I frequently saw women disposing of wash water directly into gutters, or

witnessed opaque waters flowing out of household pipes directly into the gutter. In this

study, the percentage of gutters with opaque waters was considerably higher in both

Jamestown and Nima (80.9% and 87.6%, respectively) than in the wealthier communities

of Asylum Down (56.7%) or East Legon (25.9%).

Another measure considered was what I have deemed the “flood risk” for a

particular gutter. This was measured by taking the depth of water in the gutter and

normalizing by the depth of the gutter itself. This measure was intended to approximate

the risk that water in the gutter will overflow the bounds of the constructed gutter.

Because many gutters contain fecal waste due to defecation, as well as other sewage and

waste products, flooding can spread this contamination in the neighborhood and lead to

poor neighborhood hygiene.

2
 Most gutters had very low flood risk according to this measurement; however,

some gutters, particularly those found in Jamestown, were shallow and less able to

capacitate their usual water flow. The “flood risk” for a neighborhood was measured by

taking the mean of flood risks for all gutters along the walking path, weighted by the

length of each gutter. According to this simple metric, the flood risk in Jamestown is

highest (0.146), making it more than twice the flood risk calculated in Asylum Down

(0.062) and three times that in East Legon (0.048). The flood risk calculated for Nima is

also high, and is nearly twice that found in East Legon (0.084).

Table 6-10: Summary of important characteristics of gutter water in the four neighborhoods.

These differences in flood risk are perhaps due to the shallow construction of

gutters in Jamestown and Nima in comparison to the gutters of Asylum Down and East

Legon. If all gutters with a width greater than one meter are excluded from calculations

(to exclude the very large drainage gutters in East Legon and Aslyum Down), it is clear

that gutters constructed in Nima and Jamestown are, on average, much smaller than those

found in Aslyum Down and East Legon. Average depths and widths are summarized in

Table 6-2. Additionally, it is possible that residents of Nima and Jamestown utilize the

drainage gutters more frequently for the disposal of household liquid wastes, resulting in

higher water levels, which would exacerbate the flood risk in these communities.

Table 6-11: Average width and depth of gutters in the four neighborhoods (in centimeters).

2
Figure 6-30: Classification of water flow in gutters along the walking paths for the four study areas.

2
Figure 6-31: Measure of flood risk for gutters along the walking paths for the four study areas.

2
Multiple Characteristics and Comparisons

The unit of analysis thus far has been the neighborhood; however, it is useful to

consider comparisons between the different characteristics described above. Correlations

between these characteristics may be suggestive of causal relationships which, if explored

further, could lead to helpful policy suggestions. For example, if the accumulation of

trash in gutters is associated with stagnant water flow, then the removal of trash might act

as a means of improving water flow in street side gutters. There could be causality in the

other direction as well—fast water flow may remove trash that would otherwise

accumulate.

Ideally, comparisons would be made by estimating these characteristics for many

neighborhoods, instead of just the four considered in this study, and then considering

relationships between these characteristics for this large sampling of neighborhoods.

However, with such a limited sampling, it makes more sense to pool all the gutter data,

and consider some relationships between variables for this pooled dataset.

One obvious comparison is to consider the relationship between the level of

littered waste and water flow in the gutter; as previously discussed, stagnant water could

be caused by high levels of solid waste that clog gutters and prevent water flow. Gutters

with no water flow were excluded from this portion of the analysis. For gutters with no

trash, the proportion of fast flowing gutters is slightly higher than the proportion with

slow or stagnant flow. For low levels of waste, on the other hand, differences in water

flow were small, with a slightly higher proportion of slow and stagnant gutters. Gutters

classified as having medium trash levels had a slightly higher portion of stagnant gutters.

Notably, however, clogged gutters and gutters with high levels of trash were much more

2
likely to have stagnant waters than another water type; the proportion of clogged gutters

with stagnant waters exceeded the proportion of clogged gutters with fast flow more than

ten-fold. Thus it appears that there is a correlation between higher levels of waste and

decreased water flow (stagnant and slow-flowing gutters).

Figure 6-32: Comparison of trash level to water flow for all measured gutters (pooled across
neighborhoods).

Higher levels of waste were associated with higher flood risk in gutters, measured

as the depth of water in the gutter divided by the total depth of the gutter. The flood risks

in gutters with high and clogged levels of waste (0.128 and 0.122, respectively) were

nearly three times flood risks for gutters with both no waste and low levels of waste

(0.045 and 0.037, respectively). Thus, there appears to be a correlation of higher trash

levels with increased flood risk. Also, increased flood risk was associated with stagnant

2
waters; the risk in gutters with stagnant waters was more than twice that of gutters with

fast flowing water.

Table 6-12: Flood risk of gutters with specified characteristics, namely, level of littered waste (left)
and water flow (right).

Summary

This analysis has demonstrated differences between the four neighborhoods in the

level of trash, the flow rate, the turbidity of water and the flood risk of drainage gutters.

In general, the poorer communities of Nima and Jamestown had a larger proportion of

gutters that were clogged or had high levels of waste than did their wealthier

counterparts. Jamestown had the highest proportion of gutters with stagnant waters and

the greatest flood risk in gutters of the four communities, while Nima had the highest

percentage of gutters with opaque waters, indicating the use of gutters for the disposal of

waste waters.

When the data are pooled together for the four communities, it is evident that

multiple characteristics are correlated; for example, gutters with higher levels of trash

also had higher flood risk and were more likely to have stagnant or slow-flowing waters.

Stagnant gutters also had, on average, higher flood risk than gutters with slow or fast

flow. While these correlations do not establish causality, they do suggest that improving

one characteristic of gutters in a neighborhood could influence other characteristics for

the better.

2
Chapter 7: Household Drinking Water—Source versus
Consumption

This chapter focuses on biological contamination of drinking water, that is, the

presence of organisms such as bacteria, protozoa, viruses and worms in water that is used

for direct human consumption. This biological contamination can be separated into two

categories. First, contamination can occur before the household has access to it—as

piped water travels from a treatment facility to the neighborhood or home, or when

commercial water is packaged and transported. Alternatively, further contamination or,

alternatively, improvements in water quality, can occur after water is obtained by the

household from the source, as water is transported and stored prior to consumption.

What follows is an analysis of drinking water from a very limited sample of

households in the four study neighborhoods. It is not possible to draw rigorous

comparisons between neighborhoods, as the choice of households within each

neighborhood was not sufficiently random. The small sample size also leads to

considerable uncertainty surrounding the results. However, the analysis does indicate

differences between neighborhoods in source type, methods of storage and hygiene

behaviors, and provides evidence of differences in the quality of water consumed.

Water Sources by Neighborhood

A total of 59 households were sampled and observed in this study, with 18

households located in Jamestown, 15 in Nima, 15 in Asylum Down, and 11 in East

Legon. Fewer samples were taken in East Legon because the residents of the households

2
were absent or away during the measurement period. The sampled households obtained

drinking water from a variety of sources, including bottled water, sachet water, and water

from private or public taps.

Overall, 16 households (27%) sampled used a commercial source of water. This

included households using either bottled or sachet water as a primary source of drinking

water. East Legon had the highest proportion of households using commercial sources

(45%), followed by Asylum Down (36%) and Nima (36%), with Jamestown having the

lowest use (17%). The most common form of commercial water available in Accra is the

plastic sachet, discussed briefly in Chapter 5. Sachet water is a cheap alternative to

bottled water that is sold by vendors throughout the city, usually costing only US$0.04-

0.05, but is considered by urban residents to be of varied quality. Some wealthier

residents told me that they did not trust the quality of sachet water because some

companies will fill sachets indiscriminately from piped sources without any tests for

quality. In addition to households using plastic water sachets as a primary source of

drinking water, two households, both in East Legon, used bottled water, another

commercial source.

On the other hand, a total of 43 households sampled described their primary

source of water as a piped source. These sources included taps inside the home, pipes in

the yard that are shared by a number of households within the compound, and public taps

used by many households in the neighborhood. Although these samples were not

adequately randomized to make representative comparisons between neighborhoods, the

sampled households do make up a rough estimate of the types of piped sources used

within each neighborhood. Notably, the majority of residents in Jamestown and Nima

2
use public standpipes as their primary water source, while households in Asylum Down

were more likely to use water that was piped into the yard or compound. Most

households with piped water in East Legon had an indoor tap.

Neighborhood Total households Pipe indoors Pipe in yard Public standpipe

with piped sources
East Legon 6 3 (50%) 2 (33%) 1 (17%)
Aslyum Down 11 4 (36%) 6 (55%) 1 (9%)
Nima 11 0 (0%) 4 (36%) 7 (64%)
Jamestown 15 1 (7%) 4 (27%) 10 (67%)
Table 7-13: Piped sources used by sampled households within each neighborhood.

Household Storage and Hygiene Practices by Neighborhood

In Accra, existing water shortages and lack of infrastructure make water storage a

necessity for most households. Shortages in water supply do not originate from a lack of

water resources or from drought—water demand for 2020 is estimated at only 12% of

total surface waters—but rather from deficits in coverage.63 When collecting samples for

this study, households were often visited multiple times in order to obtain a source

sample, as the pipes would only have flowing water two or three times per week. Storage

time for household samples ranged between 0-7 days, with an average storage time of 1.6

days for piped sources. While not every household visited was storing water at the time

when samples were taken, every household described some means of storing water when

pipes were not flowing.

Storage and hygiene practices differed noticeably between neighborhoods. I

observed both the type of storage container and location of the storage container in each

household where water from a piped source was stored. Types of containers observed

included sealed bottles, polytanks (large, sealed, storage tanks), plastic barrels and metal

63

2
barrels. In all four neighborhoods, plastic barrels were the most common storage

containers, although Nima had a high percentage of households using metal barrels as

well. Use of bottles and polytanks was more common in the wealthier neighborhoods of

Asylum Down and East Legon.

Neighborhood Total households Bottle Polytank Plastic Metal

with stored water barrel barrel
East Legon 6 33% 17% 50% 0%
Aslyum Down 10 20% 10% 70% 0%
Nima 8 0% 0% 57% 43%
Jamestown 14 0% 0% 86% 14%
Table 7-14: Of households that store drinking water prior to consumption, percentages using various
containers for water storage.

There was also evidence that households of different socioeconomic status stored

drinking water in different parts of the home or compound. Once again, in the wealthier

neighborhoods, more households refrigerated their stored drinking water (these

households often separated smaller quantities of water used for drinking from water used

for bathing and other purposes). In the poorer communities, none of the sampled

households stored water in a refrigerator. The proportion of households storing water

indoors (not refrigerated) versus outdoors does not appear to be as affected by changes in

socioeconomic status.

Neighborhood Total households Stored in Stored indoors Stored outdoors

with stored water refrigerator
East Legon 6 50% 17% 33%
Aslyum Down 10 30% 60% 10%
Nima 8 0% 50% 50%
Jamestown 14 0% 43% 57%
Table 7-15: Location of the storage container within the home in each neighborhood (as a percentage
of households that store drinking water prior to consumption).

Finally, household hygiene behaviors also differed by neighborhood. The

wealthier neighborhoods had a higher percentage of households that boiled or filtered

2
water prior to use, although these practices were generally uncommon in all four

neighborhoods. Washing hands prior to fetching water from the storage location was also

a practice utilized by a small number of households in the poorer neighborhoods,

particularly in households where water was stored in a barrel or bucket and retrieved with

a dipping cup. However, only a very small minority of households utilized any of these

methods to prevent or reduce contamination of drinking water.

Neighborhood Total households with Boil water Filter water Hands

piped sources prior to use prior to use washed
East Legon 6 33% 17% 0
Aslyum Down 11 18% 0% 9%
Nima 11 0% 0% 18%
Jamestown 15 0% 0% 13%
Table 7-16: Percentage of households demonstrating particular hygiene behaviors in the household
prior to consumption from piped sources.

Total Coliforms and E. coli as Indicators of Biological Contamination

Total coliforms and E. coli are frequently used as indicators to compare biological

contamination of water samples. Coliforms are bacteria found in soils, surface waters,

and, importantly, in the guts and feces of endothermic species, including humans. While

coliforms are generally harmless, they are an indicator of the presence of enteric

pathogens in water. As disease-causing pathogens are difficult to culture in vitro, total

coliforms can be used to more easily measure the potential risk for contracting water-

borne disease.64 Coliforms are also generally more resistant to disinfectants and other

water treatments such as boiling, and thus the absence of coliforms from water indicates

that that water is safe for consumption.65

64
65

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 Total coliform count measures all coliform bacteria present in the sample,

including bacteria of the genera Citrobacter, Enterobacter, Escherichia, and Klebsiella,

and is measured typically measured in colony-forming units per 100mL water

(cfus/100mL).66 The presence of total coliforms is considered to be an indicator of

potential bacterial contamination from soils, plants or fecal matter. Water that tests

positive for total coliforms alone is thus not necessarily contaminated specifically by

fecal sources; however, total coliforms are a standard test for water safety, as pathogens

from all of the above-mentioned sources are considered unsafe for consumption. In the

United States, standards for drinking water are based on total coliform counts, and

require a measure of zero total coliforms per 100 mL water in more than 95% of

samples.67

Fecal coliforms—coliforms that persist at higher temperatures, such as those

found in the human gut—and the subset Escherichia coli, are more specific to fecal

contamination. Thus, presence of E. coli in water can be used as a specific indicator of

contamination from contact with human or animal wastes. The WHO standard for safe

drinking water calls for no detection of E. coli in a 100mL sample.68 As noted above,

most coliforms are harmless if ingested by humans. The 0157:H7 strain of E. coli is a

notable exception and has been the subject of recent media coverage. Cases of 0157:H7

infection are usually due to the consumption of undercooked meat, and are rarely

attributed to contaminated drinking water.69 The different classes of coliform bacteria

used in water testing are summarized in Figure 7-1.

66

67
68
69

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Figure 7-33: Classes of coliform bacteria used as indication of biological contamination in water
(Source: Washington State Department of Health, 2007).70

In this study, both E. coli and total coliforms are used to compare the quality and

potential health risk of drinking water samples. E. coli is used specifically to compare

the likelihood of fecal contamination. It is important to note that the absolute quantities of

these indicators do not necessarily indicate absolute differences in health risks, but are

rather a general indicator of the presence and rough magnitude of biological

contamination. Also, as mentioned in Chapter 3, the testing equipment used does not

yield reliable results when coliforms in the sample are in excess of 200 cfus. Thus,

coliform concentrations greater than 200 cfus/5mL were considered too numerous to

count (TNTC) and have been approximated in this analysis. A complete table of sampled

households can be found in Appendix B.

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Contamination in Commercial Sources

In households using a commercial source, only one sample was taken, as

individuals typically drink water directly from the container used for sale, and thus the

source sample and the consumption sample are the same. Only two households used

bottled water as a primary source of drinking water, and both of these samples contained

no total coliforms or E. coli. While the precision on these tests is not enough to

determine if this water passes WHO drinking standards, it is possible to conclude that this

water is less contaminated than most other samples, and is unlikely to suffer from the

large problems of contamination that occur during storage within the home, as discussed

in the next section.

The level of contamination found in sachet water samples, while it varied

considerably, was low. Importantly, no samples of sachet water detected any E. coli

contamination; thus, there is no evidence of fecal contamination in these commercial

sources of drinking water. Total coliforms detected in the 5mL samples ranged from 0 to

154 cfus, with a mean level of 12.7 cfus/5mL. Out of the 14 samples of sachet water, 6

had no total coliforms detected, and all samples but two had less than 10 cfus/5mL.

There was only one sample, from a household in Jamestown, with relatively high levels

of total coliform contamination (154 cfus/5mL). Thus, bottled and sachet water, while

they may not pass WHO standards for drinking water, are sources with relatively little

environmental or fecal contamination at the point of consumption.

Contamination in Piped Water Sources

Previous studies in Accra have focused on the quality of piped water at the source,

considering only contamination that occurs in pipes between the water treatment facility

2
and community taps due to leaks or the presence of biofilms within the piping

infrastructure. An independent assessment of microbial contamination in taps across the

city conducted by the Public Utilities Regulatory Commission in 2006 indicated that

quality varies substantially, with total coliform counts ranging between 0 and 220

cfus/100mL, and fecal coliform counts ranging from 0 to 96 cfus/100mL.71 On the

whole, fecal contamination, while in excess of the WHO standards for drinking water,

was relatively low in comparison to the levels of contamination found in my study both at

the source and the point of consumption.

The levels of contamination found in piped source samples in my study were also

relatively low (see Table 7-5). Of these samples, 33 source samples detected no E. coli

contamination, 8 samples had a measured contamination of 1 cfu/5mL, and 2 samples

had contamination greater than 1 cfu/5mL. The mean number of E. coli detected for all

piped source samples was 1.88 cfus/5mL. It should be noted, however, that these counts

were much higher than those found in the previous Public Utilities Regulatory

Commission studies (approximately equivalent to 0-1320 cfus/100mL).

In contrast, only 25 consumption samples from piped sources had no detected E.

coli contamination (four of these sampled households with no contamination boiled their

water prior to consumption). While 11 samples had between 1-10 cfus/5mL, 6

households had greater than 10 cfus/5mL, with one sample being denoted too numerous

to count (TNTC). The mean level of contamination for the piped consumption samples

was 6.21 cfus/5mL, but this estimate excluded the TNTC sample and is therefore an

underestimate.

Source samples Consumption samples

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Total 43 43
No contamination (0 cfus/5mL) 33 25
Low contamination (1 cfu/5mL) 8 3
Intermediate contamination (2-10 cfus/5mL) 1 8
High contamination (>10 cfus/5mL) 1 6
TNTC (>200 cfus/5mL) 0 1
Mean level of contamination (cfus/5mL) 1.88 6.21
Table 7-17: Comparisons of E. coli contamination in piped samples, at the source and at the point of
consumption.

Environmental contamination in consumption samples, as measured by the total

coliform count, also greatly exceeded the contamination in found in source samples (see

Table 7-6). While the vast majority of source samples had no more than 10 cfus/5mL

(76.7%), the majority of consumption samples had counts exceeding 10 cfus/5mL

(74.4%), and a large portion of consumption samples had total coliforms exceeding 200

cfus/5mL (39.5%).

Source samples Consumption samples

Total 43 43
No contamination (0 cfus/5mL) 15 7
Low contamination (1 cfu/5mL) 7 1
Intermediate contamination (2-10 cfus/5mL) 11 4
High contamination (>10 cfus/5mL) 9 14
TNTC (>200 cfus/5mL) 1 17
Mean level of contamination (cfus/5mL) 7.50 42
Table 7-18: Comparisons of total coliforms in piped samples, at the source and at the point of
consumption.

The mean number of total coliforms in consumption samples was more than five

times greater than that found in the original source samples, but even this is a strict

underestimate of the difference in contamination. This mean does not include censored

samples denoted TNTC, and is therefore much lower than the true mean. If the total

coliform count of these TNTC samples is set to 200 cfus/5mL, which would be the

minimum possible number of coliforms present in the sample, the mean of total coliforms

2
in the consumption samples is 108.6 coliforms (nearly fifteen times greater than that

found in source samples). This is still a considerable underestimate, as many TNTC

samples have coliforms well in excess of 200 cfus/5mL.

Differences in Contamination by Source Type

Importantly, this evidence indicates that transportation, storage, and hygiene

practices that occur after water leaves the source pipe play an in important role in the

quality of the drinking water consumed by households in Accra. When water is obtained

outside the home at a public standpipe, that water must be transported back to the

household compound and stored prior to use; contamination can occur if water is carried

in unclean or unsealed containers. Once the water reaches the household, it must be

stored until it is used, and if not properly sealed, may be contaminated by the surrounding

environment. Existing pathogens may also proliferate during storage, increasing

contamination. Alternatively, households may employ some method, such as boiling or

filtering water, that improves the quality of water before consumption.

That the bacteriological quality of water differs between source and point-of-use

is not a new finding72; one study of 93 households in Lima, Peru indicated that

transportation and initial storage played the largest role in fecal contamination of water.

While all water sources used by the households tested negative for E. coli, more than

30% of households had positive tests for E. coli at the point of consumption in this

study.73

72
73

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 In my study, I use the difference between contamination in the consumption

sample and contamination in the source sample to determine any patterns in water quality

improvement (when source contamination is greater than consumption contamination)

and deterioration (when consumption contamination is greater than source

contamination) that can be attributed to household storage and hygiene practices. One

possible corollary with these differences in contamination is the source type. As

mentioned previously, transportation and storage prior to consumption play a large role in

determining the overall quality of water at the point of use. In particular, one hypothesis

is that the further the source is from the home, the greater the likelihood of contamination

prior to consumption.

2
 Overall, seven households showed improvements in E. coli contamination at the

point of consumption relative to the source, that is to say, E. coli in the consumption

sample were less than E. coli found in the source sample. On average, households with

pipes found in the yard actually showed an improvement in contamination of -2.38

cfus/5mL, and only 31.3% of samples showed any deterioration in water quality. Water

piped indoors, on average, showed some further fecal contamination occurred, with a

mean increase in E. coli counts of 3.88 cfus/5mL. However, only 25% of sampled

households in this category had any increases in contamination, and 75% of households

showed no change or improvements in quality. Thus, it appears that for both water that is

piped indoors and water that is piped into the yard, further fecal contamination during

storage and transport is less of a concern. Households that bought water from a public

standpipe, however, showed, on average, an increase of 7.5 cfus/5mL, with more than

half of samples showing increases in E. coli counts between source and consumption.

Once again, this is an underestimate due to one sample being TNTC; the mean increase is

likely in excess of 17.6 cfus/5mL if this is taken into account.

Pipe indoors Pipe in yard Public standpipe

Total samples 8 16 19
Large improvement (>4 cfus/5mL) 0 (0%) 1 (6.3%) 0 (0%)
Small improvement (1-4 cfus/5mL) 2 (25%) 3 (18.8%) 1 (5.3%)
No change (0 cfus/5mL) 4 (50%) 7 (43.8%) 7 (36.8%)
Small deterioration (1-4 cfus/5mL) 1 (12.5%) 4 (25%) 4 (21.1%)
Large deterioration (>4 cfus/5mL) 1 (12.5%) 1 (6.3%) 6 (31.6%)
TNTC deterioration 0 (0%) 0 (0%) 1 (5.3%)
Mean level of contamination (cfus/5mL) 3.88 -2.38 7.5 (17.6)
Table 7-19: Difference in E. coli contamination between consumption samples and source samples for
all households with piped water sources, by source type.

Only five samples showed any decrease in the number of total coliforms between

the source and the consumption sample. Most samples (72.1%) showed a large or TNTC

2
increase in total coliforms (see Table 7-8). The total coliform increase in this study is

consistent with the hypothesis that contamination is related to distance from the source.

The overwhelming majority of samples from public standpipes (89.5%) showed increases

in excess of 10 cfus/5mL for total coliforms between source and consumption, and more

than half showed increases that were TNTC (in excess of 200 cfus/5mL). These

differences are augmented when the TNTC samples are incorporated into the average. At

minimum, water from a source in the yard had approximately twice the contamination

found in water piped into the house, and water from a standpipe contained, on average,

more than three times the number of total coliforms found in indoor piped samples.

Pipe indoors Pipe in yard Public standpipe

Total samples 8 16 19
TNTC improvement 0 (0%) 1 (6.3%) 0 (0%)
Large improvement (>10 cfus/5mL) 1 (12.5%) 1 (6.3%) 0 (0%)
Small improvement (1-10 cfus/5mL) 1 (12.5%) 1 (6.3%) 0 (0%)
No change (0 cfus/5mL) 3 (37.5%) 3 (18.8%) 2 (10.5%)
Small deterioration (1-10 cfus/5mL) 0 (0%) 0 (0%) 0 (0%)
Large deterioration (>10 cfus/5mL) 2 (25%) 5 (31.3%) 6 (31.6%)
TNTC deterioration 1 (12.5%) 5 (31.3%) 11 (57.9%)
Mean level of contamination (cfus/5mL) 19.9 (42.4) 29.5 (68.4) 56.0 (139.4)
Table 7-20: Difference in total coliform contamination between consumption samples and source
samples for all households with piped water sources, by source type.

Differences in Contamination by Storage and Hygienic Practices

It is also interesting to consider differences in contamination that might be

attributable to the specific storage and hygiene practices of the household. One example

of such practices is the location of the household’s water storage. In 6 of the 38

households that stored water, drinking water was stored in a refrigerator. Only one of

these households demonstrated any increase in E. coli between the source and the

consumption sample, and even this change was small (2 cfus/5mL). Similarly, only one

2
sample had any increases in total coliform counts, although the change was large

(TNTC). Outdoor storage and indoor storage were less distinguishable in quality. While

both indoor and outdoor storage had roughly the same proportion of households that

demonstrated a deterioration in quality from source to consumption sample (52.9% and

56.7%, respectively), outdoor storage had a slightly higher mean difference in E. coli

counts.

Similarly, when considering total coliforms, households that refrigerated drinking

water had substantially lower deterioration of water quality from source to consumption

when compared with samples that were stored indoors or outdoors. Only one household

with refrigerated storage showed any increase in total coliforms, although this change

was large (TNTC). When this sample is taken into account (estimated at 200 cfus/5mL),

the mean level of contamination can be approximated at 29.6 cfus/5mL. Similar to E.

coli counts, the differences between indoor and outdoor storage were small, with an

approximate contamination of 128.3 cfus/5mL for indoor storage as compared to 124.1

cfus/5mL for outdoor storage. The vast majority of samples in both categories (88.2%

and 86.7%, respectively) had increases in total coliforms between source and

consumption that were in excess of 10 cfus/5mL.

Total Mean level E. coli Mean level total

Samples contamination coliform contamination
Refrigerator 6 -10.3 -4.5 (29.6)
Indoor storage (not refrigerated) 17 8.1 47.6 (128.3)
Outdoor storage (not refrigerated) 15 4.1 (17.2) 57.8 (124.1)
7-21: Mean differences in E. coli and total coliform contamination between consumption samples and
source samples for all households with piped water sources, by storage location. Numbers in
parentheses include TNTC samples by approximating TNTC counts at the minimum 200 cfus/5mL.

2
 Similarly, the contamination that occurs between source and consumption could

vary by the type of storage container. While the large majority of samples use plastic

barrels for water storage, six households, concentrated in Asylum Down and East Legon,

use sealed plastic storage tanks—known as polytanks—or plastic bottles to store water.

These sealed containers were associated with much lower levels of deterioration during

household storage; in fact, no households that used bottles or polytanks as a storage

container had increases in E. coli counts between the source and consumption sample.

On the other hand, households using metal barrels and plastic barrels had large increases

in E. coli counts, with 80% of all households using metal barrels experiencing

deterioration in quality, and 58% of households using plastic barrels having deterioration

in quality. The mean differences between consumption and source samples are shown in

Table 7-10.

The results for changes in total coliforms between source and consumption

samples also demonstrate that contamination varies by storage type. Once again, no

households that used plastic bottles for water storage had increases in total coliform

counts, and only one sample from a household that used a polytank had an increase in

contamination (12 cfus/5mL). Once again, households that used metal or plastic barrels

for storage had much larger increases in total coliform contamination, with all households

with metal barrels showing increases in excess of 10 cfus/5mL, and the majority of

households with storage in plastic barrels showing increases in total coliforms that were

TNTC.

Total Mean level E. coli Mean level total coliform

Samples contamination contamination
Plastic bottle 4 -16.5 -5.7
Polytank 2 -0.5 6.0

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Metal barrel 5 4.6 121.3 (156.0)
Plastic barrel 26 6.8 (14.3) 38.8 (135.7
7-22: Mean differences in E. coli and total coliform contamination between consumption samples and
source samples for all households with piped water sources, by storage container type. Numbers in
parentheses include TNTC samples by approximating TNTC counts at the minimum 200 cfus/5mL.

Finally, household hygiene practices could explain differences in contamination

between source and consumption; however, very few households sampled used these

methods. It is notable, however, that of households that boiled or filtered water prior to

use, none had any increase in E. coli or total coliform concentration between source and

consumption. On average, households that boiled water (n = 4) showed a mean decrease

in E. coli of -16.5 cfus/5mL, and a mean decrease in total coliforms of -54.0 cfus/5mL.

Thus, boiling water seems to be an effective means of reducing coliform contamination

prior to consumption. Hand washing had no notable effect on reducing E. coli or total

coliform contamination between the source and consumption.

Summary

When considering risk from waterborne infectious disease, it is important to

consider biological contamination that exists in the household water source. However,

the results of this study indicate that in Accra it is equally, if not more important, to also

consider the effects of transportation, storage and hygiene behavior that occur after water

is obtained from the source. In particular, different water sources were associated with

different levels of contamination. In this study, samples from commercial sources of

water such as water bottles and sachet water contained no E. coli and only low levels of

total coliforms. Households with piped water sources also had low contamination in the

initial source samples, but the samples that were taken at the time of consumption had

2
unexpectedly high levels of both E. coli and total coliform contamination. In particular,

consumption samples from households that obtained water from public taps had very

high levels of contamination. It is important to note that commercial samples and indoor

taps were most frequent in the wealthier communities, while public standpipes were used

primarily in the poorest communities.

Infrequent and intermittent water supply in the city has led to a variety of storage

behaviors; households in this study most frequently used plastic or metal barrels for

storing drinking water, although a small subset of households in East Legon and Asylum

Down used sealed water storage tanks (polytanks) or sealed bottles for storage. Both E.

coli and total coliform counts indicate that households that used these sealed containers

had, on average, much less change in contamination between the source and point of

consumption. Similarly, households that used refrigerated storage had low levels of

contamination prior to consumption. Lastly, while there is evidence that hygienic

measures such as boiling or filtration had an effect on the quality of water consumed,

hand washing did not have a noticeable effect. Importantly, the storage and hygiene

methods that were associated with lower levels of household contamination we found

most frequently, if not exclusively, in the wealthier communities. Thus, despite the

problems of sampling discussed earlier, there is evidence for the existence of substantial

differences in the quality of water consumed by households in different neighborhoods,

although differences in source contamination are small.

2
Chapter 8: Discussion, Conclusions, and Suggestions for
Future Policy

Previous studies have demonstrated that environmental risks have profound

impacts on human health, particularly in the developing world. The World Health

Organization estimates that 12.2% of all deaths in Ghana can be attributed to unsafe

water, sanitation and hygiene.74 Thus, improving access to adequate WSH can greatly

reduce the burden of common diseases such as diarrhea and malaria. The focus of

research in this field has generally demonstrated a “rural bias” and has been located

primarily in rural areas and at the household level. However, with rapid urbanization

occurring in the developing world, it is important to consider the particulars of these

environmental risks in urban communities and to account for neighborhood effects as

well. It is also important to consider the magnitude of discrepancies in environmental

risks among subpopulations in the urban community, and to work to rectify the disparities

in access to services.

While the ability to improve environmental conditions for the urban poor is

certainly subject to economic and political constraints, it is impossible to move forward

without concrete evidence on the intervention need. This thesis has shown that it is

possible to systematically quantify environmental risks that exist in urban communities of

the developing world. In particular, these risks can be researched and assessed in

resource-poor settings at relatively little cost and without the need for an on-site research

laboratory or sophisticated technology. This thesis also serves as a body of empirical

74

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evidence that can be used to promote policies to improve the situation in the urban slums

of Accra and other cities in sub-Saharan Africa.

Summary of Specific Findings

This thesis has considered several dimensions of environmental inequity in Accra

by focusing on four study areas of varying socioeconomic status. I have focused

primarily on the environmental risk factor of water, sanitation, and hygiene. In Chapter

4, I presented some important contrasts in household water supply, liquid and solid waste

management, and sanitation facilities, using data from the 2000 National Census and

household surveys conducted in 2007. This analysis showed that the slum communities

of Jamestown and Nima had markedly different profiles for these different household

attributes than did the wealthier communities of Asylum Down and East Legon.

In my consideration of solid waste management in Chapter 5, I focused on plastic

waste because it is the predominant form of littered waste found in my research, and a

visible part of the neighborhood environment in many parts of Accra. Additionally,

unlike organic waste products, littered plastic waste will remain perpetually unless

collected and removed. This longer life cycle makes plastic waste a particularly good

indicator of public solid waste accumulation.

The level of plastic waste litter found differed significantly between the four

neighborhoods, with the slum areas of Jamestown and Nima having higher levels. The

percentage of households using a public dumpsite was a good predictor to explain intra-

neighborhood differences in littered waste. However, further analysis, either

observational or experimental, would be needed to determine if this predictor is relevant

2
causally; that is, to establish that public dumpsters are a less effective means of removing

waste from these neighborhoods. If this is the case, it might be possible to improve the

littered waste situation in these neighborhoods by encouraging households to switch to

other waste disposal methods, such as private collection.

Similarly, distinct patterns among the four communities emerged in the

characteristics of open drainage systems (Chapter 6). The level of littered waste in the

gutters, classified by percent coverage, was higher in Nima and Jamestown, with the

lowest levels of waste in East Legon. Nima and Jamestown also had a higher percentage

of gutters that were characterized by stagnant water flow, which is an indicator of malaria

risk. A much higher percentage of gutters in these slum communities had turbid waters,

which indicates disposal of household waste water used for cooking and cleaning into the

gutter system. Finally, these communities, particularly Jamestown, had higher levels of

“flood risk”—a measurement of the capacity of the gutter system to deal with existing

levels of water flowing through them.

While the gutter data have primarily served to explore differences between the

study areas, it is also possible to pool the data and consider patterns and correlations

between the characteristics observed. In particular, there was a correlation between the

level of littered waste in gutters and water flow; gutters with high levels of waste and

clogged gutters were most often characterized by stagnant water flow. Likewise, gutters

with higher levels of waste were also characterized by higher flood risk. Finally, gutters

with stagnant waters were associated with higher flood risk when compared to gutters

with slow or fast flowing waters. This suggests that an effort to improve one

characteristic of gutters in the poorer communities (such as reducing high trash levels)

2
could lead to improvements in other areas (for example, lowering flood risk or decreasing

stagnant waters).

Chapter 7 considered household drinking water quality, and focused in particular

on microbial contamination that occurred between the source—the tap—and the point of

consumption. These changes demonstrate the importance of household and

neighborhood sanitation and hygiene behaviors in determining the quality of water

consumed by residents of Accra. In particular, the magnitude of changes in

contamination that occurred during household storage greatly exceeds contamination in

the source pipes, and while contamination in the source pipes is thus relatively low, most

piped water in Accra does not meet WHO standards for drinking water.

Use of commercial sources such as water bottles and sachets appears to be one

means of reducing the risk of fecal contamination in drinking water, as none of the

commercial sources tested positive for E. coli contamination. However, this strategy

comes with its own environmental concerns relating back to solid waste management;

plastic sachets are one of the most common littered items in Accra. Similarly, households

using public taps had, on average, higher levels of E. coli and total coliform

contamination at the point of consumption, which would indicate that access to taps

closer to the household improves the quality of water consumed. Households that used

sealed storage containers such as plastic water bottles or polytanks, particularly when the

storage container was located in a refrigerator during storage, demonstrated lower levels

of contamination during storage and thus these storage practices appear to be more

effective. Finally, there is evidence that boiling water is an effective means of reducing

coliform contamination prior to consumption. Notably, the storage and hygiene practices

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that led to lower levels of household contamination were most common in the wealthier

communities of East Legon and Asylum Down. There is no evidence that the hygiene

practices found in the poor communities of Nima and Jamestown, such as hand washing,

are successful in improving water quality.

Quantifying Environmental Equity

This thesis has attempted to quantitatively compare the quality of water,

sanitation, and hygiene at the neighborhood level. Similar empirical studies on

comparative environmental risks and burden of disease in the different localities of the

Greater Accra Metropolitan Area were undertaken by the Stockholm Environment

Institute (SEI) and the University of Ghana in the 1990s. While these studies were much

more comprehensive, taking into consideration all neighborhoods within the city, my

methodology has attempted to make these comparisons more quantitative and detailed.

These previous studies compared aggregate environmental burden for different

areas of the city by qualitatively assessing multiple characteristics—proxy indicators—

and rating the risk they posed on a point-scale for each neighborhood. For example,

“pools of stagnant water in drains”, “mounds of uncollected waste within a community”

and “frequent water supply interruptions within the community” were among the 81

proxy indicators assessed in studies by Songsore et. al. Each proxy indicator was

considered by a panel of experts and given a maximum point value based on their

assessment of its relationship to disease burden (more important risks were assigned

higher point values). Each study community was then scored for each proxy indicator,

and relative environmental risk was calculated from the total score of all proxy indicator

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values.75 According to this scale, Nima was determined to be the most environmentally

deprived residential area of Accra, and was calculated to have approximately 4.75 times

the level of environmental risk as the least deprived quintile of residential areas.76 On

this aggregate scale of environmental deprivation, Jamestown was classified in the

second most deprived quintile, Asylum Down in the third, and East Legon in the fourth.77

My results are consistent with and complementary to these previous findings.

However, I have attempted to be more rigorous, quantitative, and specific in my approach

to the study of environmental risks. In general, the magnitude of the disparities between

neighborhoods in these measured variables (levels of littered waste, qualities of open

drainage gutters, etc) are smaller than those approximated in the methods of previous

studies; none of the environmental indicators that I examined demonstrated four- or five-

fold differences between the study neighborhoods. While the magnitudes of

environmental inequity I have calculated are not as staggering as those estimated

previously, they still clearly articulate the need for action to rectify disparities within the

urban context, and specify the targets of such actions. Furthermore, my attempt to

quantify environmental inequities has led to the observation of differences that cannot be

as easily ascribed to the subjectivity of chosen proxy indicators and measures.

Limitations of the Study

My research was limited by both time and resource constraints in the data

collection process. It was not possible to extend the analysis beyond the four study areas

of Jamestown, Nima, Aslyum Down, and East Legon. While these neighborhoods do

75

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vary in socioeconomic status, and thus allow for some conclusions about environmental

inequity in Accra, the conclusions of this study would be much more robust with a larger

selection of research areas. In particular, it is impossible to determine the extent to which

the patterns observed are socioeconomic, particularly when the neighborhoods also differ

in other, potentially related, characteristics (such as population density, location within

the city, and types of land use). Given that I collected this data with only a small team of

field assistants over a period of less than eight weeks, I limited myself to the four

neighborhoods with which I was most familiar.

In the case of the neighborhood-level data on littered waste and drainage gutter

quality, it would also be helpful to have data collection methods that incorporated

temporal variability. It is possible that the levels of waste and the characteristics of

gutters change over time—either short term (by day) or long term (seasonally). The data

that I have collected are thus limited to a snapshot of conditions in the neighborhood.

Also, data were not collected simultaneously in each neighborhood, but rather over a

period of several weeks, and thus comparisons rest on the assumption that conditions did

not change dramatically in each neighborhood during the measurement period. However,

measures were taken to limit the effect of temporal variation on the data; for example,

measurements were not taken on days with unusual weather, such as days following

rainstorms, which occur only occasionally in the summer. Similarly, all data collection

was undertaken in the early morning, to limit the effects of any diurnal variation that

might exist. Also, the littered waste data collection was structured so that it was possible

to check for variations between measurement days; indeed, there were no significant

differences for neighborhood-level averages for these measurement days.

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 Another concern was the uncertainty due to changes in the study neighborhoods

—be they demographic, environmental, or spatial—during the time between the National

Census (2000) and my own data collection (2007-2008). While both the census data and

previous environmental research in Accra indicate that conditions in the slum community

of Nima are on par, or even worse, than those in Jamestown, both the 2007 household

surveys and my own experience on the ground indicate that environmental conditions in

Nima are superior. This is perhaps explained by the presence of community

organizations, such as the Federation of Youth Clubs, that have partnered with lawyers,

community members, and political leaders to actively campaign for improved conditions

in this neighborhood. Similarly, rapid infrastructural development and population growth

have occurred in East Legon over the past decade, which could make the data of the 2000

census less representative of the present context.

In the case of the analysis of household water quality, an obvious difficulty was

limited testing equipment and the lack of access to a laboratory in Accra. Because of this,

field testing kits were used as a substitute. These techniques are highly imprecise, and as

used in this study, could not detect the presence of coliforms below a level of 20

cfus/100mL. It was not possible to do multiple dilutions to quantify the level of

contamination in highly polluted samples. In samples where coliforms exceeded 200

cfus/5mL, and were thus denoted too numerous to count (TNTC), it would have been

preferable to run another sample to test a smaller quantity of water.

For analysis, it would have also been helpful to have a more comprehensive set of

variables at the EA-level. The census provides information on population density,

household water sources, methods of solid and liquid waste disposal, and sanitation.

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However, other spatial information, such as land use and density of commercial versus

residential use, might have been helpful in considering patterns of littered waste. For

example, one qualitative observation I made while conducting the survey was that areas

in front of store shops tended to have lower levels of waste, perhaps due to the fact that

these areas are actively maintained by to attract customers. Similarly, areas where there

was no clear private ownership of the land—such as market places, back alleys, and

abandoned lands—were characterized by high levels of littered waste. However, because

no information was available on land use, it was not possible to analyze these

observations quantitatively. It might be possible to do so in a future study, perhaps with

the use of satellite data and remote sensing, which could be used to infer land use in the

study areas.

A final concern in the neighborhood sampling is the measurement error inherent

in much of the data. Although efforts were made to measure and classify characteristics

as accurately as possible, there was often room for error in classifications. Many

quantities, such as the level of littered waste in gutters or in the surrounding five-meter

radius, were estimated visually. However, efforts were made in the design of the research

protocol to minimize this measurement error by specifying both methods for performing

these estimations and making classifications as specific as possible.

Lessons and Implications for Future Environmental Policy

One reaction to the numerous problems of urbanization and poverty has been to

focus on rural areas in an attempt to rectify the urban bias in development; accelerating

economic development in rural areas, it is hypothesized, will raise living standards and

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discourage rural-to-urban migration, thus “solving” the growing problems of the urban

poor.78 What is often ignored is that urbanization simultaneously represents a great

opportunity for developing countries. While denser populations can mean concentrated

wastes and environmental risks, it is possible, with good governance, to provide services

to residents of cities at lower costs. Concentrations of people provide economies of scale

in providing clean water, disposing solid and liquid waste, and constructing adequate

storm drainage systems.79 In turn, cities often provide a source of remittances to rural

areas, and thus simultaneously improve rural conditions.80 Studies have also shown that

in sub-Saharan Africa, development, as measured by the human development index, is

positively correlated with the level of urbanization, although the causality of this

relationship remains yet to be established.81

Unfortunately, the lack of quantitative evidence on environmental risks in urban

areas impedes both advocacy and programmatic progress towards this ideal. Residents in

urban slum communities experience the reality of environmental risks every day of their

lives. Many slum residents in Nima and Jamestown expressed awareness of the

detrimental effects of poor water quality and neighborhood sanitation on their health. As

has been stated by human rights advocate Chidi Anselm Odinkalu: “People are acutely

aware of the injustices inflicted upon them…What they need is a movement that channels

these frustrations into articulate demands that evoke responses from the political

process.”82 While any inhabitant of Nima or Jamestown could probably describe some of

the problems of water, sanitation and hygiene in his or her community, empirical

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evidence can serve as a catalyst for action and a means of targeting limited resources to

improve conditions in these deprived areas. In particular, if community workers could be

trained to carry out this analysis in a larger collection of neighborhoods in Accra, it is

possible that the results could place political pressure on governing bodies to put

resources into developing infrastructure in poor urban communities. The quantifications

presented in this study can act as a foundation for community organizers to elicit

government funding, or for local NGOs to press for resources from international donors.

This type of community-based approach to water and sanitation issues has been shown to

be very effective in other parts of the globe.83

This study has also emphasized the fact that environmental inequities in the

developing world are primarily a problem of delivery, not technology. Improving

sanitation and water quality does not require complicated technological solutions, such as

those currently under consideration to counter the effects of global climate change or to

manage the byproducts of nuclear facilities. Indeed, the estimated costs to improve the

global situation of WSH are minimal. Among the UN Millennium Development Goals is

the target to reduce by half the number of people without access to safe drinking water

and basic sanitation by the year 2015. The World Bank estimates that it would take an

additional 5 to 21 billion dollars annually to reach these goals84; even at the high end of

these estimates, this is less than 0.1% of the GDP in the United States alone.85 Improving

water, sanitation, and hygiene in developing cities, such as Accra, is both an achievable

and necessary goal.

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Works Cited

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Appendix A
Coliform Measurements – Testing Protocol

Samples in the study were tested for total coliforms and E. coli using the

Coliscan® Easygel® system (Micrology Laboratories #25001). This testing method uses

chromogenic substrates that react with the enzymes galactosidase and glucuronidase,

which are produced in the lactose fermentation of coliforms and E. coli, respectively.

The pre-treated petri dishes contain these chromogenic substrates, as well as inhibitors

that limit the growth of other bacteria in the sample. The dishes are incubated at room

temperature for 36-48 hours, at which point colonies that have grown on the substrate can

be enumerated.86 Sampling was undertaken using the following protocol:

1.2. Collection
1. Record the Household ID and location of the sample using GPS.
2. Collect each sample in a pre-labeled and sterile collection tube (Micrology
Laboratories #TST15) using nitrile gloves.
3. Keep all samples in a cooler on ice until they are processed.
1.3. Preparation and Incubation
1. Test all samples for coliforms within 12 hours of collection.
2. Pre-label all petri dishes before testing samples according to Household ID.
3. Transfer 5.0 mL of each water sample to a bottle of Coliscan® Easygel® medium
using a sterile pipette.
4. Swirl sample and medium to mix thoroughly before pouring into pre-treated, pre-
labeled petri dish (do not shake).
5. Place all petri dishes on a level surface in a warm part of the room for 48 hours.
1.4. Inspection
1. Take digital photograph of petri dish on a white paper, including sample
identification in the photograph.
2. Count all purple/blue colonies (disregard light blue, green, or white colonies),
report as E. coli per 5.0 mL. Do not count colonies smaller than a pinhead.
3. Count all pink and purple colonies, report as coliforms per 5.0 mL. Do not count
colonies smaller than a pinhead.
1.5. Disposal
1. Place all materials in a large pan, cover with water, and boil for 45 minutes,
discard in normal trash.

86
Cite?

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Appendix B
Compiled Table of Household Samples
Consumption Consumption Source E. Source Source Type Neighborhood Storage Type Storage Storage Hands Boiled Filtered
E. coli total coli total Location Time Washed
coliforms coliforms (days)
0 0 0 0 commercial EL
0 0 0 0 commercial EL
0 0 0 0 commercial EL
0 0 0 0 commercial EL
0 0 0 0 commercial EL
0 13 1 1 indoor EL polytank outdoor NA NA FALSE FALSE
0 0 0 0 indoor EL bottle fridge 0 NA TRUE FALSE
0 0 0 17 indoor EL bottle fridge 0 NA TRUE TRUE
1 TNTC 0 4 in yard EL plastic barrel indoor 7 FALSE FALSE FALSE
2 TNTC 0 0 in yard EL plastic barrel fridge 7 NA FALSE FALSE
32 TNTC 7 48 public tap EL plastic barrel outdoor NA FALSE FALSE FALSE
0 11 0 11 commercial AD
0 0 0 0 commercial AD
0 1 0 1 commercial AD
0 0 0 0 commercial AD
0 0 0 0 indoor AD bottle fridge 2 NA FALSE FALSE
0 5 1 9 indoor AD not stored not stored NA NA FALSE FALSE
0 0 0 0 indoor AD polytank indoor 0 NA TRUE FALSE
32 TNTC 0 16 indoor AD plastic barrel indoor 1 FALSE FALSE FALSE
26 TNTC 1 2 in yard AD plastic barrel indoor 1 TRUE FALSE FALSE
0 3 1 4 in yard AD plastic barrel fridge 1 NA FALSE FALSE

Consumption Consumption Source E. Source Source Type Neighborhood Storage Type Storage Storage Hands Boiled Filtered
E. coli total coli total Location Time Washed
coliforms coliforms (days)
0 1 66 TNTC in yard AD bottle fridge 3 NA TRUE FALSE
 0 153 1 83 in yard AD plastic barrel outdoor 0 0 FALSE FALSE
0 0 1 12 in yard AD plastic barrel indoor 3 0 FALSE FALSE
1 TNTC 0 1 in yard AD plastic barrel indoor 3 0 FALSE FALSE
0 102 0 38 public tap AD plastic barrel indoor 0 0 FALSE FALSE
0 5 0 5 commercial NM
0 3 0 3 in yard NM not stored not stored NA NA NA NA
0 84 0 1 in yard NM metal barrel indoor 1 TRUE FALSE FALSE
0 17 0 17 in yard NM not stored not stored NA NA FALSE FALSE
0 0 0 0 in yard NM not stored not stored NA NA NA NA
15 0 1 public tap NM metal barrel outdoor 0 TRUE FALSE FALSE
0 0 3 public tap NM plastic barrel indoor 3 FALSE FALSE FALSE
0 0 0 public tap NM plastic barrel indoor 0 FALSE FALSE FALSE
4 0 0 public tap NM plastic barrel outdoor 1 FALSE FALSE FALSE
0 55 0 0 public tap NM plastic barrel outdoor 2 NA FALSE FALSE
5 133 0 0 public tap NM metal barrel outdoor 0 FALSE FALSE FALSE
2 0 0 public tap NM NA indoor NA NA FALSE FALSE
0 154 0 154 commercial JT
0 0 0 0 commercial JT
0 6 0 6 commercial JT
1 164 0 16 indoor JT metal barrel outdoor 0 TRUE FALSE FALSE
2 TNTC 0 0 in yard JT metal barrel indoor 3 NA FALSE FALSE
0 61 0 0 in yard JT not stored not stored NA NA NA NA
0 52 0 2 in yard JT plastic barrel indoor 0 FALSE FALSE FALSE
0 45 0 1 in yard JT plastic barrel outdoor 3 FALSE FALSE FALSE

Consumption Consumption Source E. Source total Source Type Neighborhood Storage Type Storage Storage Hands Boiled Filtered
E. coli total coliforms coli coliforms Location Time Washed
(days)
0 3 1 3 public tap JT plastic barrel outdoor 3 FALSE FALSE FALSE
0 26 0 0 public tap JT plastic barrel indoor 2 FALSE FALSE FALSE
57 TNTC 0 16 public tap JT plastic barrel indoor 2 FALSE FALSE FALSE
8 TNTC 1 3 public tap JT plastic barrel outdoor 3 FALSE FALSE FALSE
TNTC TNTC 0 6 public tap JT plastic barrel outdoor 1 FALSE FALSE FALSE
0 TNTC 0 6 public tap JT plastic barrel outdoor 3 FALSE FALSE FALSE

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 14 84 0 1 public tap JT plastic barrel indoor 0 FALSE FALSE FALSE
4 88 0 1 public tap JT plastic barrel indoor 0 FALSE FALSE FALSE
3 0 0 public tap JT plastic barrel outdoor 0 TRUE FALSE FALSE
0 0 0 0 public tap JT plastic barrel outdoor 3 FALSE FALSE FALSE