Greywater characterization and handling practices among urban households in Ghana: the case of three communities in Kumasi Metropolis.

Greywater management in Ghana receives little or no attention although untreated greywater is associated with environmental and public health risks. This paper assesses greywater characteristics and handling practices among urban households in three selected communities in Kumasi, the second largest city of Ghana. The study involved in-depth surveys (interviews and observations) with 90 households, and collection of 18 greywater samples from nine greywater sources for laboratory analysis. Average greywater generation is 43.36 ± 17 litres per capita per day, equivalent to 36% of average water consumption. Greywater is untreated before disposal (≈99%), and disposal is mainly (89%) into drains and onto streets. Biochemical oxygen demand (BOD) and chemical oxygen demand (COD) levels are high but give very low BOD/COD ratios (0.20 ± 0.07) indicating a very low biodegradability potential. Nutrient levels are high: 12 times (P) and 30 times (N) in excess of standard discharge limits. Other contaminants detected are heavy metals (Fe, Pb, Zn and Cd), microbes (total coliforms, Escherichia coli and Salmonella spp.), and organic micropollutants - benzalkonium chloride, parabens (methyl and propyl), sodium benzoate and hypochlorite - and details of the levels are discussed in the paper. Greywater reuse could be useful for biomass production, but it also presents a challenge and threat to natural biological processes and water sources.

Effect of Smoking and Grilling on Polycyclic Aromatic Hydrocarbons in Ghanaian Tilapia.

The study assessed 18 Polycyclic Aromatic Hydrocarbons (PAHs) in O. niloticus (Nile tilapia) sampled from an aquaculture cage (farm) and a wild catch. The PAHs in fish samples were analysed using Gas Chromatography-Mass Spectrometry. Four PAHs (in order of levels: Indeno [1,2,3-cd] pyrene > Anthracene > Perylene > Pyrene; 100-0.8 µg/kg) and only one PAH (Pyrene: 4 µg/kg) were detected in raw samples from the cage and wild catch respectively. Chargrilling significantly increased Pyrene levels after cooking (wild: 4-11 µg/kg; cage: 5-23 µg/kg, p < .05), and likewise Anthracene levels in cage samples (13-153 µg/kg) but decreased Indeno [1,2,3-cd] pyrene levels from 100 ± 20 to 1.2 ± 0.2 µg/kg in cage samples. Smoking significantly increased 13 to 15 PAH congeners' levels (from < 1.0 up to 340 µg/kg) and total PAHs (wild: 4 to 840 µg/kg; cage: 110 to 560 µg/kg), and decreased Indeno [1,2,3-cd] pyrene (100 to 1.3 µg/kg) in cage samples but showed no effect on Benzo [g, h, i] perylene and Dibenzo [a, h] anthracene levels in all samples. For smoked samples, Benzo [a] pyrene and PAH4 (Benzo [a] anthracene, Chrysene, Benzo [b] fluoranthene, and Benzo [a] pyrene) exceeded the respective maximum permissible limits of 2 µg/kg and 12 µg/kg, and significantly influenced the levels of carcinogenic PAHs (CPAH, 135-170 µg/kg). Nevertheless, the Excess Cancer Risk (ECR) estimates, from a conservative approach, were far below the threshold (10-4), implying that consuming smoked or grilled tilapia from the study site is safe.

Prevalence of self-medication in Ghana: a systematic review and meta-analysis.

OBJECTIVES: This study estimates the prevalence of self-medication and provides an understanding of the reasons for self-medication in Ghana through the synthesis of relevant literature. METHODS: A comprehensive search was conducted in PubMed, Science Direct and African Journals Online to identify observational studies published from inception to March 2022. Google scholar and institutional websites were searched for grey literature. We included studies reporting primary data on the prevalence and/or reasons for self-medication in Ghana. Random-effects meta-analysis was used to estimate the prevalence of self-medication. Subgroup analysis was performed with the study population (pregnant women, patients and students), geopolitical zone (coastal, middle and northern) and study setting (rural and urban). Using inductive thematic analysis, reasons for self-medication were classified and tallied under key themes. RESULTS: Thirty studies involving 9271 participants were included in this review. The pooled prevalence of self-medication in Ghana was 53.7% (95% CI 46.2% to 61.0%; I²=98.51%, p<0.001). Prevalence of self-medication was highest among pregnant women (65.5%; 95% CI 58.1% to 72.5%; I2=88%), in the middle belt of the country (62.1%; 95% CI 40.9% to 82.0%; I²=98%; p<0.001) and in rural settings (61.2%; 95% CI 36.5% to 84.5%; I²=98%; p<0.001). The most cited reasons for self-medication included long waiting time at health facilities (73.3%), previous use of drugs (66.7%) and the perceived unseriousness of diseases (53.3%). CONCLUSION: This study has revealed that self-medication is still an unresolved public health challenge in Ghana, with a high prevalence estimate. Self-medication is influenced by inconveniences associated with accessing healthcare coupled with poor health seeking behaviours. There is the need for improved access to quality healthcare and the promotion of appropriate health-seeking behaviours.

Performance evaluation of a full-scale upflow anaerobic sludge blanket reactor coupled with trickling filters for municipal wastewater treatment in a developing country.

Poor wastewater management remains a critical health and environmental challenge in most developing countries in Sub-Saharan Africa due to the lack of adequate infrastructure for collection and treatment. This study evaluated the performance and methane production of a full-scale upflow anaerobic sludge blanket (UASB) reactor of capacity 18000 m3/d, with post-treatment unit: trickling filters followed by final settling tanks for municipal wastewater treatment in Ghana. Data was collected on operational conditions and physicochemical parameters of wastewater (influent and effluent) over a period of 35 weeks in 2021 (from January to August). The influent biochemical oxygen demand to chemical oxygen demand (BOD:COD) ratio was 0.58 ± 0.16, indicating the presence of highly biodegradable compounds in the sewage. Operational conditions for the UASB reactors were observed to be within the optimal range for anaerobic systems, with an applied organic loading rate of 1.30 ± 0.79 kgCOD/m3/d. Generally, Plant performance was satisfactory with carbon removal at 93% for COD and 98% for BOD. Biogas yield was 0.2 m3/kgCOD removed, culminating in an average biogas production rate of 831.6 ± 292.7 m3/d. Average methane composition was 64.7 ± 11.9% of the biogas output, whilst an estimated 35% of the methane generated remained dissolved in the UASB effluent. The UASB reactor presents an efficient technology that can be implemented in developing countries for effective and sustainable wastewater management.

Acceptance and utilization of HIV testing among the youth: a cross-sectional study in Techiman, Ghana.

BACKGROUND: In Ghana, efforts including 'Know Your Status' campaign have been made to increase awareness and improve the uptake of HIV screening. OBJECTIVE: This study examined the acceptance and utilization of the HIV/AIDS 'Know Your Status' campaign and determine dthe differences in HIV testing by demographic characteristics among the youth in Techiman, Ghana. METHOD: This study was a cross-sectional study conducted among the youth aged 15-24 years. A structured questionnaire was used to collect data from 200 purposively selected respondents. RESULTS: The mean age of the respondents was 19.6±2.72 years. There was a universal awareness (100%) of HIV/AIDs, and were knowledgeable about the mode of transmission, symptoms and the prevention of HIV. A high proportion of the respondents (n=161, 80.5%) had heard about the 'Know Your Status' (KYS) campaign. Less than half of respondents (n=91, 45.5%) had tested for HIV, and only 16.5% (n=15/91) of respondents tested through the KYS campaign. Testing for HIV was associated with age (p<0.001) and marital status (p<0.001). CONCLUSION: The youth should therefore be targeted in the awareness and the 'Know Your Status campaigns', and in an effortsto promote screening for HIV.

Toilet chemical additives and their effect on faecal sludge characteristics.

This study investigated the effects of two mostly improvised chemical additives, calcium carbide and lambda super 2.5 EC (LSEC), on the physico-chemical and microbial characteristics of faecal sludge from toilets. The quality of faecal sludge was assessed before and after application of the chemical additives in an experimental setup of ten different treatment units including a control, and treatment replicates. The initial characteristic of the faecal sludge was slightly acidic with high content of slowly degradable organic matter. The experimental control without additives after 30 days showed reduction in BOD5, COD, helminth eggs and sludge mass by a maximum of 30%, 34.7%, 99.8% and 55% respectively. Similarly, calcium carbide additive reduced the BOD5, COD, helminth eggs and the mass of the faecal sludge by 47.4%, 48.3%, 99.6% and 61% respectively. Also, LSEC additive reduced BOD5, COD, helminth eggs and the mass of the sludge by 40.6%, 47.9%, 95.9% and 58% respectively. The two additives showed significant treatment effect on the faecal sludge although the level of treatment could not meet the regulatory discharge limits for the key quality parameters assessed including sanitisation. The study is still a grey area and more research is recommended to enrich the findings.

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

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

Cost and effectiveness of water, sanitation and hygiene promotion intervention in Ghana: the case of four communities in the Brong Ahafo region.

Knowledge of cost and effectiveness of Ghana's main hygiene promotion intervention (HPI), Community-Led Total Sanitation (CLTS), is critical for policy direction. Cost and resultant effect of HPI is examined using a case study of four communities. Surveys were conducted with 300 households, CLTS implementers and relevant agencies during the study period (May 2012 to February 2014). The HPI produced marginal but statistically significant effect (8%, p < 0.001). Improvement in hygiene behaviour was statistically associated with both government investments (p < 0.001) and household investments (p < 0.001). Actual HPI cost is US$ 90 per household: US$ 51 and 39 from government and households respectively. Cost-effectiveness of the HPI is US$ 106.42 per capita of improved hygiene behaviour.

Breastfeeding practices and determinants of exclusive breastfeeding in a cross-sectional study at a child welfare clinic in Tema Manhean, Ghana.

BACKGROUND: Exclusive breastfeeding is important for child health and growth, but its practice is low in many developing countries. This study aimed at determining the breastfeeding practices and examining the sociodemographic characteristics that influence exclusive breastfeeding among mothers attending child welfare clinic at Manhean, in the Tema East Sub-Meteropolitan area of Greater Accra region of Ghana. METHODS: This was a cross-sectional study that employed a structured questionnaire to collect data among 355 mothers of children aged 0-24 months selected through simple random sampling, attending a child welfare clinic from May to June, 2016. Breastfeeding practices were assessed based on the practices in the last 24 h prior to the study as defined by the World Health Organization. RESULTS: There was a universal awareness and high knowledge about exclusive breastfeeding among mothers, but prevalence among infants less than 6 months was 66.0% (n = 138/209). Mothers currently breastfeeding were 263 (74.0%); 225 (63.4%) initiated breastfeeding within the first hour after delivery and 289 (81.0%) of the mothers offered colostrum to babies after delivery. Continued breastfeeding rate at 1 year was 77.3% (n = 17/22). Only 33.7% (n = 31/92) of infants aged 6-8 months had started receiving complementary foods. For infants aged less than 24 months, 30.1% (n = 98/326) were bottle feeding. Mothers aged 20-24 (Adjusted odd ratio [AOR] 9.80; 95% confidence interval [CI] 2.11, 45.46), 25-29 (AOR 9.49; 95% CI 2.07, 43.47) and 30-34 (AOR 6.02; 95% CI 1.41, 25.65) were more likely to practice exclusive breastfeeding. Mothers who had tertiary education were less likely to practice EBF than those with no education (AOR 0.18; 95% CI 0.36, 0.85). Mothers from ethnic groups in northern Ghana were less likely to exclusively breastfeed their infants compared to those of Ghanaian (Ga) ethnicity (AOR 0.29; 95% CI 0.09, 0.96). CONCLUSIONS: Exclusive breastfeeding and timely complementary feeding practices are suboptimal. Educational status, age and ethnicity of mothers strongly predicted maternal practice of exclusive breastfeeding. Interventions emphasizing a practical education should therefore be targeted at addressing factors that influence exclusive breastfeeding.