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Sanitation Challenge for Ghana: SaniPath partners TREND, Kumasi Metropolitan Assembly, and Accra Metropolitan Assembly recognized for their work on liquid waste management

Sanitation Challenge for Ghana Participants (Photo Credit:

The Sanitation Challenge for Ghana is a program established to promote innovation and partnerships between Metropolitan, Municipal, and District Assemblies (MMDAs) and private and non-state sector actors to improve liquid waste management in low-income urban households in Ghanaian cities with populations over 15,000. The Challenge was first launched in 2015 by the Government of Ghana and is supported by IMC Worldwide (UK Department of International Development), IRC Ghana, and WASHealth Solutions. The Challenge consisted of two stages in which MMDAs submitted their work to be evaluated alongside their peers. Stage 1 consisted of 139 MMDAs with 17 being invited to participate in the second and final stage of judging. Private and non-state actors were eligible for entry if they had or will be partnering with at least one of the 17 Stage 2 MMDAs on a project related to liquid waste management.


2019 Ghana National Sanitation Stakeholders Forum

Benedict Tuffuor, Ato Kwamena Senayah, and Joshua Tetteh-Nortey, partners at TREND Ghana and Kumasi Metropolitan Assembly, presented at the Ghana National Sanitation Stakeholders Forum on July 17th, 2019. Benedict presented on the establishment of TREND as a SaniPath Training Hub and the recent work they have conducted alongside metropolitan assemblies. Ato and Joshua provided a presentation on the use of data in sanitation intervention planning and decision making. Data from the 2018 SaniPath Exposure Assessment in Kumasi, Ghana were used to call attention to potential areas for intervention to improve public health by reducing exposure to fecal contamination. These presentations highlighted the capacity building activities of TREND pertaining to behavioral, environmental, and laboratory work involved in conducting exposure assessment data collection and the potential impact of results provided by this type of work. TREND is continuing in their role as a SaniPath Training Hub by disseminating results and sharing the experience of partner organizations to create demand within other municipal assemblies.

Access Training Hub Presentation Here

Access Data in Decision Making Presentation Here

Associations between open drain flooding and pediatric enteric infections in the MAL-ED cohort in a low-income, urban neighborhood in Vellore, India

Authors: D. Berendes, J. Leon, A. Kirby, J. Clennon, S. Raj, H. Yakubu, K. Robb, A. Kartikeyan, P. Hemavathy, A. Gunasekaran, S. Roy, B. Ghale, J. Kumar, V. Mohan, G. Kang, CL Moe


Background: Open drains are common methods of transporting solid waste and excreta in low-income urban neighborhoods. Open drains can overflow due to blockages with solid waste and during rainfall, posing exposure risks. The goal of this study was to evaluate whether pediatric enteric infection was associated with open drains and flooding in a dense, low-income, urban neighborhood.

Methods: As part of the MAL-ED study in Vellore, India, a cohort of 230 children provided stool specimens at 14–17 scheduled home visits and during diarrheal episodes in the first two years of life. All specimens were analyzed for enteric pathogens. Caregivers in 100 households reported on flooding of drains and households and monthly frequency of contact with open drains and flood water. Household GPS points were collected. Monthly rainfall totals for the Vellore district were collected from the Indian Meteorological Department. Clustering of reported drain and house flooding were identified by Kulldorff’s Bernoulli Spatial Scan. Differences in enteric infection were assessed for household responses and spatial clusters, with interactions between reported flooding and rainfall to approximate monthly drain flooding retrospectively, using multivariable, mixed-effects logistic regression models.

Results: Coverage of household toilets was low (33%), and most toilets (82%) discharged directly into open drains, suggesting poor neighborhood fecal sludge management. Odds of enteric infection increased significantly with total monthly rainfall for children who lived in households that reported that the nearby drain flooded (4% increase per cm of rain: OR: 1.04, 95% CI: 1.00–1.08) and for children in households in a downstream spatial cluster of reported drain flooding (5% increase per cm of rain: OR: 1.05, 95% CI: 1.01–1.09). There was no association between odds of enteric infection and frequency of reported contact with drain or floodwater.

Conclusions: Children in areas susceptible to open drain flooding had increased odds of enteric infection as rainfall increased. Results suggested that infection increased with rainfall due to neighborhood infrastructure (including poor fecal sludge management) and not frequency of contact. Thus, these exposures may not be mitigated by changes in personal behaviors alone. These results underscore the importance of improving the neighborhood environment to improve children’s health in low-income, urban settings.

Access paper here

Examining Exposure to Fecal Contamination in Low-Income Urban Environments: Findings from SaniPath Exposure Assessments in Seven Cities

CL Moe

University of Florida Emerging Pathogens Institute Seminar Series

Dr. Christine Moe presented at the University of Florida as part of The Emerging Pathogens Institute Seminar Series. Dr. Moe shared findings from SaniPath Exposure Assessments conducted in seven cities around the world. Comparisons of results from assessments in different settings allows for trends in exposure, both regionally and globally, to be explored to highlight routes of exposure to fecal contamination that are of increased importance. Produce, Open Drains, and Flood water are commonly observed to be dominant pathways of exposure for adults and children across study sites.

Presentation coming soon!