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Research Article
The campaign for improved sanitation is increasingly threatened as people’s attitudes seem not
to promote proper sanitation practices. The study examined attitudes of urban dwellers in some
communities in Central Region of Ghana towards sanitation and their influence on sanitation
practices. A cross sectional survey research design was adopted for the study. Simple random
sampling technique was used to select 360 inhabitants in three urban communities. A structured
questionnaire was used for data collection. Descriptive and inferential statistics were used to
analyse the data. A significant number of respondents (76.4 %) had good attitudes towards
sanitation whilst 58.0 % of respondents had good standard of sanitation practices. About half of
the respondents (49.8 %) disposed of their solid waste daily through open dumping and three out
of every ten persons disposed of their solid waste through open burning. Respondents’ attitudes
towards sanitation weakly influenced their sanitation practices (r = 0.058, p = 0.269). This is
because respondents’ attitudes towards sanitation contributed only by 5.8% in their sanitation
practices. The findings of the study led to a conclusion that the high level of sanitation attitudes
among urban dwellers in some communities in Central Region of Ghana could not be translated
into actual practice. There was a gap between respondents’ attitudes towards sanitation and their
standard of practices. It is recommended that the Central Regional Environmental Health and
Sanitation Directorate should embark on a comprehensive campaign on health benefits of good
sanitation practices and enforce a more robust environmental sanitation approach and health
education to help translate the high sanitation attitudes among urban dwellers into actual
practice.
Key words: Open dumping, Practices, Sanitation attitudes, Urban dwellers, Waste disposal
INTRODUCTION
Kasapoglu (2010) defines attitude as a cognitive, affective assertion that sanitation practices are heavily influenced
and behavioural response which is organized on the basis by people’s knowledge and attitudes towards it.
of experience and knowledge of the individual or event
around the environment. Oskamp and Scshultz (2005) Inadequate sanitation is a major cause of diseases
define attitude as a predisposition to respond in a worldwide, and improving sanitation is known to have a
favourable or unfavourable manner to a given situation or significant beneficial impact on health both in households
object. Abudu and Gbadamosi (2014) also view attitude as and across communities (WHO, 2012). Sanitation related
a hypothetical construct that indicates an individual like diseases exacerbate poverty by diminishing productivity
and dislike towards an item. On the other hand, practice and household income. In addition, the natural cost of lost
refers to the ways in which people demonstrate their productivity, reduced educational potential and huge
knowledge and attitude through their actions curative health costs constitute a major drain on the local
(Kaliyaperumal, 2004). There should be higher and national economy (Ekong, 2015). Besides, a dirty
relationship between sanitation attitudes of people and environment with its attendant health consequences, as
their sanitation practices because both involve an prevails in most cities, can discourage tourists and
individual to have knowledge or event around the investors and undermine economic benefits of tourism to
environment. Mohd and Malik (2017) confirmed this the country.
Sanitation Attitudes of Urban Dwellers and their Influence on Sanitation Practices in Central Region of Ghana
Safo-Adu G. 071
The deposition of faecal matter near homes, necessary to understand how the people value and
contamination of drinking water sources, dumping of perceive an environmental change. Hence, assessment of
refuse and sweeping into gutters, defecating and attitudes and practices is particularly useful for this
disposing of faeces by street corners and waterways, and research.
selling of food stuffs and cooked food by the road side are
all unwholesome practices that pose potential risk to the The menace of gutters chocked with garbage and plastics,
development of diseases (Ekong, 2015). Poor sanitation is and the indiscriminate disposal of refuse at unauthorized
linked to transmission of diseases such as cholera, places in most communities in the Central Region and
diarrhoea, dysentery, hepatitis A, typhoid and Ghana as a whole is worrisome (Nsiah -Gyaabah, 2004)
poliomyelitis. Sah et al. (2013) revealed that people and has become a great concern to many environmental
drinking untreated water suffered from diarrhoea (38.4 %) educators and public health advocates. Baseline data on
followed by dysentery (9.8 %) whilst people devoid of current attitudes about sanitation in the Central Region of
latrine facilities suffered from diarrhea (40.7 %) followed by Ghana is scarce. As important as data on sanitation
dysentery (12.0 %) respectively. UNICEF and WHO attitudes is to healthcare planning, a search for the
(2017) reiterated that inadequate sanitation is estimated to available literature revealed that not much research has
cause 280, 000 diarrhoeal deaths annually and it is a major been conducted to examine the attitudes of people
factor in several neglected tropical diseases including towards sanitation in the Central Region of Ghana. The
schistosomiasis and trachoma. lack of appropriate information on attitudes of people
towards sanitation is an impediment to identify priority
Globally, 2.3 billion people still do not have basic sanitary needs. This study was designed to fill this gap.
facilities such as toilet or latrines. Of these, 892 million still
defecate in the open, for example in street gutters, behind The present work examined the attitudes of urban dwellers
bushes or into open bodies of water (UNICEF and WHO, in some communities in Central Region of Ghana towards
2017). An Analytical report on sanitation in Central Region sanitation and their influence on sanitation practices.
of Ghana revealed that 15 % of households had no toilet Specifically, the study sought to identify methods
facilities and 2,633 households still use buckets/pan toilet employed by urban dwellers in disposing of their solid
facilities even though there is a ban on its use (Ghana waste. It also aimed at assessing the attitudes of urban
Statistical Service, 2013). The proportion of households dwellers in some communities in Central Region towards
whose members use public toilet (39.5 %) was higher than sanitation and evaluating the influence of sanitation
the national average which is 34.6 %. Also, 1 out of 20 attitudes on their sanitation practices.
dwelling units (5.4 %) dump solid wastes indiscriminately.
Moreover, 13.4 % of dwelling units burn their solid wastes. The following questions guided the study:
The dumping of solid waste is the most common method 1. What methods do urban dwellers in some
of waste disposal in the Central Region. About 2 out of 5 communities in Central Region of Ghana employ to
dwelling units (41.0 %) throw liquid waste onto their dispose of their solid waste?
compounds whiles 31.1 % throw liquid waste on the street 2. What are the attitudes of urban dwellers in some
or outside the house or into gutters. communities in Central Region of Ghana towards
sanitation?
A study conducted by Duru et al. (2017) on the attitudes 3. What influence do sanitation attitudes among urban
and practices of sanitation in semi-urban communities in dwellers in some communities in Central Region of
Orlu, Imo State, Nigeria revealed that respondents’ Ghana have on their sanitation practices?
attitudes (38.6 %) and practices (20.8 %) towards
sanitation were low, and the commonest solid waste The following null hypotheses were tested:
disposal practices among respondents was open dumping Ho 1: Attitudes of urban dwellers in some communities in
(49.8 %). A research conducted by Osofo (2015) on Central Region of Ghana has no influence on their
attitudes of traders towards environmental sanitation in sanitation practice.
Hohoe market in the Volta Region of Ghana showed that, Ho 2: There is no relationship between the attitudes of
the attitudes of traders towards sanitation was positive but urban dwellers in some communities in Central Region of
could be more favorable if they had been provided with Ghana and their demographic characteristics.
support systems. Also, a study carried out by Sah et al.
(2017) on sanitation attitudes and practices of urban
dwellers in Sapturi District, Nepal showed that about 57 % MATERIALS AND METHODS
of participants had positive attitude towards sanitation
while 43 % had negative attitudes towards sanitation. 60 The study was conducted in three urban communities,
% participants had good sanitation practices while 40 % Potsin, Asebu and Afransi, in the Central Region of Ghana.
had poor sanitation practices. Attitude and practice The region occupies an area of 9, 826 square kilometers
research approaches are used to understand what people and has a population of 2,201, 863 inhabitants which
believe and do in relation to specific topics (WHO, 2008). accounts for 8.9 % of the population of Ghana (Ghana
To effectively achieve sustainable behaviour change, it’s Statistical Service, 2013). The Central Region shares
Sanitation Attitudes of Urban Dwellers and their Influence on Sanitation Practices in Central Region of Ghana
Int. J. Toxicol. Environ. Health 072
common boundaries with the Western Region on the west, Respondent’s attitude towards sanitation was categorized
Ashanti Region and Eastern Region on the east. On the into five levels: Strongly agree, agree, not sure, disagree
south is the 168 kilometre length Atlantic Ocean coastline. and strongly disagree. For positive items, the scores were
A cross sectional survey was adopted in the study. scaled as follows: ‘Strongly agree’ 5, ‘Agree’ 4, ‘Not sure’
According to Sedgwick (2014), a cross sectional survey is 3, ‘Disagree’ 2 and ‘Strongly disagree’ 1. The opposite held
generally quick, easy and cheap to perform. Also, it is for negative items. The categories were re-categorised
particularly suitable for estimating the prevalence of into agree, neutral and disagree to ease interpretation of
behaviour in a population. A sample of 360 was estimated the results. Strongly agree’ and agree were categorized as
for the study using StatCalc in Epi Info Version 7 ‘agree’ whiles ‘strongly disagree’ and ‘disagree’ were
developed by the American Center for Disease Control categorized as ‘disagree’. Respondent attitudes were
and Prevention, Atlantic Georgia (2010). A random classified into three levels. ‘Good attitude’, moderate
sampling technique was employed to obtain 120 attitude and bad attitude. The cut off points for ‘good
households from the three urban communities. Three attitude’ was 70 % of 50 score and above, ‘moderate
people (adult males and females and one youth) who attitude’ ranged from 50% to 70 % of 50 score and bad
understood basic communication were randomly selected attitude was 50 % of 50 score and below. The responses
from each selected household to answer a structured of respondents’ practices regarding environmental
questionnaire. sanitation were categorized into four levels which were: All
the time, Most of the time, Sometimes and Never. The
The questionnaire contained 22 items divided into three levels were scored as follows: ‘All the time’ 3, ‘Most of the
sections (Sections A to C). Section A solicited the time’ 2, ‘Sometimes’ 1 and ‘Never’ zero (0). The reverse
demographic characteristics of the respondents. Section B was true for negative items. The total possible scores for
is comprised of 3 items to identify methods respondents respondents ranged from 45 to 0. Respondents’ practices
adopt in disposing of their solid waste. Section C is were put into three categories - good practice, moderate
comprised of 15 items to assess the sanitation attitudes of practice and poor practice. The cut-off points for ‘good
respondents on effects of garbage pile in households, practice’ was 70% of 45 score and above, ‘moderate
indiscriminate dumping of refuse, health effects of practice’ ranged from 50% of 45 score to 70% of 45 score
insanitary conditions and community sanitation exercise and ‘poor practice’ was 50% of 45 scores and below.
participation. Section D is comprised of 15 items to assess
self-reported practices regarding sanitation like community The responses of the participants were analysed using
sanitation exercise participation, water purification, hand Statistical Package for Social Sciences (SPSS) version 20.
washing, water storage, toilet cleaning and household Frequencies and percentages were computed for
cleaning practices. categorical variables. Also, mean scores and standard
deviation of the sample responses were determined. Chi
The instrument was reviewed by experts in the square test was statistically used to test the hypothesis
Department of Integrated Science Education of University that there is no relationship between the attitudes of urban
of Education, Winneba to ensure its face and content dwellers and their demographic characteristics. Also,
validity. Afterwards, it was pre-tested in urban Pearson product moment correlation was used to examine
communities in Western Region with similar the influence of sanitation attitudes of urban dwellers on
characteristics of people in the urban communities of the their sanitation practices.
study area to estimate its reliability. The items were
subjected to item analysis in order to identify those items
whose removal or modification would enhance the internal RESULTS
consistency of the instrument (Onwoioduokit, 2000). The
Statistical Package for Social Sciences (SPSS) was used The results of demographic distribution of respondents
to determine the Cronbach alpha coefficient value for the presented in Table 1 showed that out of the 360
instrument which was of 0.87. The responses of respondents, who filled the questionnaire, 164
participants indicated that they understood the questions respondents (48.0%) were males and 178 respondents
and that the wordings of the items were appropriate. The (52.0%) were females. Few respondents (24.0 %) were
consent of the municipal assemblies and chiefs in the between 10 and 17 years, whilst the majority of the
study area were sought before collecting the data. respondents (76.0 %) were 18 years and above. Most of
Respondents gave out the information voluntarily and the respondents were students (37.0%) and traders (31.1
were assured that whatever information they gave out %) whilst few were civil servants (8.1 %) and politicians
would be treated confidentially. Five teaching assistants in (0.8 %). About half of the respondents (49.7 %) had
the Department of Integrated Science Education of secondary education as the highest level of education
University of Education, Winneba (UEW) were trained and whilst 34.2 % had primary education as their highest level
engaged as research assistants. A day’s training was held of education. Only 8.9 % and 7.2 % had tertiary education
for the research assistants before data collection and non-formal education, respectively.
commenced.
Sanitation Attitudes of Urban Dwellers and their Influence on Sanitation Practices in Central Region of Ghana
Safo-Adu G. 073
The methods employed by respondents for solid waste disposed of their solid waste daily. One out of 24 persons
disposal presented in Table 2 showed that the majority of disposed of their waste monthly. Moreover, few
the respondents (46.7 %) disposed of their solid waste respondents (17.7 %) disposed of their waste weekly.
through open dumping. Also, about 31.0 % of the Less than half of the respondents (48 %) temporarily
respondents disposed of their waste through open stored their solid waste in buckets/pans before disposing
burning. Few respondents (20.2 %) disposed of their them off. In addition, few respondents (24.2 %) temporarily
waste by duping them into municipal waste containers or stored their solid waste in dustbins before disposal.
skips. A significant number of respondents (77.2 %)
Table 2. Methods employed by respondents for solid waste disposal (N = 360)
Variable Number of Respondents Percentage (%)
Method of solid waste Open burning 112 31.1
disposal Open dumping 168 46.7
Burying 7 2.0
Municipal waste disposal 73 20.2
Regularity of waste Daily 278 77.2
disposal Weekly 63 17.7
Monthly 15 4.1
No specific time 4 1.1
Means of solid waste Dustbin 87 24.2
storage Polythene bags 100 27.8
Bucket/pan 173 48.0
The association between respondent regularity of solid houses. In addition, a significant proportion of respondents
waste disposal and their demographic characteristics are (96.7 %) reported that stagnant waters around households
shown in Table 3. The analysis of the results indicated that could serve as breeding grounds for mosquitoes. This
there was statistically no significant association between could pose health risks to inhabitants in the study area.
regularity of solid waste disposal and sex (p = 0.225, p> The participants who agreed that weeding surroundings
0.05) educational qualification (p = 0.741, p > 0.05) and and keeping households clean protect the human body
occupation (p = 0.650, p > 0.05). against certain diseases were about 93.0 % which is more
than participants who disagreed. Moreover, a huge
Table 4 presents the results of respondents’ attitudes number of respondents (84.7%) believed that it is the
towards sanitation in the study area. The majority of the responsibility of anyone who generates refuse to put it into
respondents (84.7 %) disagreed that ‘defecating in the dustbin.
bushes/fields and backyards has no adverse health effects
on people whilst few respondents (10.0 %) agreed. The participants who disagreed that throwing faeces into
Respondents (87.8 %) who believed that germs are easily streams is a good sanitation practice were 54.8 % which is
found in filthy places with a lot of garbage were more than more than participants who agreed. The number of
respondents (24.0 %) who never believed. Also, most respondents who disagreed that community sanitation
participants (93.0 %) indicated that garbage pile around exercise was not the responsibility of the youth was very
dustbin in a household invite houseflies and rodents into low (11.1 %) as compared to participants (84.7 %) who
Sanitation Attitudes of Urban Dwellers and their Influence on Sanitation Practices in Central Region of Ghana
Int. J. Toxicol. Environ. Health 074
Table 3. Univariate association between respondents’ regularities of solid waste disposal and their demographic
characteristics (N=360)
Demographic characteristics Daily Weekly Monthly NSP* Total 𝝌𝟐 p-value
f(%) f(%) f(%) f (%) f(%) f(%) f(%)
Sex
Male 123(36.6) 34(9.4) 4(1.2) 2(0.6) 173 (48.3)
Female 142(40.4) 29(8.0) 11(3.0) 2(0.6) 187 (52.0) 4.365 0.225
Total 278(84.5) 63(17.4) 15(4.2) 4(1.2) 360 (100.0)
Occupation
Student 90(29.2) 19(6.2) 2(0.6) 4(1.3) 115(37.3)
Farmer 35(11.4) 4(1.3) 0(0.0) 0(0.0) 39 (12.7)
Civil servant 22(7.1) 3(1.0) 0(0.0) 0(0.0) 25(8.1)
Politician 1(0.3) 0(0.0) 0(0.0) 0(0.0) 1(0.3) 12.382 0.650
Trader 87(28.2) 11(3.6) 1(0.3) 0(0.0) 99(32.1)
No occupation 26(8.4) 2(0.6) 1(0.3) 0(0.0) 29(9.4)
Total 261(84.7) 39(12.7) 4(1.2) 4(1.3) 360(100.0)
Educational status (Highest)
Primary
Secondary 118(32.7) 23(6.4) 1(0.2) 3(0.9) 145(40.2)
Tertiary 137(38.0) 27(7.5) 3(0.8) 1(0.2) 168(46.6)
None 21(5.8) 4(1.1) 0(0.0) 0(0.0) 25(6.9) 5.985 0.741
Total 21(5.8) 1(0.2) 0(0.0) 0(0.0) 22(6.0)
297(82.3) 55(15.2) 4(1.0) 4(1.1) 360 (100)
*No Specific Time
Table 4. Results of respondents’ attitude towards sanitation (N= 360)
S/N Agree Not Sure Disagree Mean SD*
Statement
1 It is the responsibility of anyone who generates refuse to put it into 305 15 40
the dustbin (84.7%) (4.2%) (11.1%) 4.08 1.18
2 Community sanitation exercise is not the responsibility of the youth 93 15 252
(25.8 %) (4.2 %) (70.0 %) 2.28 1.35
3 Defecating in bushes/fields and backyard has no adverse health 36 19 305 1.76 1.05
effects on people (10.0 %) (5.3%) (84.7 %)
4 Throwing refuse into gutters and on the street can cause flood. 305 20 35
(84.7 %) (5.6%) (9.7) 4.19 1.12
5 Always covering drinking water stored in containers does not 111 60 189
prevent contamination (30.8 %) (16.7%) (52.5 %) 2.61 1.31
6 Improper disposal of waste is one of the environmental challenges 305 20 35
that needs to be solved urgently (84.7 %) (5.6%) (9.7 %) 4.21 1.13
7 Leaving cooking utensils without washing for days after cooking is 303 13(3.6 %) 44
not hygienic (84.1 %) (12.3 %) 4.18 1.17
8 Weeding your surroundings and keeping your household clean 345 5 10
could protect the body against certain diseases (95.9 %) (1.4%) (2.7 %) 4.42 0.70
9 Leaving stagnant waters around your household could serve as 348 4 8
breeding grounds for mosquitoes. (96.7 %) (1.1 %) (2.2 %) 4.42 0.70
10 Treating water through disinfection kills the germs 261 84 15
(72.5 %) (23.6%) (4.0 %) 3.86 0.85
11 Throwing faeces into streams is a good sanitation and hygienic 68 14 278
practice (18.9 %) (3.8 %) (77.3 %) 1.98 1.28
12 Frequent washing of hands with soap after visiting the toilet can 332 8 20
help in protecting the body from diseases (92.2 %) (2.2 %) (5.6 %) 4.35 0.89
13 Garbage piled around a dustbin in a household can invite houseflies 334 9 17
and rodents into that house (92.8 %) (2.5%) (4.7 %) 4.37 0.82
14 Burning garbage or refuse at backyards of households is not 248 24 88
environmentally sound (68.9 %) (6.7%) (24.4 %) 3.67 1.28
15 Germs are easily found in filthy places with a lot of refuse/garbage. 316 20 24
(87.8 %) (5.5%) (6.7 %) 4.20 0.95
*SD – Standard Deviation
Sanitation Attitudes of Urban Dwellers and their Influence on Sanitation Practices in Central Region of Ghana
Safo-Adu G. 075
agreed. Again, many respondents (84.7 %) believed that respondents (76.4 %) had good attitudes towards
throwing refuse into gutters and on streets can cause sanitation. Few respondents (3.3 %) had bad attitudes
flood. and one out of every 24 persons never believed that towards sanitation. Respondents who had moderate
treating water through disinfection kills the germs in the attitude towards sanitation constituted 20.3 %.
water. Furthermore, participants (52.5 %) who disagreed
that always covering drinking water stored in containers Table 5. Summary of results on respondents’ attitude
does not prevent contamination were 21.7 % which is more towards sanitation and hygiene (N=360)
that participants (30.8 %) who agreed. It was agreed by Attitude Frequency Percent
many respondents (84.1 %) that leaving cooking utensils Good (> 52.5) 275 76.4
without washing for days after cooking is not hygienic. In Moderate (37.5 ≤ v ≤ 52.5) 73 20.3
addition, most respondents (70.0 %) felt that community Bad (< 37.5) 12 3.3
sanitation exercise is the responsibility of the youth. Also, Mean 2.73
it was reported by many participants (92. %) that frequent Standard Deviation 0.51
washing of hands with soap after visiting the toilet can help
protect the body against diseases and about 69.0 % of The result of Chi- square test performed to examine the
participants agreed to the fact that burning of garbage or relationship between respondents’ attitudes towards
refuse at backyards of households is not environmentally sanitation and their demographic characteristics is
sound. 84.7 % of respondents reported that improper presented in Table 6. There was no significant
disposal of waste is one of the environmental challenges relationship between respondents’ attitudes towards
that need to be solved urgently. sanitation and their sex (𝜒 2 = 3.11, p = 0.21), age (𝜒 2 =
The summary of results on respondents’ attitude towards 3.80, p = 0.15) occupation (𝜒 2 = 13.38, p = 0.20) and
sanitation is shown in Table 5, as a significant number of educational qualification ( 𝜒 2 = 6.62, p = 0.36).
Table 6. Univariate association between respondents’ attitudes toward sanitation and their demographic characteristics
(N=360)
Demographic Respondents attitude Total 𝜒2 p-value
characteristics Bad f(%) Moderate f(%) Good f(%) f(%) f(%) f(%)
Sex
Male 6(1.8) 27(7.9) 131(38.3) 173(48.0)
Female 6(1.8) 43(12.6) 129(37.7) 187(52.0) 3.105 0.212
Total 12(3.5) 70(20.5) 260(76.0) 360(100.0)
Age Group
10 – 17 0(0.0) 15(4.3) 64(18.5) 85(22.8)
18 and above 12(3.5) 53(15.3) 202 (58.4) 275(77.2) 3.801 0.149
Total 12(3.5) 68(19.7) 266(76.9) 360(100.0)
Occupation
Student 3(0.9) 16(5.0) 100(31.2) 119(37.1)
Farmer 1(0.3) 10(3.1) 33(10.3) 44(13.7)
Civil servant 1(0.3) 4(1.2) 21(6.5) 26(8.1)
Politician 0(0.0) 1(0.3) 0(0.0) 1(0.3) 13.375 0.203
Trader 4(1.2) 20(6.2) 77(24.0) 101(31.5
No occupation 2 (0.6) 10(3.1) 18(5.6) 30(9.3)
Total 11(3.4) 61(19.0) 249(77.6) 360(100.0)
Educational
status(Highest)
Primary 3(0.9) 27(8.5) 78(24.7) 108(34.2)
Secondary 7(2.2) 24(7.6) 127(40.2) 158(50.0)
Tertiary 2(0.6) 5(1.6) 21(6.6) 28(8.9) 6.615 0.358
None 0(0.0) 6(1.9) 16(5.1) 22(7.0)
Total 12(3.8) 62(19.6) 242(76.6) 360(100.0)
Summary of the results of respondents’ sanitation had poor sanitation practices. Also, about 27 % of the
practices is shown in Figure 1. Most respondents (58 %) respondents had moderate standard sanitation practices.
had good sanitation practices. Few respondents (15.0 %)
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Sanitation Attitudes of Urban Dwellers and their Influence on Sanitation Practices in Central Region of Ghana