Behavioral influences on risk of exposure to fecal contamination in low-resource neighborhoods in Accra, Ghana

Rapid urbanization in low-resource countries has led to a growing sanitation crisis, with widespread fecal contamination and risk of adverse health outcomes. Understanding how to change sanitation behaviors and reduce exposure to fecal contamination is central to Sustainable Development Goal 6. This study examines behavioral influences on fecal contamination in six low-resource neighborhoods of Accra, Ghana. Qualitative data comprised 12 key informant interviews with community leaders and 16 focus group discussions with residents. Results identify behaviors that increase the presence of feces in urban neighborhoods and risk of exposure to fecal contamination. Significant barriers to access and use of public and private latrines led to a range of defecation and excreta management practices. These methods of fecal disposal, together with poor sanitation services (i.e. refuse collection, public drainage, public latrines), environmental conditions (i.e. wind, rain), and employment activities (i.e. fishing, hawking), exacerbate the spread of feces and risk of exposure to fecal contamination. The transfer of fecal contamination between public and private domains creates repeated risk of exposure to fecal contamination for residents during daily activities. This pervasiveness of fecal contamination in the environment, suggests the need for multi-sectoral approaches to reduce fecal contamination that go beyond provision of public or private latrines.