American Journal of Epidemiology and Infectious Disease
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American Journal of Epidemiology and Infectious Disease. 2015, 3(3), 61-69
DOI: 10.12691/ajeid-3-3-3
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Persistent “Cholerization” of Metropolitan Accra, Ghana: Digging into the Facts

Daniel A. Bagah1, Issaka K. Osumanu2 and Ebenezer Owusu-Sekyere3,

1Department of Social, Political and Historical Studies, University for Development Studies, Wa, Ghana

2Department of Environment and Resource Studies, University for Development Studies Wa, Ghana

3Department of Development Studies, University for Development Studies Wa, Ghana

Pub. Date: July 13, 2015

Cite this paper:
Daniel A. Bagah, Issaka K. Osumanu and Ebenezer Owusu-Sekyere. Persistent “Cholerization” of Metropolitan Accra, Ghana: Digging into the Facts. American Journal of Epidemiology and Infectious Disease. 2015; 3(3):61-69. doi: 10.12691/ajeid-3-3-3


This paper examines the risk factors responsible for the 2014 cholera epidemic in Accra, Ghana’s primate city which affected 30,000 people and claimed over 200 lives in five months (May to September). Drawing on insights from a wide range of sources, we observed that laxity in potable water provision and sanitation services, coupled with erroneous socio-cultural beliefs were at the heights among the risk factors but have tended to be viewed within a narrow analytical frame. The most deprived and inadequately housed, and the indigenous communities disproportionately exemplified these challenges. In our view, this situation demonstrates how ineffective and insufficiently attentive environmental governance has perpetuated the inequality in spatial patterns of vulnerability and health risks facing humanity. We advocate the need for a broad-spectrum environmental policy that in cooperates intensive public health education that can addresses the erroneous beliefs in the disease epidemiology.

accra cholera ghana poor sanitation risk factors

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[1]  GHS, (2014). Special Ghana Health Service Report on the 2014 Cholera Outbreak.
[2]  Oteng-Ababio, M. (2012). The Role of the Informal Sector in Solid Waste Management in the GAMA, Ghana: Challenges and Opportunities. Tijdschr Econ Soc Geogr 2012, 103: 412-425.
[3]  Boadi, K. O., Kuitunen M. (2005). Childhood diarrheal morbidity in the Accra Metropolitan Area, Ghana: Socio-Economic, Environmental and Behavioral Risk Determinants. Journal of Health and Population in Developing Countries.
[4]  GSS, (2008). Ghana Living Standards Survey Report on the Fifth Round (GLSS5). Accra, Ghana Statistical Services, Government of Ghana.
[5]  Songsore, J., Nabila, J. S., Yangyuoru, Y., Amoah, E., Bosque-Hamilton, E. K., Etsibah, K, K., Gustafsson, J. E., Jacks, G. (2005). State of Environmental Health Report of the Greater Accra Metropolitan Area (GAMA) (Ghana Universities Press, Accra).
[6]  ISSER. (2012). Institute of Statistical, Social and Economic Research). Ghana Social development outlook, 2012, University of Ghana. Accra.
[7]  GSS, (2010). Final Report on Population and Housing Census, Accra: Sakoa Press Limited. Ghana Statistical Service.
[8]  Ghana Social Outlook, (2012). Institute of Statistical, Social and Economic Research, 201 ISSER, Accra.
[9]  Huober, A. L. (2010). Moving Towards Sustainable Solid Waste Management in Accra: Bridging the Formal-Informal Divide. Desertation, Amherst College.
[10]  WHO (2010). Cholera vaccines: WHO position paper. Weekly epidemiological record 85(13):117-128.
[11]  Osei, F.B., Duker, A.A., Augustijn, E.W., Stein, A. (2010). Spatial Dependency of Cholera Prevalence on Potential Cholera Reservoirs in an Urban Area; Kumasi; Ghana. Int. J. Appl. Earth Obs. Geoinf. 12(5):331-339.
[12]  Kelly, M. P., Bonnefoy, J., Morgan, A., Florenzano, F. (2006). The Development of the Evidence Base about the Social Determinants of Health. Measurement and Evidence Knowledge Network. http://www.who.
[13]  Sack, D.A., Tacket, C.O., Cohen, M.B., Sack, R.B., Losonsky, G.A.; Shimko, J., Nataro, J. P., Edelman, R., Levine, M.M., Giannella, R.A., Schiff, G., Lang, D. (1998). Validation of a Volunteer Model of Cholera with Frozen Bacteria as the Challenge. Infect. Immun. 66(5):1968-1972.
[14]  Hornick, R.B., Music, S.I., Wensel, R., Cash, R., Libonati, J. P., Snyder, M. J. Woodward, T. E. (1971). The Broad Street Pump Revisited; Response of Volunteers to Ingested Cholera vibrios. Bull. NY Acad. Med. 47(10):1181-1191.
[15]  WHO, (2006). The World Health Report 2002: Reducing Risks, Promoting Health Life. Geneva, WHO.
[16]  WHO, (1993). Guidelines for Cholera Control. World Health Organization; Geneva.
[17]  Sack, D.A., Sack, R.B., Nair, G. B., Siddique, A. K. (2004). Cholera. Lancet 363 (9404): 223-233.
[18]  Mahalanabis, D., Molla, A., Sack, D. (1992). Clinical Management of Cholera. In Cholera, D. Barua, & W. Greenough III (Eds.). Plenum Medical Book Company, New York, pp 253-283.
[19]  WHO, (2011) 64th World Health Assembly Report, WHA 64.15 (Assessed on 30/04/2013).
[20]  Garau, P., (2008). Revisiting Urban Planning in Developed Countries’, Unpublished Regional Study Prepared for the Global Report on Human Settlements 2009,
[21]  WHO, (1979). Child Care Practices Related to Diarrhoeal Diseases. Diarrhoeal Diseases Control Programmes, Geneva. WHO/CDD/SER/79.4, WHO.
[22]  Harmer, D. H., Cash, R. A. (1999). Secretory Diarrheas: Cholera and Enterotoxigenic Escherichia Coli. In: Infectious Diseases, Donald, A. & Cohen, J. (Eds.), Harcourt Publishers Ltd, Mosby.
[23]  Faruque, S. M., Albert, M.J., Mekalanos, J. J. (1998). Epidemiology; Genetics and Ecology of Toxigenic Vibrio cholerae. Microbiol. Mol. Biol. Rev. 62(4):1301-1314.
[24]  WHO, (2009). Integrating Poverty and Gender into Health Programmes. A Sourcebook for Health Professionals.
[25]  Dickson, K. B, (1969) A Historical Geography of Ghana (Cambridge University Press, Cambridge).
[26]  World Bank, (2007). Report on Infrastructure Development in Ghana. Washington DC, The World Bank.
[27]  Angel, S., Sheppard, S., Civco, D., (2005). The Dynamics of Global Urban Expansion. Transport and Urban Development Department, the World Bank, 2005.
[28]  Farvacque-Vitkovic, C., Madhu Raghunath, M., Eghoff, C., Boakye C., (2008). Development of the Cities of Ghana: Challenges, Priorities and Tools; Africa Region Working Paper Series Number 110. World Bank. Working Paper Series web address:
[29]  Oteng-Ababio, M. (2013). Unscripted (in) Justice: Unequal Exposure to Ecological Hazards in Metropolitan Accra. Journal of Environmnt and Planning A, 45.
[30]  Issaka, K. O. (2007). Household Environmental and Behavioural Determinants of Childhood Diarrhoea Morbidity in the Tamale Metropolitan Area (TMA), Ghana. Danish Journal of Geography 107(1):59-68, 2007.
[31]  Benneh, G., Songsore, J., Nabila, J.S, Amuzu, A.T., Tutu, K.A., Yangyuoru, Y. and McGranahan, G. (1993). Environmental Problems and the Urban Household in the Greater Accra Metropolitan Area (GAMA) – Ghana, (Stockholm Environment Institute, Stockholm).
[32]  Kenny, D. A. (1987). Statistics for the social sciences. Boston, Little Brown.
[33]  Shier, R. P., Dollimore, N., Ross, D. A., Binka, F. N., Quigley, M., Smith, P. G. (1996). Drinking Water Sources, Mortality And Diarrhoea Morbidity Among Young Children in Northern Ghana. Tropical Medicine and International Health, 1: 334-41.
[34]  Faber, D. R., Krieg, E. J. (2002). Unequal Exposure to Ecological Hazards: Environmental Injustices in the Commonwealth of Massachusetts” Environmental Health Perspectives 110 277-288.
[35]  Mensah, P., Yeboah-Manu, D., Owusu-Darko, K., Ablordey, A. (2002). Street foods in Accra, Ghana: how safe are they? Bulletin of the World Health Organisation, 80: 546-554.