Drivers of sanitation compliance in Ghanaian households: a case study of Wa and Sagnarigu

ABSTRACT Understanding household compliance with environmental sanitation by-laws is vital for strengthening urban health governance in low- and middle-income countries. This study investigated the socio-demographic determinants of sanitation by-law awareness and compliance in two rapidly urbanising municipalities in Ghana – Wa and Sagnarigu – using a mixed-methods approach. Structured household surveys provided quantitative data while qualitative interviews and group discussions offered deeper insights. Results revealed that 81.85% of households were aware of sanitation by-laws, with significant variation across districts and educational levels (at p 0.001). Education, occupation, and household income were strongly associated with awareness and receipt of penalties for non-compliance, while age and sex showed no significant effects. Results of the chi-square test revealed that education is the strongest predictor of responsible sanitation practices, particularly waste segregation. Logistic regression identified a lack of knowledge (p 0.001) and distance to disposal sites (p = 0.039) as major barriers to awareness. In contrast, inconsistent waste collection services (p = 0.0027) were positively associated with awareness, likely due to increased exposure through service-related complaints or interventions. These findings highlight the need for context-specific enforcement, community-based education, and infrastructural investment to improve urban sanitation governance and advance equitable environmental health outcomes in sub-Saharan Africa.