An a busy morning in an Accra market, the day begins long before most customers arrive.
Traders arrange vegetables, prepare food and fill containers with water. Nearby, pedestrians move through crowded walkways while food vendors serve meals to workers, traders and commuters.
For thousands of people, this is an ordinary morning. But hidden within this everyday routine is a public-health problem that Ghana has struggled with for decades: typhoid fever.
Typhoid is not an unavoidable disease. It is mainly transmitted through food and water contaminated with faeces, meaning that safe drinking water, proper sanitation, hand hygiene and safe food handling can prevent much of its transmission.
The World Health Organisation (WHO) identifies access to safe water, adequate sanitation, food-handler hygiene and vaccination as important tools for prevention.
Yet, prevention becomes difficult when the systems supporting these behaviours are unreliable.
In many markets, food vendors operate informally, often in crowded environments where access to clean water, toilets, waste disposal facilities and suitable food preparation spaces may be limited.
Research on food vendors in Ghana has found that having the knowledge of food safety does not always translate into consistent safe practices.
The problem is, therefore, bigger than an individual vendor failing to wash their hands.
Consider a vendor who wants to prepare food safely.
If the available water is limited, if there is no convenient handwashing station, or if the nearest toilet is poorly maintained, maintaining good hygiene becomes considerably harder.
Chain
Water is another part of the chain. In Accra, intermittent access to municipal water has contributed to dependence on alternative water sources, including packaged water.
While research has found good microbial quality in some sachet water samples, the continued need for alternative water supplies demonstrates how important reliable water infrastructure is to public health.
The danger can also enter the food chain before food reaches the market.
A study examining produce in Accra found widespread E.coli contamination and identified irrigation water and soil as important risk factors.
Prepared salads sold by street vendors were particularly contaminated, while dirty water used to rinse produce was also observed.
Then there is the market environment itself. Choked drains, overflowing waste containers and poorly maintained toilets can create conditions in which human waste and contaminated water come into contact with food, hands and surfaces.
Recent reporting from the Adjen Kotoku Market, for example, documented concerns about deteriorating toilet facilities and inadequate sanitation infrastructure.
Food vendors are not necessarily unaware of these dangers.
A study involving vendors in Accra found that many had knowledge of basic food safety practices, but some practices were not consistently followed.
One identified risk was washing food utensils with water that had already been used for handwashing after toilet attendance.
Enforcement is particularly important because food safety regulations only protect the public when they are implemented consistently.
Research on Ghana's urban food markets has identified weak enforcement of food safety regulations as one contributor to continuing food safety challenges.
Another study identified vendor anonymity, poor trust in the regulatory system and risky vendor practices as interconnected barriers to sustaining street food safety.
There have been enforcement efforts.
In 2022, for instance, the Accra Metropolitan Assembly reported taking more than 30 food vendors to court for operating under unhygienic conditions or without health certificates.
But periodic enforcement cannot substitute for a system in which safe infrastructure, routine inspection and continuous education are available every day.
The solution, therefore, cannot simply be to tell the public to “wash their hands” or tell vendors to “keep their food clean.”
Ghana needs functioning toilets and drainage systems in markets, dependable access to safe water, appropriate facilities for food preparation, regular inspection of food businesses, practical hygiene training and consistent enforcement of food safety regulations.
Vaccination can add another layer of protection, particularly in populations at risk.
Typhoid remains stubbornly common not because Ghana lacks knowledge about how to prevent it, but because prevention breaks down at several points between the water source, the market, the food vendor and the consumer.
Until those gaps are addressed together, the same bacteria can continue to travel through the same everyday pathways, quietly moving from contaminated environments into food, from food into people, and from one household to another.
For the trader opening a stall at dawn, the customer buying breakfast and the child drinking water after school, typhoid prevention should not depend on luck.
Safe food, safe water and adequate sanitation should be ordinary features of daily life, not privileges available only when every part of the system happens to work.
The writer is a Biochemistry and Molecular Biology student,
University of Health and Allied Sciences (UHAS).
