The stakes could hardly be higher. Groundwater is often assumed to be inherently safe because soil and rock layers filter out many contaminants as water percolates downward. Globally, it supplies drinking water to an estimated two billion people and constitutes roughly thirty percent of the planet’s available freshwater. In Ghana, national survey data show that groundwater sources, mainly boreholes and hand-dug wells, provide the primary drinking water for about 36.4 percent of households nationwide and 37.1 percent in the Northern region. Yet the new findings demonstrate that this reputation for safety can be dangerously misleading in densely settling urban catchments where sanitation lags behind growth.

Tamale is a case study in rapid, uneven urbanization. The city has grown from fewer than two thousand residents in 1907 to more than 232,000 by the 2010 census, and between 2001 and 2014 its built-up area expanded by an estimated 78 percent, an annual growth rate of 4.4 percent. The metropolis now encompasses the urban core, seventeen peri-urban communities and 115 villages spread across 922 square kilometres. Pipe-borne water, treated at a conventional facility at Dalun-Naawuni, reaches only part of this sprawl, and erratic supply, poor distribution to new suburbs and rising tariffs push households toward self-supply. The result is a dense scatter of boreholes and wells, many of them privately developed, poorly maintained and unprotected from the wastes of the settlements that surround them.

To assess the consequences, researchers from the Council for Scientific and Industrial Research Water Research Institute and partner institutions sampled twenty groundwater sites, ten hand-dug wells and ten boreholes, distributed across different suburbs using cluster and purposive sampling. Fieldwork took place during the 2022/23 lean season, when low rainfall means the aquifer reflects its true baseline condition rather than storm-driven dilution or flushing. Borehole samples were drawn after flaming the pump nozzle with ethanol-soaked cotton and purging the system for eight to twelve minutes, while well samples were collected with a flamed metallic sampler lowered to the water level. All samples reached the laboratory within two hours, where analysts used the membrane filtration technique standardized by the American Public Health Association, incubating total coliforms and Escherichia coli at 37 degrees Celsius and faecal coliforms at 44 degrees Celsius for roughly 24 hours.

The numbers are stark. In hand-dug wells, total coliform counts ranged from zero to 32,200 colony-forming units per 100 millilitres, with a median of 379. Faecal coliforms reached 18,000 cfu/100 ml, and E. coli, the single most reliable indicator of faecal contamination and a causative agent of diarrhoeal disease and urinary tract infections, was detected in half of the wells, with counts up to 16,000 cfu/100 ml. Seventy percent of wells tested positive for total and faecal coliforms. Boreholes fared better but not cleanly: half exceeded acceptable total coliform limits, twenty percent carried faecal coliforms above 200 cfu/100 ml, and although no borehole sample exceeded the E. coli guideline, the median total coliform count of 600 cfu/100 ml signals that contamination pathways exist even in these supposedly protected sources.

Physical measurements reinforced the microbial picture. Median turbidity, a measure of suspended particles that both shelters microbes and interferes with disinfection, stood at 78 NTU for wells and 119 NTU for boreholes, with individual readings as high as 234 and 182 NTU respectively, all far above the permissible range for potable water. Statistical testing, including Shapiro-Wilk normality checks, an unpaired t-test and the non-parametric Mann-Whitney U test, found no significant difference in turbidity between the two source types, suggesting the problem is catchment-wide rather than specific to one technology. Turbid water demands more treatment, raising costs for households and the informal water vendors who resell supplies, and it provides substrates on which bacteria can persist and multiply.

Perhaps the most alarming discovery came from antibiotic susceptibility testing. Confirmed E. coli isolates from the wells were challenged against eight antimicrobial agents using the Kirby-Bauer disk diffusion method on Mueller-Hinton agar. The isolates resisted six of them, ceftazidime, cefuroxime, augmentin, cefixime and, in some tests, gentamicin and nitrofurantoin, while remaining susceptible to the fluoroquinolones ciprofloxacin and ofloxacin. The finding means that people infected through contaminated groundwater face treatment options narrowed by resistance, and it adds Tamale’s water supply to the growing global map of environmental reservoirs of antimicrobial resistance, a phenomenon with direct implications for empirical treatment protocols in regional clinics.

Sanitary inspections, conducted with a World Health Organization risk assessment form adapted to local conditions, explained much of what the laboratory revealed. Inspectors scored each site against risk factors such as unsanitary covers, aprons smaller than one metre in radius, missing or faulty fences, nearby pollution sources and latrines within ten metres. Dug-wells scored between 1 and 7, with most falling into higher risk categories, while boreholes scored between 2 and 6 and achieved four low-risk ratings. The most frequent risk factors were other sources of pollution and unsanitary or inadequate covers and aprons. Notably, no latrines were found within ten metres of any well and no ponding within two metres of any borehole, the latter likely a seasonal effect of dry harmattan winds and rapid evaporation. Binomial regression suggested that a small apron increased the odds of high faecal coliform loading by a factor of 4.3, although the associations did not reach statistical significance at the 0.05 level.

Applying WHO infection risk classifications, in which any E. coli count above zero is unsafe, 1 to 10 cfu/100 ml is low risk, 11 to 100 is intermediate and above 100 is high, the team found that half of the dug wells posed no E. coli risk, twenty percent posed low risk, twenty percent intermediate and ten percent high risk. Boreholes conformed to the E. coli guideline entirely. The researchers attribute the boreholes’ relative advantage to deeper construction, intact contamination pathways, safe distancing from septic points and, in some cases, developers’ compliance with the Water Resource Commission’s requirement that groundwater points sit 100 feet from septic infrastructure. Still, the presence of coliforms in half of the boreholes means the barrier is not absolute, and the absence of delineated protection zones around some sites leaves them vulnerable as the city grows.

The authors conclude that periodic disinfection and proper maintenance of aprons, covers and auxiliary components of both wells and boreholes are essential, alongside stronger enforcement of metropolitan by-laws on water safety, subsidies for household treatment technologies and penalties for non-compliant private vendors. They also acknowledge limitations, including the modest sample size imposed by logistics and laboratory resources, and call for future work on pathogens such as Salmonella and Campylobacter and their resistance profiles. For now, the message for Tamale’s residents is clear: the water beneath their feet is not automatically safe, and in a city adding new suburbs faster than pipes, the microbial margin between a functioning well and a source of typhoid, diarrhoea and drug-resistant infection is being decided by maintenance, distance and vigilance rather than by geology alone.

Subject of Research: Microbial contamination and health risk assessment of groundwater in urbanizing Tamale, Northern Ghana

Article Title: Groundwater microbial quality and risk evaluation in a rapidly transforming urbanized area of Northern Ghana

Article References: Bekoe, E. M. O., Hayford, D., Quarcoo, G., & Yar, D. D. (2025). Groundwater microbial quality and risk evaluation in a rapidly transforming urbanized area of Northern Ghana. BMC Environmental Science, 2(1), Article 9. https://doi.org/10.1186/s44329-025-00022-w

Image Credits: AI Generated

DOI: 10.1186/s44329-025-00022-w

Keywords: groundwater, E. coli, coliforms, water quality, Tamale, Ghana, urbanization, sanitary inspection, antimicrobial resistance, boreholes, hand-dug wells, public health

The study comes at a time when effective conventional treatment for malaria is theoretically within reach of most Ghanaian families. Artemisinin-based combination therapies, the World Health Organization-recommended standard for uncomplicated malaria, are widely distributed through hospitals, clinics, and licensed over-the-counter medicine sellers, and Ghana’s National Health Insurance Scheme is designed to reduce the financial barrier to seeking formal care. Yet the research team, led by Evans Paul Kwame Ameade of the Department of Pharmacognosy and Herbal Medicine, found that despite this infrastructure, herbal preparations continue to occupy a substantial place in the domestic management of febrile illness. The persistence of plant-based medicine use in an urban metropolis, rather than only in remote rural communities, is one of the most notable aspects of the work.

Methodologically, the investigation took the form of a community-based cross-sectional survey. The researchers recruited participants through convenience sampling and administered a semi-structured questionnaire to female caregivers of children aged twelve years or below. Data were analysed using SPSS version 23, with chi-square tests employed to explore initial associations between caregiver characteristics and the use of plant-based medicines, and logistic regression then applied to adjust for confounding variables and calculate adjusted odds ratios. The ethical protocol, including the use of verbal rather than written informed consent, was approved by the Ethics Committee of the School of Medicine and Health Sciences, a decision the authors justified on the grounds of minimal risk and the community-based nature of household interviews.

The clinical picture that emerged from the survey is familiar to anyone who has studied malaria-endemic settings. Fever and vomiting were the symptoms most commonly cited by caregivers as the triggers for suspecting malaria in a child, a pattern consistent with the way the disease typically announces itself in paediatric patients. When asked where they would prefer to take a child with suspected malaria, 77.6 percent of caregivers named the hospital as their primary healthcare facility. On the surface, this figure suggests strong confidence in formal medical institutions. Yet the same population reported substantial use of herbal first-line treatment, indicating that preference for hospitals and recourse to plants are not mutually exclusive but instead operate as parallel strategies within the same households.

The botanical pharmacopoeia identified by the study reads like a catalogue of the region’s most abundant trees and shrubs. The neem tree, Azadirachta indica, was the most frequently cited antimalarial plant, mentioned by 18.7 percent of caregivers who reported herbal use. It was followed by Carica papaya, the papaya, at 16.5 percent, and Psidium guajava, the guava, at 14.3 percent. Senna occidentalis accounted for 10.0 percent of citations and Mangifera indica, the mango, for 9.6 percent. Each of these species has a long history in West African traditional medicine, and several contain phytochemicals with documented or suspected biological activity. Neem, for instance, is rich in limonoids such as azadirachtin and nimbin, while papaya leaves contain alkaloids and phenolic compounds that have attracted laboratory interest for their effects on malaria parasites and on the platelet changes associated with the disease.

The researchers were careful, however, to frame these findings in terms of practice rather than efficacy. The study documents what caregivers do, not whether the preparations they administer work against Plasmodium infection. This distinction matters clinically. Unvalidated herbal treatments for a febrile illness that may or may not be malaria carry the risk of delaying accurate diagnosis and effective artemisinin-based therapy, which in children can mean the difference between a rapid recovery and progression to severe disease. At the same time, the authors note that caregivers use multiple treatment approaches, and plant-based medicines may be deployed alongside, rather than instead of, conventional drugs, raising additional questions about interactions and dosing that current health communication rarely addresses.

Perhaps the most consequential results are the two factors that independently predicted herbal first-line use. Caregivers from low-income households had dramatically higher odds of using plant-based medicines, with an adjusted odds ratio of 9.449 and a 95 percent confidence interval spanning 1.185 to 75.354, a statistically significant association at p equal to 0.034. The second significant predictor was family size: caregivers with more than two children under the age of five had an adjusted odds ratio of 7.905, with a confidence interval of 1.384 to 45.162 and a p value of 0.020. The wide confidence intervals reflect the modest sample size of 265 participants, and the authors and readers alike should interpret the magnitude of these estimates with appropriate statistical caution. Nevertheless, the direction of both associations is intuitively coherent and aligns with broader patterns in health-seeking behaviour research.

The income effect is particularly telling in the context of Ghana’s health financing reforms. The National Health Insurance Scheme was established precisely to remove cost as a deterrent to formal care, yet the study suggests that economic pressure continues to push households toward remedies that are essentially free for the gathering. A handful of neem leaves or papaya leaves requires no transport fare, no registration fee, and no waiting time. For a mother managing several children under five, each susceptible to the fevers that sweep through the rainy season, the calculus is shaped not only by money but by time and logistics. A caregiver responsible for multiple infants and toddlers may find that preparing a herbal infusion at home is the only feasible response when a child falls ill at night, or when taking one child to hospital would mean carrying the others along.

The public health implications of the study extend beyond Tamale. Malaria control programmes across sub-Saharan Africa have invested heavily in expanding access to diagnostics and artemisinin-based combination therapy, and progress against the disease depends on children receiving confirmed diagnoses and complete courses of effective drugs promptly. If more than a third of caregivers in an urban metropolis with good hospital access begin treatment with plants, then the true scale of herbal first response across more rural settings is likely to be at least as large. The authors argue that understanding the sociodemographic drivers of this behaviour, rather than simply discouraging it, is essential for designing interventions that meet families where they are. Targeted health education aimed at low-income households and at caregivers of large families of young children could address the specific circumstances that make herbal treatment the default choice.

The study also carries a message for the research community. The plants identified by caregivers, led by neem, papaya, and guava, represent a documented corpus of local knowledge that could inform future phytochemical and pharmacological investigation, provided such work proceeds with rigorous standards for safety and efficacy. Meanwhile, the finding that hospitals remain the preferred facility for the overwhelming majority of caregivers suggests that trust in biomedical care is not the obstacle; accessibility, affordability in practice, and the realities of household management are. As Ghana and its neighbours push toward malaria elimination, studies of this kind, grounded in the everyday decisions of mothers and grandmothers, illuminate the gap between what health systems offer and what families actually do, a gap that no single drug or policy can close without understanding the lives of the people it is meant to protect.

Subject of Research: Prevalence and determinants of plant-based medicine use among caregivers treating suspected malaria in children in Tamale, Ghana

Article Title: Use of plant-based medicines for suspected childhood malaria in Tamale Metropolis, Ghana: prevalence and associated factors

Article References: Ameade, E. P. K., Laari, S. M., & Adom, E. (2026). Use of plant-based medicines for suspected childhood malaria in Tamale Metropolis, Ghana: prevalence and associated factors. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05608-8

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05608-8

Keywords: malaria, plant-based medicines, traditional medicine, child health, Ghana, caregivers, complementary medicine, Azadirachta indica, Carica papaya, public health, Tamale, health-seeking behaviour