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Coastal Community Resilience to Climate and Diarrhoea (C2R-CD) Project

Principal Investigator (PI) - Dr. Dzidzo Yirenya-Tawiah, Senior Research Fellow, IESS-UG


Global climate change is expected to severely impact human health in various ways, including increasing the occurrence of waterborne enteric diseases, especially in poor and vulnerable communities that have low adaptive capacity. The relationship between climate change and health is however complex as many factors are interlinked, and include mediating drivers such as ecosystem disruption, biodiversity loss and social and economic conditions. As a result, promoting climate resilient health solutions require a comprehensive approaches developed with multi-stakeholder and multi-sectoral participation.
Diarrhoea, a highly preventable waterborne disease, causes an estimated 1.31 million deaths per year, with nearly half a million deaths in children under 5 years. In addition to morbidity and mortality rates, diarrhoea also impairs growth and cognitive development as well as increases susceptibility to other infectious and chronic diseases. With climate change, the relative risks of diarrhoea is projected to increase by 8-11% (2010-2039) and 22-29% by the end of the century. The greatest burden of climate attributable deaths is focused in sub-Saharan Africa (SSA) and Asia, with estimates of 37,084 and 62,618 deaths in children ages 0-15, based on minimum and maximum temperature anomalies, respectively, by 2030.
Evidence show a significantly positive association between meteorological conditions such as temperature, rainfall and flooding, and diarrhoeal occurrence. Floods, for instance, are identified as the most pervasive hydro-meteorological hazard with variable annual dynamics that can change dramatically in flow volume, duration, frequency, and timing. Increasing risks of diarrhoea have been reported in flood affected areas linked to particular pathogens found during or after floods. The interacting hydrological, geomorphological, and sedimentary processes are fundamental determinants of microbial dynamics, water quality, and waterborne pathogen exposure in humans and animals in flood-prone areas.
The quantification of climate-related health impacts is limited due to lack of high-quality long-term empirical data and the complex multi-directional impacts from cause-effect relations, hampering ability to address climate-mediated population vulnerabilities. In developing countries, diarrhoeal transmission processes are exacerbated by various risk factors such as inadequate access to safe water and sanitation, poor nutrition and hygiene practices, and inadequate access to healthcare, which are influenced by existing environmental and socio-economic issues. For this reason, transdisciplinary based approaches are required to integrate empirical evidence of the various factors influencing diarrhoea in computational models to better quantify the risk and management of diarrhoea under different climate scenarios. This will ensure that effective and appropriate adaptation strategies are co-developed and implemented by relevant actors to improve community resilience to current and future risks.
Ghana is among countries at risk from direct exposure to climate change and impacts on waterborne diseases, including diarrhoea. It ranks 107th out of 181 countries in the world for climate vulnerability and is the 68th most vulnerable country and the 81st least ready country, meaning that it is vulnerable to, and moderately ready to address climate change impacts. Already, the country is experiencing increased extreme weather conditions with higher incidences and more prolonged periods of flooding and droughts. Coastal communities have been identified as high-risk areas to climate change, with increased incidences of flooding due to sea level rise, coastal erosion, storm surges, surface runoff, etc. The numerous coastal wetland ecosystems are not only prone to regular flooding events that are linked to the risk of various water-borne infectious diseases but also serve as sites for transmission, especially with increasing contamination from land based sources.
In Ghana, diarrhoeal disease has remained in the top five causes of outpatient morbidity, increasing from 287,816 cases in 2012 to 1,429,990 in 2017. Transmission is strongly associated with unsafe water, poor sanitation and hygiene practices, a situation that is frequently seen in low-income communities that have limited access to basic water and sanitation infrastructure. Records show that diarrhoea prevalence is lowest among children who live in households with improved, unshared toilet facilities (5%), and households that are in the highest wealth quintile (7%).
A study conducted by the Ghana Statistical Service, Ghana Health Service and ICF International has also shown that most diarrhoea cases are not appropriately managed. Most low-income communities depend on community health systems such as over-the-counter medicine sellers (OTMS), especially for childhood disease management. A 2014 demographic health survey indicated that majority of caregivers seek diarrhoeal treatment for their children first from OTMS and private pharmacies, while a few depend on other sources such as traditional practitioners. As frontline health workers, OTMS play an important role in disease management and behaviour change. However, due to their low levels of education, they face credibility issues with customers and are generally unable to influence dispensing outcomes. Understanding the transactional dynamics between OTMS and customers is therefore critical for the success of programs seeking to improve the practices of this group of private providers and important for community-based climate-resilient health-care systems.
Alluding to all the complexities of climate change impacts and diarrhoea, amidst the socio-demographic and institutional linkages, the Coastal Communities Resilience to Climate and Diarrhoea (C2R-CD) project aims to generate long-term data series to model the interactions between climatic, hydrological, environmental, epidemiological, institutional and socio-cultural determinants of diarrhoea. The study will focus on communities found along the eastern and central coastline of the country, which are the most vulnerable to sea level rise and flooding incidents. The research will help explore the complexities and dynamics of diarrhoeal diseases under various climatic, social and environmental scenarios towards co-developing innovative and effective resilience solutions in coastal communities. Transdisciplinary processes will be used to engage multi-level and multi-sectoral stakeholders from the beginning to ensure that knowledge generated will be owned by all for better uptake. Training and awareness-raising activities will improve awareness and enhance understanding of climate change impacts on diarrhoea and ways to develop resilient health systems. Knowledge products will be made available to policy- and decision-makers to provide country-specific, evidence-based solutions towards addressing climate related health risks in coastal communities.


In Ghana, health is prioritized in the current national development agenda, the Coordinated Programme of Economic and Social Development Policies (2017-2024), as well as in sectoral frameworks that address public and environmental health. These include the Public Health Act (2012, Act 851), Ghana National Action Plan for Health Security (2018), and National Climate Change Policy (2016) and its Action Plan (2015-2020). Currently, a national One Health Policy is being developed to provide a collaborative strategy for addressing health risks that are interlinked across the human-animal-environment sectors. Achieving national health objectives therefore requires greater cooperation between various actors within and across multiple agencies, working at local, national and global levels. In recognition of these multi-sectoral and multi-level complexities, the C2R-CD project intends to employ a comprehensive approach to co-design interventions through participatory processes and transdisciplinary based approaches for developing the resilience of coastal communities to climate change and diarrhoeal diseases. Local partners from both the public and private sectors who have extensive experience in participatory stakeholder processes will play a key role in the implementation of the project.
The project aligns with Danish-Ghana Development Cooperation efforts in social progress at the local level with emphasis on improving health and better use of research results for evidence-based decision making. It also contributes to achieving the global SDGs 3 (Good Health and Wellbeing), 4 (Quality Education), 6 (Clean Water and Sanitation) and 13 (Climate Action) by supporting strategies to reduce under-five mortalities especially due to diarrhoea; promoting safe water and improved sanitation systems in communities, building capacity of researchers, PhD students, and communities in transdisciplinary processes linking various types of data to predictive modelling; as well as co-creation and co-implementation of innovative solutions for early warning systems and adequate response measures to climate hazards and diarrhoeal outbreaks. Finally, findings of the project will contribute to knowledge gaps that have been identified at the 10th Focal Point Forum of the Nairobi work programme on impacts, vulnerability and adaptation to climate change, which focused on health and adaptation; such as how changes in ecosystems influence the epidemiology and distribution of infectious diseases, how and where diseases are spread and the driving factors, and how current and projected climate change may impact on waterborne diseases (and water quality in general), vector-borne diseases and disasters.


The overall goal of the C2R-CD project is to build resilience to climate change and improve diarrhoeal management in coastal communities. To address this goal, the project will address the following key research questions:
1. What is the role of the biophysical environment, including climate change, on the incidence of diarrhoea diseases in coastal communities?
2. What are the linkages between the epidemiology and environmental determinants of diarrhoea-pathogen transmission in coastal communities?
3. What are the demographic, socio-cultural, economic and political barriers and enablers of effectively managing diarrhoeal diseases?
4. What are the implications of interactions and interlinkages between the environment, epidemiological situation, and socio-economic factors under various climate scenarios in different coastal communities? How can these be managed in an integrated and sustainable way?
5. In what ways can the resilience and health of coastal communities in Ghana be developed and up-scaled to other communities? How can local and national initiatives support these processes in innovative ways?
The specific objectives to achieve these aims are to:
1. Assess climatic and non-climatic determinants of diarrhoeal diseases in coastal communities in Ghana and understand how they impact on diarrhoeal transmission.
2. Understand the epidemiology and transmission pathways of diarrhoea in coastal communities.
3. Assess local governance systems that address climate related extreme events, disasters and disease outbreaks. Assess the capacity of community health systems to manage diarrhoea.
4. Develop a probabilistic scenario-testing framework for visualization of the complex interactions of the many factors associated with diarrhoea under climate change and climate extreme scenarios.
5. Build the capacity of communities in diarrhoea prevention and management, especially in during climate related events e.g. floods. Build capacity of PhD students, research scientists, communities and institutions in conducting transdisciplinary and applied research.


  • Gain understanding the dynamics of biophysical and climatic factors on coastal ecosystems to inform diarrhoeal management in coastal communities.
  • Strengthened knowledge on epidemiology of diarrhoea on coastal communities.
  • Improved knowledge on community based diarrhoeal management and response to climate hazards. Build coastal communities resilience to diarrhoea disease management especially in the events of climate variability
  • Strengthen the capacity of project team to undertake advanced data analysis and statistics based on open source software (e.g. Python); and produce a probabilistic scenario testing framework, which allows visualization by stakeholders of how incidences of diarrhoea may develop under climate change and climate extreme scenarios.
  • Strengthened community participation in co-creating knowledge and implementing strategies to address risk of climate hazards and manage diarrhoea in coastal areas.
  • Trained researchers in conducting transdisciplinary collaborative research and application of relevant modelling and scenario building tools for predicting climatic effects on diarrhoea


  • Acquisition, generation and organization of data on climatic and non-climatic factors impacting diarrhoea disease occurrence and economic and socio-cultural drivers of diarrhoea in coastal communities to inform decision-making.
  • Mechanism of diarrhoea transmission in coastal communities defined.
  • Established information/knowledge on existing institutional arrangements for health delivery within the coastal communities.
  • Open source data platform to enable sharing of data and information.
  • Scientific reports, policy briefs and publications.
  • Software workflow that allow probabilistic evaluation of diarrhoea incidences under future climate and climate extreme scenarios.
  • Visualization routines for dissemination of scenario results.
  • Workshops, seminars and conferences contributions.

Research Approach

The project will be implemented through five work packages (WPs): WP1 will generate climate related biophysical information, and WP2 will assess the epidemiological, environmental drivers and transmission pathways issues of the project. WP3 will explore the socio-cultural and economic factors and community level institutional arrangements in disaster risk management and diarrhoea prevention and management. Data generated from WPs 1-3 will be collated and modelled for scenario predictions in WP4 to inform disease management. WP5 will integrate community participation into the research process and implementation of innovative strategies that will be informed by the various WPs, particularly WP4.
Each WP will have one lead and one co-lead academic researcher; however, other researchers with relevant expertise will be included at different stages of the research process. WPs 1-4 will each have 1 PhD student who will be fully supported by the project (tuition and field costs) to build their capacity in the various disciplines covered by this project (Marine Science, Public Health, Environmental Science, and Modelling). The non-academic partner institutions will provide support to the participatory processes with local communities and institutions for knowledge sharing and development of innovative solutions. Ethical permission will be sought from relevant ethical review boards, such as the Ethical Review Boards of the College of Basic and Applied Science (CBAS), University of Ghana, and the Noguchi Memorial Institute for Medical Research (NMIMR) in Ghana.

Capacity strengthening

This project will fully fund the PhD training (tuition and research) of four students. As part of the training, students will undertake course work to enhance their understanding of theoretical concepts. The project will also work closely with UG’s Doctoral school and other research institutions to organize special project training workshops for students, senior researchers, technicians and government agencies to increase their capacity in data collection and analysis, modelling and scientific report writing.

Project Team

The project team includes University of Ghana (Lead), Department of Biosciences, Aarhus University, Denmark (Danish partners), Peoples Dialogue on Human Settlements (PD) and the Ghana Environmental Protection Agency (EPA).