Abstract / Summary
Abstract Background. Older adults in low- and middle-income countries face water, sanitation and hygiene (WASH) barriers that are inseparable from their functional capacity, yet WASH research rarely treats functional limitation and hygiene-related morbidity together. This study examined how functional and ageing-related vulnerabilities intersect with WASH barriers and self-reported morbidity among older adults in urban Ghana. Methods. Cross-sectional study of 224 adults aged 60 years and above in urban communities of Sunyani Municipality, Bono Region, Ghana (June to July 2025), with structured observation of household sanitation facilities in a nested subset of 177 households. Functional vulnerability was captured through self-reported ageing-related conditions and hygiene-related functional difficulties; WASH barriers were captured by self-report and by direct observation. Outcomes were self-reported hygiene-related symptoms in the preceding six months and healthcare utilisation for such illness. Descriptive statistics with 95% confidence intervals, chi-square tests, and a newly derived observed WASH Barrier Burden score were used. Individual-level survey records were not available for this analysis, so no new multivariable model of morbidity could be fitted; this is reported as an explicit limitation rather than estimated. Results. Ageing-related conditions affecting hygiene were common: arthritis 167/224 (75%), low energy 112/224 (50%), visual loss 37/224 (17%), faecal incontinence 27/224 (12%) and urinary incontinence 20/224 (9%). Physical limitation was the leading barrier to intimate-area cleansing (137/224, 61%) and financial constraint the leading overall hygiene barrier (137/224, 61%). Sanitation-related joint pain was the most frequently reported symptom (124/224, 55%), followed by eye infection (64/224, 29%), diarrhoea/stomach upset (50/224, 22%) and skin infection (43/224, 19%); only 29/224 (13%) reported no hygiene-related symptom, and 87/224 (39%) reported healthcare visits more than monthly for such illness. In the observed subset, households carried a median of 5 of 10 concurrent WASH barriers (IQR 3–7), with 138/177 (78%) carrying three or more. Age was associated with sanitation-related joint pain (p = 0.04), limited mobility with bathing frequency (p = 0.01), and both perceived poor water and poor food hygiene with diarrhoea/stomach upset (p = 0.01 each). Conclusions. For older adults in this setting, sanitation is not merely a coverage problem. A high burden of functional limitation coincides with dense, concurrent household WASH barriers and with frequently reported hygiene-related symptoms and healthcare use. Findings support disability-inclusive, age-friendly WASH programming, but the cross-sectional design and reliance on self-reported, unverified morbidity preclude causal interpretation.