The treatment of sewage at 15 degrees C was investigated in a one-stage upflow anaerobic sludge blanket (UASB) reactor and a UASB-Digester system. The latter consists of a UASB reactor complemented with a digester for mutual sewage treatment and sludge stabilisation. The UASB reactor was operated at a hydraulic retention time of 6h and a controlled temperature of 15 degrees C, the average sewage temperature during wintertime of some Middle East countries. The digester was operated at 35 degrees C. The UASB-Digester system provided significantly (significance level 5%) higher COD removal efficiencies than the one-stage UASB reactor. The achieved removal efficiencies in the UASB-Digester system and the one-stage UASB reactor for total, suspended, colloidal and dissolved COD were 66%, 87%, 44% and 30%, and 44%, 73%, 3% and 5% for both systems, respectively. The stability values of the wasted sludge from the one-stage UASB reactor and the UASB-Digester system were, respectively, 0.47 and 0.36g CH(4)-COD/g COD. Therefore, the anaerobic sewage treatment at low temperature in a UASB-Digester system is promising.