Inadequate provision of solid waste management facilities in Third World cities results in indiscriminate disposal and unsanitary environments, which threatens the health of urban residents. The study reported here examined household-level waste management and disposal practices in the Accra Metropolitan Area, Ghana. The residents of Accra currently generate large amounts of solid waste, beyond the management capabilities of the existing waste management system. Because the solid waste infrastructure is inadequate, over 80 percent of the population do not have home collection services. Only 13.5 percent of respondents are served with door-to-door collection of solid waste, while the rest dispose of their waste at communal collection points, in open spaces, and in waterways. The majority of households store their waste in open containers and plastic bags in the home. Waste storage in the home is associated with the presence of houseflies in the kitchen (r = .17, p < .0001). The presence of houseflies in the kitchen during cooking is correlated with the incidence of childhood diarrhea (r = .36, p < .0001). Inadequate solid waste facilities result in indiscriminate burning and burying of solid waste. There is an association between waste burning and the incidence of respiratory health symptoms among adults (r = .25, p < .0001) and children (r = .22, p < .05). Poor handling and disposal of waste are major causes of environmental pollution, which creates breeding grounds for pathogenic organisms, and the spread of infectious diseases. Improving access to solid waste collection facilities and services will help achieve sound environmental health in Accra.