The 21st century has been characterized by rapid urbanization with its associated environmental sanitation challenges
especially in developing countries. However, studies have focused largely on institutional capacity and the resources needed to manage environmental sanitation challenges, with few insights on the attitudes of city residents. This paper analyzes the environmental sanitation situation in a rapidly urbanizing Tamale metropolis, examines how city residents’ attitudes have contributed to poor environmental sanitation and further reviews approaches that have been employed to manage environmental sanitation. Using secondary and empirical data sources, the paper reveals that only 7.5 tons of
150 tons of total daily solid wastes generated is effectively managed. The findings suggest that the poor sanitation in the city is influenced by two factors; poor attitudes of city residents and weak institutions. While poor attitudes towards environmental sanitation has resulted in indiscriminate disposal of waste, weak institutions have resulted in
lack of capacity and pragmatic interventions to manage the environmental sanitation challenges in the city. The paper
recommends public education on environmental sanitation, public private partnership, increased stakeholder engagement and preparation and implementation of environmental sanitation plan as mechanisms to ensure effective environmental sanitation management in the Tamale metropolis.