Samuel Agyei-Mensah

Epidemiological Transition and the Double Burden of Disease in Accra, Ghana

It has long been recognized that as societies modernize, they experience significant changes in their patterns of health and disease. Despite rapid modernization across the globe, there are relatively few detailed case studies of changes in health and disease within specific countries especially for sub-Saharan African countries. This paper presents evidence to illustrate the nature and speed of the epidemiological transition in Accra, Ghana’s capital city. As the most urbanized and modernized Ghanaian city, and as the national center of multidisciplinary research since becoming state capital in 1877, Accra constitutes an important case study for understanding the epidemiological transition in African cities. We review multidisciplinary research on culture, development, health, and disease in Accra since the late nineteenth century, as well as relevant work on Ghana’s socio-economic and demographic changes and burden of chronic disease. Our review indicates that the epidemiological transition in Accra reflects a protracted polarized model. A “protracted” double burden of infectious and chronic disease constitutes major causes of morbidity and mortality. This double burden is polarized across social class. While wealthy communities experience higher risk of chronic diseases, poor communities experience higher risk of infectious diseases and a double burden of infectious and chronic diseases. Urbanization, urban poverty and globalization are key factors in the transition. We explore the structures and processes of these factors and consider the implications for the epidemiological transition in other African cities.

Air Pollution in Accra Neighborhoods: Spatial, Socioeconomic, and Temporal Patterns

This study examined the spatial, socioeconomic status (SES), and temporal patterns of ambient air pollution in Accra, Ghana. Over 22 months, integrated and continuous rooftop particulate matter (PM) monitors were placed at a total of 11 residential or roadside monitoring sites in four neighborhoods of varying SES and biomass fuel use. PM concentrations were highest in late December and January, due to dust blown from the Sahara. Excluding this period, annual PM(2.5) ranged from 39 to 53 microg/m(3) at roadside sites and 30 to 70 microg/m(3) at residential sites; mean annual PM(10) ranged from 80 to 108 microg/m(3) at roadside sites and 57 to 106 microg/m(3) at residential sites. The low-income and densely populated neighborhood of Jamestown/Ushertown had the single highest residential PM concentration. There was less difference across traffic sites. Daily PM increased at all sites at daybreak, followed by a mid-day peak at some sites, and a more spread-out evening peak at all sites. Average carbon monoxide concentrations at different sites and seasons ranged from 7 to 55 ppm, and were generally lower at residential sites than at traffic sites. The results show that PM in these four neighborhoods is substantially higher than the WHO Air Quality Guidelines and in some cases even higher than the WHO Interim Target 1, with the highest pollution in the poorest neighborhood.

Slums of hope and slums of despair: Mobility and livelihoods in Nima, Accra

Slums are universally assumed to be the worst places for people to live in, and it is often taken for granted that the livelihood situations of slum communities are also uniform and homogenous. So pervasive is the latter idea that most studies examining the livelihood situations of slum communities do not compare the socio-economic and cultural differences within such communities. A distinctive feature of slum communities is the pursuance of multiple livelihood strategies that are tied to migration. However, the links between migration and livelihood situations in many slum communities have not been extensively examined. The article seeks to examine the many faces of Nima, a slum community in Accra (Ghana), and link these to livelihoods and migration. The data for the study are drawn from varied sources, including in-depth, key informant interviews, personal observations, and census reports. The complexity and varied migration patterns both internationally and internally tied to livelihoods in Nima are revealed. The changing character of slums is discussed and it is concluded that slums are not only a matter of the negative aspects of urban places but there are positive sides as well. The significance of migration and migrants is crucial for understanding Nimas role in urban development, and for making the appropriate recommendations for livelihoods development in Nima.

Traders on the run: Activities of street vendors in the Accra Metropolitan Area, Ghana

In recent years the activities of street vendors have become a topical issue within the urban spaces of the developing world. Still, research that explores the geographical dimensions of street vending activities in Ghana is limited. Based on field interviews with street vendors, consumers, shop owners, and metropolitan authorities, a number of findings emerged. First, there were no noticeable socio-economic differences amongst street vendors operating within the study areas. However, noticeable differences in the areas of origin of vendors were observed, with most of them originating from the Eastern, Ashanti and Central Regions of the country. The study also shows a progression amongst trades over time, in terms of the types of goods which the vendors trade in. As may be expected, a shift to higher value items takes place as traders build up capital. Another important finding is that most of the vendors were continuously on the run due to constant harassment, assault and seizure of goods by metropolitan authorities and other users of the city space. To be able to address some of the problems identified, it is suggested that city authorities should adopt consultation rather than confrontational approaches in dealing with street vendors.

Within-Neighborhood Patterns and Sources of Particle Pollution: Mobile Monitoring and Geographic Information System Analysis in Four Communities in Accra, Ghana

Background Sources of air pollution in developing country cities include transportation and industrial pollution, biomass and coal fuel use, and resuspended dust from unpaved roads. Objectives Our goal was to understand within-neighborhood spatial variability of particulate matter (PM) in communities of varying socioeconomic status (SES) in Accra, Ghana, and to quantify the effects of nearby sources on local PM concentration. Methods We conducted 1 week of morning and afternoon mobile and stationary air pollution measurements in four study neighborhoods. PM with aerodynamic diameters ≤ 2.5 μm (PM2.5) and ≤ 10 μm (PM10) was measured continuously, with matched global positioning system coordinates; detailed data on local sources were collected at periodic stops. The effects of nearby sources on local PM were estimated using linear mixed-effects models. Results In our measurement campaign, the geometric means of PM2.5 and PM10 along the mobile monitoring path were 21 and 49 μg/m3, respectively, in the neighborhood with highest SES and 39 and 96 μg/m3, respectively, in the neighborhood with lowest SES and highest population density. PM2.5 and PM10 were as high as 200 and 400 μg/m3, respectively, in some segments of the path. After adjusting for other factors, the factors that had the largest effects on local PM pollution were nearby wood and charcoal stoves, congested and heavy traffic, loose dirt road surface, and trash burning. Conclusions Biomass fuels, transportation, and unpaved roads may be important determinants of local PM variation in Accra neighborhoods. If confirmed by additional or supporting data, the results demonstrate the need for effective and equitable interventions and policies that reduce the impacts of traffic and biomass pollution.

Household and community poverty, biomass use, and air pollution in Accra, Ghana

Many urban households in developing countries use biomass fuels for cooking. The proportion of household biomass use varies among neighborhoods, and is generally higher in low socioeconomic status (SES) communities. Little is known of how household air pollution varies by SES and how it is affected by biomass fuels and traffic sources in developing country cities. In four neighborhoods in Accra, Ghana, we collected and analyzed geo-referenced data on household and community particulate matter (PM) pollution, SES, fuel use for domestic and small-commercial cooking, housing characteristics, and distance to major roads. Cooking area PM was lowest in the high-SES neighborhood, with geometric means of 25 (95% confidence interval, 21–29) and 28 (23–33) μg/m3 for fine and coarse PM (PM2.5 and PM2.5–10), respectively; it was highest in two low-SES slums, with geometric means reaching 71 (62–80) and 131 (114–150) μg/m3 for fine and coarse PM. After adjustment for other factors, living in a community where all households use biomass fuels would be associated with 1.5- to 2.7-times PM levels in models with and without adjustment for ambient PM. Community biomass use had a stronger association with household PM than households own fuel choice in crude and adjusted estimates. Lack of regular physical access to clean fuels is an obstacle to fuel switching in low-income neighborhoods and should be addressed through equitable energy infrastructure.

Neighborhoods and fertility in Accra, Ghana: an AMOEBA-based approach

Fertility levels remain high in most of sub-Saharan Africa, despite recent declines, and even in a large capital city such as Accra, Ghana, women are having children at a pace that is well above replacement level and this will contribute to significant levels of future population growth in the city. Our purpose in this article is to evaluate the way in which neighborhood context might shape reproductive behavior in Accra. In the process, we introduce several important innovations to the understanding of intraurban fertility levels in a sub-Saharan African city: (1) Despite the near explosion of work on neighborhoods as a spatial unit of analysis, very little of this research has been conducted outside of the richer countries; (2) we characterize neighborhoods on the basis of local knowledge of what we call vernacular neighborhoods; (3) we then define what we call organic neighborhoods using a new clustering tool—the AMOEBA algorithm—to create these neighborhoods; and (4) we then we evaluate and explain which of the neighborhood concepts has the largest measurable contextual effect on an individual womans reproductive behavior. Multilevel regression analysis suggests that vernacular neighborhoods are more influential on a womans decision to delay marriage, whereas the organic neighborhoods based on socioeconomic status better capture the factors that shape fertility decisions after marriage.

Twelve Years of HIV/AIDS in Ghana: Puzzles of Interpretation

ResumeS’il existe une litterature extensive sur les nombreux aspects de l’epidemie du VIH/SIDA en Afrique de l’est et du sud, en revanche on a tres peu ecrit sur les aspects geographiques de l’epidemie en Afrique de l’ouest. Largement fonde sur des donnees derivees du Programme ghaneen de controle du SIDA et des Donnees du Sentinel Surveillance offerts par le Ministere de la sante, cet article explore les aspects geographiques de l’epidemie de 1986 a 1998. On observe des modeles significatifs bases sur l’âge, le sexe et la geographie. On identifie trois vagues de diffusion essentielles: un nombre initial eleve de cas de VIH declares dans la region est; la predominance de la region Ashanti pour le nombre de cas de SIDA declares a la fin des annees 1990; et une augmentation apparente dans le nombre de cas de SIDA declares dans la region nordest a la fin des annees 1990. On en recherche les explications a l’interieur de la structure de migration et de diffusion. On utilise les variations locales pour montrer...

Spatial and temporal patterns of particulate matter sources and pollution in four communities in Accra, Ghana

Sources of air pollution in developing country cities include transportation and industrial pollution, biomass fuel use, and re-suspended dust from unpaved roads. We examined the spatial patterns of particulate matter (PM) and its sources in four neighborhoods of varying socioeconomic status (SES) in Accra. PM data were from 1 week of morning and afternoon mobile and stationary air pollution measurements in each of the study neighborhoods. PM(2.5) and PM(10) were measured continuously, with matched GPS coordinates. Data on biomass fuel use were from the Ghana 2000 population and housing census and from a census of wood and charcoal stoves along the mobile monitoring paths. We analyzed the associations of PM with sources using a mixed-effects regression model accounting for temporal and spatial autocorrelation. After adjusting for other factors, the density of wood stoves, fish smoking, and trash burning along the mobile monitoring path as well as road capacity and surface were associated with higher PM(2.5). Road capacity and road surface variables were also associated with PM(10), but the association with biomass sources was weak or absent. While wood stoves and fish smoking were significant sources of air pollution, addressing them would require financial and physical access to alternative fuels for low-income households and communities.

Perceptions of health and environmental impacts of e-waste management in Ghana

This paper explores the perception of health and environmental concerns of workers and residents living close to e-waste recycling sites in Ghana using both qualitative and quantitative research techniques. The social constructionist approach and a logit regression model were adopted to examine the rationale of their claims and concerns which have hitherto been unknown and unexplored. We find that workers’ environmental and health perceptions were seriously downplayed and do not match those of epidemiological studies, revealing a lack of convergence between lay and expert knowledge. This study further shows a respondent-specificity rationale; the perception of those directly involved in the processes was mainly influenced by economic considerations, while some at bestdisplayed “genuine” ignorance. We recommend that all policy interventions incorporate approaches that have a better chance of arriving at conclusions economically meaningful to participants and that facilitate greater understanding of health and environmental issues.