The unsustainable expansion of cities is generating urban heat islands (UHIs) by exchanging (trading) vegetation cover (green) for built impervious surfaces which is associated with heat-related health risks, globally. This phenomenon is exacerbated by climate change and anthropogenic activities like urban population growth, particularly in African cities. This study explores the spatio-temporal trends of land surface temperature (LST), land use land cover (LULC) and their economic and health risks in the Greater Accra Metropolitan Area (GAMA) of Ghana, from 1991 to 2021. We extracted LST/LULC information from Landsat datasets to perform change analysis, alongside an online survey across 56 communities on how LST relates to economic and human health risks perceptions of residents. The results show urbanization of GAMA is trading greens for heated surfaces, impacting communities’ health risks. While the built environment grew (8.6%), the vegetation cover declined (2.5%) and the mean LST rose (0.8 degrees C) in 25 years. A 30 degrees C LST corresponds to the point of inflexion of exchanging green vegetative cover for heated built surfaces. The forest community of Kisseman, the populous community of Dansoman and the harbour city of Tema corresponded to the first, fourth and fifth LST quintiles, changing at -0.05 degrees C, 0.06 degrees C and 0.164 degrees C per year. The common health risks include discomfort from heavy sweating, headaches, dehydration, thirst and skin rashes. These results call for climate action and green spatial planning through urban forestry and environmentalism in GAMA. For urban resilience and sustainable cities, we advocate green-cooling multi-purpose housing, roads, and industrial infrastructure.
Beliefs form the fabric of every society. Likewise, there are socio-cultural beliefs that people hold as causes of climate risk. This paper sought to identify the socio-cultural beliefs on drought among crop farmers in Talensi, Ghana and how these provide insights for environmental management, social vulnerability, early warning systems and coping and adaptation. The selection of Talensi District was appropriate because it is one of the agrarian districts located in drought prone zone of Ghana. The study was designed following the case study approach. A total of 69 participants were selected through purposive sampling to participate in key informant interviews and focus group discussions conducted across nine (9) communities. The study found that manifestation of bad and/or indecent behavioural practices; performance and/or non-performance of traditional rites; presence and behaviour peculiar animals; and magical conjurations and incantations by spiritualists, diviners and soothsayers were the significant socio-cultural beliefs accounting for drought. The study concludes that the socio-cultural beliefs of the local people are their social-cultural capital and this asset is a useful gamut in explaining the social vulnerability; development of early warning drought systems; and selection of coping and adaptation strategies in Talensi District. A major recommendation is that individuals and institutions with expertise in technical and scientific early warning drought information should be circumspect in not adopting a judgmental approach when they are communicating and disseminating risk information, to the detriment of indigenous knowledge.
Few studies examined the association between prenatal long-term ambient temperature exposure and stillbirth and fewer still from developing countries. Rather than ambient temperature, we used a human thermophysiological index, Universal Thermal Climate Index (UTCI) to investigate the role of long-term heat stress exposure on stillbirth in Ghana. METHODS: District-level monthly UTCI was linked with 90,532 stillbirths of 5,961,328 births across all 260 local districts between 1(st) January 2012 and 31(st) December 2020. A within-space time-series design was applied with distributed lag nonlinear models and conditional quasi-Poisson regression. RESULTS: The mean (28.5 ± 2.1 °C) and median UTCI (28.8 °C) indicated moderate heat stress. The Relative Risks (RRs) and 95% Confidence Intervals (CIs) for exposure to lower-moderate heat (1st to 25th percentiles of UTCI) and strong heat (99th percentile) stresses showed lower risks, relative to the median UTCI. The higher-moderate heat stress exposures (75th and 90th percentiles) showed greater risks which increased with the duration of heat stress exposures and were stronger in the 90th percentile. The risk ranged from 2% (RR = 1.02, 95% CI 0.99, 1.05) to 18% (RR = 1.18, 95% CI 1.02, 1.36) for the 90th percentile, relative to the median UTCI. Assuming causality, 19 (95% CI 3, 37) and 27 (95% CI 3, 54) excess stillbirths per 10,000 births were attributable to long-term exposure to the 90th percentile relative to median UTCI for the past six and nine months, respectively. Districts with low population density, low gross domestic product, and low air pollution which collectively defined rural districts were at higher risk as compared to those in the high level (urban districts). DISCUSSION: Maternal exposure to long-term heat stress was associated with a greater risk of stillbirth. Climate change-resilient interventional measures to reduce maternal exposure to heat stress, particularly in rural areas may help lower the risk of stillbirth.
Climate change poses a significant threat to various sectors, including agriculture, affecting men and women unevenly. Although gender-based perceptions of climate change have been studied, there remains a gap in understanding how these perceptions influence the adoption of adaptation strategies among men and women smallholder farmers in the production of leguminous crops in sub-Saharan Africa. This study investigated the gender differences in the adoption of climate change adaptation strategies among bean and cowpea farmers in Ghana. The findings revealed that socioeconomic and institutional factors significantly influenced the choice of adaptation strategies, with notable differences between men and women. Higher levels of education, farming experience, marital status, access to credit, and education determined the choice of adaptation strategies. On the other hand, women farmers, despite having lower levels of formal education, showed a higher utilization of extension services, possibly due to targeted efforts to reach out to more women farmers. Larger households were less likely to adopt mixed cropping and changing cropping patterns, while married individuals were less likely to use crop rotation. Training and access to credit significantly increased the likelihood of adopting crop rotation, changing cropping patterns, and using improved seeds. The study also found that [f]armers perceptions of the impacts of dry spells and delayed onset of rains influenced the use of climate change adaptation strategies. Furthermore, farmers who participated in climate change planning were more likely to use diverse adaptation strategies, underscoring the importance of a locally focused, inclusive planning process. However, gender differences were observed in the determinants of the use of these strategies. For instance, while access to extension services was found to be more influential for women, men’s decisions were more influenced by their marital status, access to credit, and education. Policy makers and local institutions need to encourage and facilitate farmers’ involvement in climate change planning processes to enable designing of effective, context-relevant, inclusive, and sustainable climate change adaptation strategies. Distinct differences in the factors underlying the use of adaptation strategies by men and women demand creation of and implementation of gender-sensitive programs that effectively reach and benefit both women and women.
Extant research has linked flooding with mental distress (MD) among flood-prone populations, but the mechanisms underlying this association remain largely unknown. This paper examines the association of flood stressors with MD among households in flood-prone communities in Ghana and estimates whether flood risk perceptions mediated the association. The study involved 767 household heads aged >= 20 years [mean = 47.3 +/- 13.7); males = 61.4%]. Flood stressors were assessed using a 15-item Flood Stress-related Scale, while the Kessler Psychological Distress Scale (K10) was used to assess MD. Linear regression-based mediation analysis using Hayes’ PROCESS macro was performed to assess the indirect effect of flood stressors with MD through flood risk perceptions. After adjusting for potential confounders, flood stressors were significantly linked with higher risks of MD (beta = .060-.080, p < .001). The mediation and bootstrapping analyses suggested that flood health risk perception partially mediated and accounted for 26.7% of the relationship between flood stressors and MD (direct effect: beta = .060, Boots 95%CI: .041-.079; indirect effect: beta = .022, Boots 95%CI: .015-.031; total effect: beta = .082, Boots 95%CI: .063-.101). The link between flood stressors and MD risk is explained partially by flood health risk perception. Knowledge of households' flood risk perception is therefore critical for effectively managing the effects of flood stressors on MD. Policy Highlights center dot The mechanisms underlying flood stressors-mental distress (MD) association remain largely unknown. center dot Flood stressors were significantly associated with higher risks of MD. center dot Flood stressors and MD risk linkage was partially explained by the health-related risk perception. center dot Timely psychological interventional services to flood-prone households via improvement in their health-risk perceptions is desirable.
The global climate has changed, and there are concerns about the effects on both humans and the environment, necessitating more research for improved adaptation. In this study, we analyzed extreme temperature and rainfall events and projected future climate change scenarios for the coastal Savannah agroecological zone (CSAZ) of Ghana. We utilized the ETCCDI, the RClimDex software (version 1.0), the Mann-Kendall test, Sen’s slope estimator, and standardized anomalies to analyze homogeneity, trends, magnitude, and seasonal variations in temperature (T-max and T-min) and rainfall datasets for the zone. The SDSM was also used to downscale future climate change scenarios based on the CanESM2 (RCP 2.6, 4.5, and 8.5 scenarios) and HadCM3 (A2 and B2 scenarios) models for the zone. Model performance was evaluated using statistical methods such as R-2, RMSE, and PBIAS. Results revealed more changepoints in T-min than in T-max and rainfall. Results again showed that the CSAZ has warmed over the last four decades. The SU25, TXn, and TN90p have increased significantly in the zone, and the opposite is the case for the TN10p and DTR. Spatially varied trends were observed for the TXx, TNx, TNn, TX10p, TX90p, and the CSDI across the zone. The decrease in RX1day, RX5day, SDII, R10, R95p, and R99p was significant in most parts of the central region compared to the Greater Accra and Volta regions, while the CDD significantly decreased in the latter two regions than in the former. The trends in CWD and PRCPTOT were insignificant throughout the zone. The overall performance of both models during calibration and validation was good and ranged from 58-99%, 0.01-1.02 degrees C, and 0.42-11.79 degrees C for R-2, RMSE, and PBIAS, respectively. T-max is expected to be the highest (1.6 degrees C) and lowest (-1.6 degrees C) across the three regions, as well as the highest (1.5 degrees C) and lowest (-1.6 degrees C) for the entire zone, according to both models. T-min is projected to be the highest (1.4 degrees C) and lowest (-2.1 degrees C) across the three regions, as well as the highest (1.4 degrees C) and lowest (-2.3 degrees C) for the entire zone. The greatest (1.6 degrees C) change in mean annual T-max is expected to occur in the 2080s under RCP8.5, while that of the T-min (3.2 degrees C) is expected to occur in the 2050s under the same scenario. Monthly rainfall is expected to change between -98.4 and 247.7% across the three regions and -29.0 and 148.0% for the entire zone under all scenarios. The lowest (0.8%) and highest (79%) changes in mean annual rainfall are expected to occur in the 2030s and 2080s. The findings of this study could be helpful for the development of appropriate adaptation plans to safeguard the livelihoods of people in the zone.
Although vulnerability assessments have been widely conducted along the coast of Ghana, they have not focused on the factors contributing to social vulnerability of households and communi-ties to disaster risks. Using an indicator-based approach, this study examines the social factors that affect the exposure, sensitivity and adaptive capacity of households and communities in the Volta estuary, Ghana. Results indicate that all the communities within the study area were ex-posed to climate change related hazards. However, two communities, Azizanya in Ada East Dis-trict and Fuveme in Anloga District, were highly exposed with unweighted indexes of 0.50 and 0.76, respectively. Sensitivity among communities was generally high ranging from 0.00 to 0.87 due to several social factors including low household income, high number of children and aged at home, and lack of social amenities such as roads, health facilities, markets, and schools. The communities recorded high adaptive capacity and were able to withstand the ravages of the ocean and the river system. Households and communities developed various adaptation measures such as relocation to nearby communities or higher grounds, open spaces and packing of their be-longings on higher objects such as tables, whiles government actions included occasional dredg-ing and constructions of sea defense structures. An integrated, multi-stakeholder approach in-volving government, non-governmental community-based organisations, communities, house-holds, and other stakeholders is proposed to design and implement a comprehensive disaster management plan to combat climate change related coastal disasters.
Water pollution is a major issue in Ghana with direct impacts on human health. However, the underlying drivers of exposure and risks are not comprehensively explored and understood, while the diseases continue posing huge burdens. The key question addressed is: what are the key drivers influencing the water-health nexus, particularly water-borne disease risks in the Odaw River basin, Ghana? Multiple approaches were integrated: qualitative system dynamic modeling and urban land-use change assessment. Multi-level stakeholder participation, including household surveys, focus group discussions, and workshops were employed in developing and identifying indicators and feedback loops. The results revealed that communities have access to water and sanitation, but water-borne diseases are still prevalent. Flooding influenced by poor land use planning and solid waste disposal are key risk factors, contributing to water pollution and disease outbreaks. The major land-use change is the conversion of natural to built-up areas, resulting in decreased urban vegetation cover and increased soil sealing, partly contributing to flood risk. Complex linkages and multiple feedback loops between land use, flooding, water pollution, and water-borne disease risks were identified. In addition to supplying safe drinking water and sanitation, multi-sectoral collaborations are required to co-design and implement integrated interventions, including flood risk reduction, urban land use plans, and improved waste management to reduce disease risks and promote health.
BACKGROUND: Diarrhea remains a significant public health problem and poses a considerable financial burden on Ghana’s health insurance scheme. In order to prioritize district-level hotspots of diarrhea incidence for effective targeted interventions, it is important to understand the potential drivers of spatiotemporal patterns of diarrhea. We aimed to identify the spatiotemporal heterogeneity of diarrhea incidence in Ghana and explore how meteorological and socio-demographic factors influence the patterns. METHODS: We used monthly district-level clinically diagnosed diarrhea data between 2012 and 2018 obtained from the Centre for Health Information and Management of the Ghana Health Services. We utilized a hierarchical Bayesian spatiotemporal modeling framework to evaluate potential associations between district-level monthly diarrhea incidence and meteorological variables (mean temperature, diurnal temperature range, surface water presence) and socio-demographic factors (population density, Gini index, District League Table score) in Ghana. In addition, we investigated whether these associations were consistent across the four agro-ecological zones. RESULTS: There was considerable spatial heterogeneity in diarrhea patterns across the districts, with clusters of high diarrhea risk areas mostly found in the transition and savannah zones. The average monthly temporal patterns of diarrhea revealed a weak biannual seasonality with major and minor peaks in June and October, respectively, coinciding with the major and minor rainy seasons. We found a significant association between both meteorological and socio-demographic factors and diarrhea risk, but the strength and direction of associations differed across the four agro-ecological zones. Surface water presence demonstrated consistently positive, while diurnal temperature range and population density demonstrated consistently negative associations with diarrhea both overall and across the agro-ecological zones. CONCLUSIONS: Although overall diarrhea incidence is declining in Ghana, our results revealed high-risk districts that could benefit from district-specific tailored intervention strategies to improve control efforts. Ghana health sector policy-makers can use these results to assess the effectiveness of ongoing interventions at the district level and prioritize resource allocation for diarrhea control.
Malaria is a major public health problem especially in Africa where 94% of global malaria cases occur. Malaria prevalence and mortalities are disproportionately higher among children. In 2019, children accounted for 67% of malaria deaths globally. Recently, climatic factors have been acknowledged to influence the number and severity of malaria cases. Plasmodium falciparum-the most deadly malaria parasite, accounts for more than 95% of malaria infections among children in Ghana. Using the 2017 Ghana Demographic Health Survey data, we examined the local variation in the prevalence and climatic determinants of child malaria. The findings showed that climatic factors such as temperature, rainfall aridity and Enhanced Vegetation Index are significantly and positively associated with Plasmodium falciparum malaria prevalence among children in Ghana. However, there are local variations in how these climatic factors affect child malaria prevalence. Plasmodium falciparum malaria prevalence was highest among children in the south western, north western and northern Ghana.
Intersectoral collaborations are an integral component of the prevention and control of diseases in a complex health system. On the one hand, One Health (OH) is promoting the establishment of intersectoral collaborations for prevention at the human-animal-environment interface. On the other hand, operationalising OH can only be realized through intersectoral collaborations. This work contributes to broadening the knowledge of the process for operationalising OH by analysing the governance structures behind different initiatives that tackle health problems at the human-animal-environment interface. The cases taken as examples for the analysis are the control and response to rabies and avian influenza under “classical OH”, and the management of floods and droughts for insights into “extended OH”. Data from Ghana and India were collected and compared to identify the key elements that enable ISC for OH. Despite the case studies being heterogeneous in terms of their geographic, economic, social, cultural, and historical contexts, strong similarities were identified on how intersectoral collaborations in OH were initiated, managed, and taken to scale. The actions documented for rabies prevention and control were historically based on one sector being the leader and implementer of activities, while avian influenza management relied more on intersectoral collaborations with clearly defined sectoral responsibilities. The management of the impact of flood and droughts on health provided a good example of intersectoral collaborations achieved by sectoral integration; however, the human health component was only involved in the response stage in the case of Ghana, while for India, there were broader schemes of intersectoral collaborations for prevention, adaptation, and response concerning climate change and disaster.
The burden of child undernutrition across Africa remains extraordinarily high. Among children under age five, chronic and acute undernutrition is responsible for more ill-health than any other cause. While climate change exacerbates the multiple burdens of undernutrition, we know very little about the embodied effects on women’s workload in agriculture and implications for feeding practices, especially for infants whose nutrition depends on mothers’ time. In this article, political ecologies of health, with its nested, place-based analysis, is used as a framework to address this knowledge gap. The study took place in Ghana’s Upper West Region, a semi-arid and resource-poor setting with higher undernutrition rates. In-depth interviews were conducted with smallholder farmers (n = 33) whose infants have sub-optimal growth, and key informants (n = 7) with expertise in nutrition and health. Findings from the study demonstrate how climate change puts pressure on women’s productive time, leading to poor child feeding practices and undernutrition. Ultimately, the article argues that there are hidden impacts of climate change on undernutrition. Global undernutrition interventions should therefore move beyond biomedical solutions to address these hidden impacts, some of which are social, gendered, and structural in nature.
Urban floods have long-term mental health implications, yet this subject remains largely neglected in flood-related studies. This paper examines the psychological distress (PD) of adults exposed to floods in Ghana. Cross-sectional data involving 767 flood-prone community-dwelling household heads aged ≥20 years were analyzed [mean = 47.3 years (SD = 13.7); males = 61.4%]. We used the Exposure to Flood-related Events Scale, and PD was assessed with the Kessler Psychological Distress Scale (K10). Ordinary Least Squares (OLS) regressions evaluated crude and adjusted associations of flood exposure with PD. The mean scores of PD (37[SD = 8]) and exposure to flood events (6[SD = 3]) significantly varied by age and sex (p < .05). After full adjustment for potential confounders, exposure to flood events was significantly and positively associated with PD index in the total sample (β = 0.030; p < .005), among male participants (β = 0.019; p < .05) and female participants (β = 0.048; p < .001). Furthermore, age-wise analysis revealed significant association of flood exposure with PD in young adults (β = 0.033; p < .001) but not in older adults (β = 0.048; p = .062). Exposure to floods increased the risk of PD. Policy and public health efforts to manage PD should include selective flood reduction interventions, including land use regulations and sustained public education.
Flooding is one of the most destructive climatic hazards which has affected agricultural activities in the world, especially Sub-Saharan Africa. This article investigated the impact of the recurrent annual floods on food production and how subsistent farmers have adapted to resultant food insecurity in the Sudan Savannah agroecological zone of Ghana. The specific objectives of the study were to understand the nature of flooding (frequency, period and extent of coverage of flood water), how the perennial floods contribute to food insecurity, how farmers adapt to it to contribute towards policy development on flood control and improve food security. Primary data were collected using questionnaires, interviews, focus group discussions and field observation. Secondary data were obtained from documents and reports from NADMO and MOFA. The questionnaires were analyzed using Statistical Package for Social Science and the focus group discussions, interviews, and fieldwork were analyzed manually using content analysis. The findings show that the study areas experience floods every year. Between 2007 and 2018, eleven floods event occurred in the study communities. The floods usually occur around August and September when rainfall is torrential coupled with overflow from the spillage of the Bagre dam upstream. The flooding has resulted in a decline in food production among subsistent farmers. As a result, households in study communities are food insecure. Farmers have learned to cope with floods/food insecurity by engaging in alternative livelihoods such as flood recession farming, dry season farming, petty trading. They have also employed other means such as rationings of food and social networks cope with food insecurity. In all these strategies, women play a critical role as they are largely in charge of food preparation and dishing. The study recommends strengthening of the alternative livelihoods, introduction of short maturing crop varieties, sensitisation of women on the preparation of healthy meals.
This research reviews climate change, flood disasters impacts and food security nexus in northern Ghana. The impacts of climate change include flood disasters which in turn affect food production with subsequent impact on food security. While climate change impact can be positive in some regions, it can be negative in other regions as it could lead to excess or lack of water, which negatively affects food production. Most especially, flood disasters have reportedly become frequent with devastating consequences on food production. Literature further suggests that the frequency of floods and their impacts have the potential to increase in the future. Floods inundate farms, pastures and livestock, which could subsequently reduce crop yields and animal production. Floods also destroys physical infrastructure and disrupts socio-economic activities which are linked to agriculture sector and could affect food production. This eventually decreases food availability, accessibility, utilization, and stability in the region. Northern Ghana has experienced flood disasters with increased frequency, which are related to climate change impacts. Although there is research on climate change, flood disasters, and food security issues in northern Ghana, the literature thus far indicates no clear focus of studies that focuses on the nexus of climate change, flood disasters, and food security of the study site. Thus, this research seeks to review the nexus of climate change, and flood disaster impacts on food security in northern Ghana with their implications on food security in the region. This study has two main research objectives. The first objective of this research is to identify and understand the potential impacts of climate change and flood disasters on food production in the study site. The second research objective is to explain the connection between climate change and flood disasters and the implications of this relationship on food security in the study site. This review study focuses on climate change, flood disasters, and food production to understand the critical impacts of climate change and flood disasters on food security in the northern part of Ghana. The aim of this research is to contribute to literature and discussion of the nexus of climate change, flood disaster impacts and food security sub-Saharan Africa.
In sub-Saharan Africa, land cover change, expansion of hydropower infrastructure, and increased flooding complicate country-level efforts to meet the Sustainable Development Goal target concerning access to safe water. The Water, Energy and Food (WEF) nexus approach recognises that addressing these complex challenges requires cross-sectoral analyses at multiple scales. Building on such an approach, our study examined the interrelationships between land cover change, dam-related flooding and access to safe water via a national-level spatial analysis with local case studies in Malawi and Ghana. Our assessment of the water-food interactions found that areas of overlap between water points and cropland increased from 2000 to 2020 for both countries at national scale, but overlap extent varied greatly depending on the land cover product used. Local-scale exploration of water point installation patterns in Zomba, Malawi confirmed this pattern, highlighting increasing non-governmental funding of borehole installation programmes. Our assessment of water-energy interactions found that flooding mediated by hydropower dams increased for the White Volta Basin in Ghana, thereby increasing inundation of groundwater points. Local-scale focus group discussions revealed flooding resulted in contaminated water sources and high risk of injury or drowning whilst fetching water. Overall, our study highlights how socio-economic drivers are bringing water points, flooding and cropland into closer proximity, requiring flood mitigation measures at water points and agro-chemical management to minimise potential water quality impacts. Given differences between land cover products, we recommend more robust integration of existing land cover products to better monitor these phenomena.
Although mixed methods research proves significant in understanding complex social phenomenon, inadequate research has explored its utility in heat exposure studies. The convergent mixed methods analysis comprising 320 surveys and two focus group interviews were used to evaluate the social impacts of occupational heat stress on Ghanaian mineworkers to enlighten policy choices for the purpose of complementarity. The study contributes to mixed methods study by affirming the practical use of between-method triangulation and complementarity. The merged quantitative and qualitative results also showed adequate corroboration and complementarity between both data, to illustrate the social impacts of work-related heat stress on mining workers as heat-related comorbidity, productive capacity loss, anxiety, slow pace of work, and inadequate social well-being. The mixed methods results would inform policy options on the health and safety of work settings, managing occupational heat stress, and adaptation guidelines in the mining industry.
Flooding is the most frequent natural hazard globally, but evidence of its impact on domestic water point contamination remains limited. This study aimed to assess dam-related flooding’s impact on microbiological contamination of rural water points and to evaluate agreement of satellite-derived flood maps with ground-based observations of water point flooding. Fieldwork took place in two Ghanaian districts frequently flooded following dam overspill. Fifty-seven water points were tested for bacterial parameters during and immediately after flooding. Forty water points were resampled in the dry season, with the remainder having run dry. Ground-based observations of flooding were compared with three satellite-derived flood maps. Boreholes were less contaminated than wells or surface waters (geometric mean E. coli = 20.2, 175.6, and 590.7 cfu/100 ml, respectively). Among groundwater points, a Wilcoxon signed-rank test indicated significantly greater median E. coli and thermotolerant coliform contamination during flooding (p = 0.025 and p < 0.001, respectively), but Shigella, salmonella, and intestinal enterococci counts were not significantly different between seasons. In contrast, among surface water points, E. coli, Shigella, and Salmonella counts were significantly greater in dry season samples (p < 0.005 for all parameters), possibly reflecting a "concentration" effect. Satellite-derived flood maps had no or low agreement with ground-based observations of water point flooding. Although groundwater quality deteriorated during and after flooding, surface waters were the most microbiologically contaminated in both seasons. The greatest public health risk thus occurred where households switched to surface water collection during or following flood season. Flood risk should be assessed before borehole installation and existing flood-prone boreholes remediated to mitigate population exposure to contaminated water.
BACKGROUND: Floods are the most frequently occurring natural disaster and constitute a significant public health risk. Several operational satellite-based flood detection systems quantify flooding extent, but it is unclear how far the choice of satellite-based flood product affects the findings of epidemiological studies of associated public health risks. Few studies of flooding’s health impacts have used mixed methods to enrich understanding of these impacts. This study therefore aims to evaluate the relationship between two satellite-derived flood products with outpatient attendance and diarrhoeal disease in northern Ghana, identifying plausible reasons for observed relationships via qualitative interviews. METHODS: A convergent parallel mixed methods design combined an ecological time series with focus group discussions and key informant interviews. Through an ecological time series component, monthly outpatient attendance and diarrhoea case counts from health facilities in two flood-prone districts for 2016-2020 were integrated with monthly flooding map layers classified via the Moderate Resolution Imaging Spectroradiometer (MODIS) and Landsat satellite sensors. The relationship between reported diarrhoea and outpatient attendance with flooding was examined using Poisson regression, controlling for seasonality and facility catchment population. Four focus group discussions with affected community members and four key informant interviews with health professionals explored flooding’s impact on healthcare delivery and access. RESULTS: Flooding detected via Landsat better predicted outpatient attendance and diarrhoea than flooding via MODIS. Outpatient attendance significantly reduced as LandSat-derived flood area per facility catchment increased (adjusted Incidence Rate Ratio = 0.78, 95% CI: 0.61-0.99, p < 0.05), whilst reported diarrhoea significantly increased with flood area per facility catchment (adjusted Incidence Rate Ratio = 4.27, 95% CI: 2.74-6.63, p < 0.001). Key informants noted how flooding affected access to health services as patients and health professionals could not reach the health facility and emergency referrals were unable to travel. CONCLUSIONS: The significant reduction in outpatient attendance during flooding suggests that flooding impairs healthcare delivery. The relationship is sensitive to the choice of satellite-derived flood product, so future studies should consider integrating multiple sources of satellite imagery for more robust exposure assessment. Health teams and communities should plan spatially targeted flood mitigation and health system adaptation strategies that explicitly address population and workforce mobility issues.
The Greater Accra Region is the smallest of the 16 administrative regions in Ghana. It is highly populated and characterized by tropical climatic conditions. Although efforts towards malaria control in Ghana have had positive impacts, malaria remains in the top five diseases reported at healthcare facilities within the Greater Accra Region. To further accelerate progress, analysis of regionally generated data is needed to inform control and management measures at this level. This study aimed to examine the climatic drivers of malaria transmission in the Greater Accra Region and identify inter-district variation in malaria burden. Monthly malaria cases for the Greater Accra Region were obtained from the Ghanaian District Health Information and Management System. Malaria cases were decomposed using seasonal-trend decomposition, based on locally weighted regression to analyze seasonality. A negative binomial regression model with a conditional autoregressive prior structure was used to quantify associations between climatic variables and malaria risk and spatial dependence. Posterior parameters were estimated using Bayesian Markov chain Monte Carlo simulation with Gibbs sampling. A total of 1,105,370 malaria cases were recorded in the region from 2015 to 2019. The overall malaria incidence for the region was approximately 47 per 1000 population. Malaria transmission was highly seasonal with an irregular inter-annual pattern. Monthly malaria case incidence was found to decrease by 2.3% (95% credible interval: 0.7-4.2%) for each 1 °C increase in monthly minimum temperature. Only five districts located in the south-central part of the region had a malaria incidence rate lower than the regional average at >95% probability level. The distribution of malaria cases was heterogeneous, seasonal, and significantly associated with climatic variables. Targeted malaria control and prevention in high-risk districts at the appropriate time points could result in a significant reduction in malaria transmission in the Greater Accra Region.
Background: This study investigated malaria transmission under various contrasting settings in the Central Region, a malaria endemic region in Ghana. Methods: This cross-sectional study was carried out in five randomly selected districts in the Central Region of Ghana. Three of the districts were forested, while the rest was coastal. Study participants were selected to coincide with either the regular rainy or dry season. From each study site, hospital attendees were randomly selected with prior consent. Consciously, study participants were selected in both rainy (September and October, 2020) and dry (November and December, 2020) seasons. Clinical data for each patient was checked for clinical malaria suspicion and microscopic confirmation of malaria. Using SPSS Version 24 (Chicago, IL, USA), bivariate analysis was done to determine the association of independent variables (ecological and seasonal variations) with malaria status. When the overall analysis did not yield significant association, further statistical analysis was performed after stratification of variables (into age and gender) to determine whether any or both of them would significantly associate with the dependent variable. Results: Of the 3993 study participants, 62.5% were suspected of malaria whereas 38.2% were confirmed to have clinical falciparum malaria. Data analysis revealed that in both rainy and dry seasons, malaria cases were significantly higher in forested districts ) than coastal districts (x2 = 217.9 vs x2 = 50.9; p < 0.001). Taken together, the risk of malaria was significantly higher in the dry season (COR = 1.471, p < 0.001) and lower in coastal zones (COR = 0.826, p = 0.007). There was significant reduced risk of participants aged over 39 years of malaria (COR=0.657, p < 0.001). Whereas, in general patients between 10 and 19 years were insignificantly less likely to have malaria (COR = 0.911, p = 0.518) compared to participants aged less than < 10 years, the reverse was observed in coastal districts where patients less than 10 years of age in coastal districts were less likely to have malaria (COR=2.440, p = 0.003). In general, gender did not associate with malaria, but when stratified by study district, the risk of female gender to malaria was significantly higher in Agona Swedru (COR = 5.605, p < 0.001), Assin central (COR = 2.172, p < 0.001), Awutu Senya (COR = 2.410, p < 0.001) and Cape Coast (COR = 3.939, p < 0.001) compared to Abura-Asebu-Kwamankese. Conclusion: This study demonstrated that the predictors of malaria differ from one endemic area to another. Therefore, malaria control interventions such as distribution of long-lasting insecticide treated bed nets, residual spraying with insecticide and mass distribution of antimalaria prophylaxis must be intensified in forested districts in all seasons with particular attention on females. (c) 2022 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. CC_BY_NC_ND_4.0
Malaria remains a serious public health challenge in Ghana including the Greater Accra Region. This study aimed to quantify the spatial, temporal and spatio-temporal patterns of malaria in the Greater Accra Region to inform targeted allocation of health resources. Malaria cases data from 2015 to 2019 were obtained from the Ghanaian District Health Information and Management System and aggregated at a district and monthly level. Spatial analysis was conducted using the Global Moran’s I, Getis-Ord Gi*, and local indicators of spatial autocorrelation. Kulldorff’s space-time scan statistics were used to investigate space-time clustering. A negative binomial regression was used to find correlations between climatic factors and sociodemographic characteristics and the incidence of malaria. A total of 1,105,370 malaria cases were reported between 2015 and 2019. Significant seasonal variation was observed, with June and July being the peak months of reported malaria cases. The hotspots districts were Kpone-Katamanso Municipal District, Ashaiman Municipal Districts, Tema Municipal District, and La-Nkwantanang-Madina Municipal District. While La-Nkwantanang-Madina Municipal District was high-high cluster. The Spatio-temporal clusters occurred between February 2015 and July 2017 in the districts of Ningo-Prampram, Shai-Osudoku, Ashaiman Municipal, and Kpone-Katamanso Municipal with a radius of 26.63 km and an relative risk of 4.66 (p < 0.001). Malaria cases were positively associated with monthly rainfall (adjusted odds ratio [AOR] = 1.01; 95% confidence interval [CI] = 1.005, 1.016) and the previous month's cases (AOR = 1.064; 95% CI 1.062, 1.065) and negatively correlated with minimum temperature (AOR = 0.86, 95% CI = 0.823, 0.899) and population density (AOR = 0.996, 95% CI = 0.994, 0.998). Malaria control and prevention should be strengthened in hotspot districts in the appropriate months to improve program effectiveness.
Whilst climate change is expected to tremendously influence the regional transmission of malaria, the available data reveal conflicting results. This study provides contextual evidence. We adopted multi-scale geographically weighted regression (MGWR) modelling approach. AICc and local r(2) were used to evaluate performance of the MGWR.. The MGWR analysis showed that LST (beta = -0.667), maximum temperature (beta = -0.507), mean temperature (beta = -0.480), and distance from streams (beta = -0.487) were negatively associated with malaria prevalence. However, enhanced vegetation index correlated positively with malaria prevalence (beta = 0.663). Our results may be important for public health interventions.
Malaria has a significant impact on the lives of many in Ghana. It is one of the key causes of mortality and morbidity, resulting in 32.5% of outpatient visits and 48.8% of under 5-year-old hospital admissions. Future climate change may impact on this risk. This study aims at estimating the impact of climate variables and health facilities on malaria prevalence in Ghana using regional data from January 2012 to May 2017. This study links data at a regional level on malaria cases with weather data to evaluate the impact that changes in weather may have on malaria prevalence in Ghana. The results of fixed-effect modelling show that the maximum temperature has a statistically significant negative impact on malaria in the context of Ghana, and rainfall with a lag of two months has a positive statistically significant impact. Adapting to climate change in Ghana requires a better understanding of the climate-malaria relationship and this paper attempts to bridge this gap.
Although there is a large and growing literature on anticipated climate change impacts on health, we know very little about the linkages between differentiated vulnerabilities to climate extremes and adverse physical and mental health outcomes. In this paper, we examine how recurrent flooding interacts with gendered vulnerability, social differentiation, and place-related historical and structural processes to produce unequal physical and mental health outcomes. We situated the study in Old Fadama, Ghana, using a Photovoice approach (n = 20) and theoretical concepts from political ecologies of health and feminist political ecology. Overall, the study revealed several adverse physical and mental health impacts of flooding, with vulnerability differentiated based particularly on gender and age, but also housing, class, and income. Our findings suggest the need for greater attentiveness to social differentiation in scholarship involving political ecologies of health. The paper builds on the health and place literature by linking the social and contextual to the medical.
The lack of empirical evidence on the effect of heat exposure on the health and safety, productivity, psychological behaviour and social well-being outcomes of small- and large-scale mining workers in Africa has derailed concrete policy directions and interventions. An explanatory cross-sectional survey involving 320 small- and large-scale mining workers was used to assess this research gap. A path analysis was used to model health and safety, productivity, psychological behaviour and social well-being as a function of heat exposure, mediated and moderated by adaptation strategies and barriers, while controlling for age, gender, level of education, years of working experience and workplace environment. Significant direct adverse effects of heat exposure on mining workers’ health and safety, productivity and psychological behaviour outcomes were found. Using a pick-a-point approach, significant difference was found in simple slopes (SS) for heat exposure on adaptation strategies at medium level of barriers and a trend toward significance at the high level of barriers. Except for health and safety outcomes, there were significant conditional indirect effects of heat exposure on the performance outcomes at the medium and high levels of barriers to adaptation strategies. However, there was no evidence of mediated-moderation for heat exposure and health and safety, productivity, psychological behaviour and social well-being outcomes. We have provided empirical evidence to establish heat exposure effect on key performance outcomes of mining workers to initiate and guide the formulation of heat exposure management policies.
Many occupational settings located outdoors in direct sun, such as open cut mining, pose a health, safety, and productivity risk to workers because of their increased exposure to heat. This issue is exacerbated by climate change effects, the physical nature of the work, the requirement to work extended shifts and the need to wear protective clothing which restricts evaporative cooling. Though Ghana has a rapidly expanding mining sector with a large workforce, there appears to be no study that has assessed the magnitude and risk of heat exposure on mining workers and its potential impact on this workforce. Questionnaires and temperature data loggers were used to assess the risk and extent of heat exposure in the working and living environments of Ghanaian miners. The variation in heat exposure risk factors across workers’ gender, education level, workload, work hours, physical work exertion and proximity to heat sources is significant (p<0.05). Mining workers are vulnerable to the hazards of heat exposure which can endanger their health and safety, productive capacity, social well-being, adaptive capacity and resilience. An evaluation of indoor and outdoor Wet Bulb Globe Temperature (WBGT) in the working and living environment showed that mining workers can be exposed to relatively high thermal load, thus raising their heat stress risk. Adequate adaptation policies and heat exposure management for workers are imperative to reduce heat stress risk, and improve productive capacity and the social health of mining workers.
Climate extreme events have significant impacts on the livelihoods of smallholder women farmers. The aim of the present study is to investigate the coping and adaptation measures that women farmers use to respond to specific climate extreme events. The data for the study comes from 187 smallholder women farmers from Upper West region of Ghana. The study employed the Bivariate Probit model in the empirical analysis. The results revealed that membership of farmer-based organizations and the use of climate information were the key factors which influenced women farmers’ coping strategies against climate extreme events. Women farmers’ adaptation measures were mainly influenced by access to credit. The key policy variable that influenced both coping and adaptation measures of women farmers was access to agricultural extension services. The study recommends that policy should focus on the promotion of specific coping and adaptation interventions against climate extreme events among women farmers. Policy should create enabling environment for the establishments of farmer-based organizations, increase women farmers’ contact with women agricultural extension officers and remove institutional barriers that impede access to credit and the use of climate information.Climate extreme events have significant impacts on the livelihoods of smallholder women farmers. The aim of the present study is to investigate the coping and adaptation measures that women farmers use to respond to specific climate extreme events. The data for the study comes from 187 smallholder women farmers from Upper West region of Ghana. The study employed the Bivariate Probit model in the empirical analysis. The results revealed that membership of farmer-based organizations and the use of climate information were the key factors which influenced women farmers’ coping strategies against climate extreme events. Women farmers’ adaptation measures were mainly influenced by access to credit. The key policy variable that influenced both coping and adaptation measures of women farmers was access to agricultural extension services. The study recommends that policy should focus on the promotion of specific coping and adaptation interventions against climate extreme events among women farmers. Policy should create enabling environment for the establishments of farmer-based organizations, increase women farmers’ contact with women agricultural extension officers and remove institutional barriers that impede access to credit and the use of climate information.
Globally, studies have shown that diurnal changes in weather conditions and extreme weather events have a profound effect on mortality. Here, we assessed the effect of apparent temperature on all-cause mortality and the modifying effect of sex on the apparent temperature-mortality relationship using mortality and weather data archived over an eleven-year period. An overdispersed Poisson regression and distributed lag nonlinear models were used for this analysis. With these models, we analysed the relative risk of mortality at different temperature values over a 10-day lag period. By and large, we observed a nonlinear association between mean daily apparent temperature and all-cause mortality. An assessment of different temperature values over a 10-day lag period showed an increased risk of death at the lowest apparent temperature (18°C) from lag 2 to 4 with the highest relative risk of mortality (RR?=?1.61, 95% CI: 1.2, 2.15, p value?=?0.001) occurring three days after exposure. The relative risk of death also varied between males (RR?=?0.31, 95% CI: 0.10, 0.94) and females (RR?=?4.88, 95% CI: 1.40, 16.99) by apparent temperature and lag. On the whole, males are sensitive to both temperature extremes whilst females are more vulnerable to low temperature-related mortality. Accordingly, our findings could inform efforts at reducing temperature-related mortality in this context and other settings with similar environmental and demographic characteristics.
Extreme weather events pose significant threats to urban health in low- and middle-income countries, particularly in sub-Saharan Africa where there are systemic health challenges. This paper investigates health system vulnerabilities associated with flooding and extreme heat, along with strategies for resilience building by service providers and community members, in Accra and Tamale, Ghana. We employed field observations, rainfall records, temperature measurements, and semi-structured interviews in health facilities within selected areas of both cities. Results indicate that poor building conditions, unstable power supply, poor sanitation and hygiene, and the built environment reduce access to healthcare for residents of poor urban areas. Health facilities are sited in low-lying areas with poor drainage systems and can be 6 °C warmer at night than reported by official records from nearby weather stations. This is due to a combination of greater thermal inertia of the buildings and the urban heat island effect. Flooding and extreme heat interact with socioeconomic conditions to impact physical infrastructure and disrupt community health as well as health facility operations. Community members and health facilities make infrastructural and operational adjustments to reduce extreme weather stress and improve healthcare provision to clients. These measures include: mobilisation of residents to clear rubbish and unclog drains; elevating equipment to protect it from floods; improving ventilation during extreme heat; and using alternative power sources for emergency surgery and storage during outages. Stakeholders recommend additional actions to manage flood and heat impacts on health in their cities, such as, improving the capacity of drainage systems to carry floodwaters, and routine temperature monitoring to better manage heat in health facilities. Finally, more timely and targeted information systems and emergency response plans are required to ensure preparedness for extreme weather events in urban areas.
Global warming is a serious threat to human existence. The relatively higher level of global warming in recent times poses higher health risks to humans, both directly and indirectly. The aim of the study was to investigate public knowledge of global warming and its effects on human health. A nationally representative survey of Ghanaian adults (N = 1130) was conducted from November 1, 2018 to February 28, 2019. Results show that 84.4% of the respondents understood the meaning of global warming. Respondents’ perceived causes of global warming include natural processes, deforestation, act of the gods, burning of fossil fuel, and carbon dioxide (CO(2)) emission from vehicles and industries. The majority of the respondents (83.4%) indicated that global warming has an impact on human health, while 8.5% indicated that it does not. Majority (78.6%) of the respondents are willing to support efforts to reduce the intensity of global warming. Television (19.1%) and social media (18.6%) were the leading preferred methods for receipt of global warming information. These findings provide useful insights for policy directions. The Government of Ghana and other stakeholders in health should develop a communication strategy to increase and sustain publicity and education of the citizenry on global warming.
