TaeggdnEd he Journal of Climate Change and Health 10 (2023) 100189
Contents lists available at ScienceDirect
gTFgiedrguae eaTggdEdn The Journal of Climate Change and Health ggeTaderugiF dEeggaTdn
journal homepage: www.elsevier.com/joclimResearch articleTaeggd1HUrbanization, climate change and health vulnerabilities in slum
communities in Ghana TadgEgdenaTgdgePEnoch Damtea, Bob Offei Manteawa,*, Charlotte Wrigley-Asanteb aTgdgeEnd
a
PTaggde Center for Climate Change and Sustainability Studies, University of Ghana
b Department of Geography and Resource Development, University of Ghana, Legon, GhanaTadgEgdenATGDGEP R T I C L E I N F O
Article History:
Received 2 July 2022
Accepted 14 November 2022
Available online 17 November 2022 ETeadgdgnaTgdgneEd* Corresponding author at: Center for Climate Chan
University of Ghana, Legon, Ghana.
E-mail address: rmanteaw@ug.edu.gh (B.O. Manteaw
https://doi.org/10.1016/j.joclim.2022.100189
2667-2782/© 2022 The Authors. Published by Elsevier M
(http://creativecommons.org/licenses/by-nc-nd/4.0/)ATGDGEP B S T R A C T
Introduction: Rapid population growth, increased migration, surge urbanization and human settlement chal-
lenges have become defining features of most African cities. Accra, the capital of Ghana, is no exception as its
fast-urbanizing processes and associated housing challenges have seen the emergence of slum communities
in and around the city. While slum communities are not new in Accra nor in Ghana, what is worrying is the
current pace of emergence, the state of such communities, population density and levels of vulnerability.
Even more worrying are the observed impacts of climate-induced extreme weather events on such commu-
nities and attendant health consequences.
Methodology: Focusing on some slum communities in and around the city of Accra, this paper investigates the
environmental health conditions of slum communities and how such conditions converge with climate
change impact manifestations to increase disease burden. The paper employed a concurrent triangulation
mixed method approach to simultaneously gather data from randomly selected slum communities in the
Accra Metropolitan Assembly and La-Nkwantanang Madina municipality to explore possible correlations
between current changes in climate and public health challenges.
Conclusion: The results affirm a correlation between observed climate change impacts and prevailing health
conditions in the selected slum communities. There is ample evidence to signal both direct and indirect link-
ages between climate-induced weather events and increased prevalence of diseases such as malaria, diar-
rhea, cholera, skin disease, lung diseases, as well as the emergence of novel diseases in the target slum
communities. The study, ultimately, succeeds in demonstrating the nexus of climate change, health, and
urbanization.
© 2022 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/) ETeadgdgnaTgTgnegddEagedPKeywords:
Climate change
Urban poor
Floods
Droughts
Slums
Health
Vulnerabilities daegEgdTnge and Sustainability Studies,
).
asson SAS. This is an open access article under the CC BY-NC-ND licenseTaeggd1H . Introduction TagdgeEdn
TagegdP he urban age is manifesting quickly and forcefully in almost
every part of the world. The continent of Africa, represented by its
different countries, remains one of the fastest urbanizing regions in
the world [1]. At current pace of urbanization, the general expecta-
tion is that urban populations in Africa could see an exponential
surge from 395 million in 2010 to around 1,339 billion in 2050 [1−2].
Such growth rates are not only unusual, but they are alarming, with
significant ramifications for the continent’s sustainable development
aspirations. TaeggdnEd
TaggedP he consequential impacts of irreversible changes on urban socio-
ecological, cultural, and economic systems, particularly as they relate
to human settlement considerations, are dire and counter-productiveaTgTgeegdPEangddto sustainable development processes [3]. The situation as is cur-
rently unfolding is even more worrying in Sub-Saharan Africa (SSA)
where increased migration, population expansion and surge urbani-
zation processes have become a defining character of most cities in
ways that have brought most governments and their city planning
authorities under tremendous pressures (Fig. 1). TgadgeEnd
gTeagdP he city of Accra, Ghana’s capital, is no exception as it endures the
negative impacts of unplanned urbanization with associated human
settlement challenges. Prominent among these challenges is the per-
vasiveness of slum communities across the city and the socio-eco-
logical and health threats that these communities face [4]. Even more
concerning is the fact that climate change as an emergent reality is
exacerbating existing challenges to make slum dwellers even more
vulnerable. Increased and intense precipitation, rising temperatures
and extreme hydro-metrological events such as floods and droughts
[5] are some of the current manifestations of climate change impacts
across Ghana and more specifically in urban communities, such as
Accra, where slum settlements are nested. EdeggTdan
TaggedEnd guFideggaTer . Damte, B.O. Manteaw and C. Wrigley-Asante The Journal of Climate Change and Health 10 (2023) 100189
Fig. 1. Map of the study area.Source: Authors’ Construct (2020). dgngeTEadaTggePdClimate change impacts have become rampant in most communi-
ties in Ghana and continue to turn fragility, disorganization, and the
sheer density of slum communities into critical risk factors in urban
environments. Typical instances are witnessed in most urban areas
like Accra where climate extreme events like flooding have become
an annual phenomenon in recent decades and hit hard on the poor
and most vulnerable people in the city [10]. Climate risks, have
become pervasive and are characterized by intense rains, frequent
flooding, drought, heat trapping, water shortages and air quality
deterioration [6]. Of particular concern is how climate-induced socio-
ecological changes are introducing new health burdens [7]. Previ-
ously eradicated diseases are re-emerging in some instances and
there is growing evidence of diseases such as smallpox, cholera from
poor water safety, influenza, yellow fever and others which are wors-
ening existing health burdens of slum dwellers [8].TadgEgden
TgagedAP s observed changes become more pronounced in some slum
communities in Accra, it has also become a worrying concern that no
focused attention has been given to urban slums to understand the
impacts of climate change on these settlements and the health of the
communities. TaggdeEnd
aTggePd his study aims to bring the issue into focus by highlighting the
link between climate change and urbanization. Specifically, the study
investigates the problem of climate change in the context of2
TadgEgdenTgagedPunplanned urbanization in cities such as Accra and the consequential
emergence of slum settlements. Focusing on Accra, the capital of
Ghana, the study examines evidence of climate change to establish
the extent and nature of impacts on health in selected slum commu-
nities. The paper then explores the extent and nature of vulnerabil-
ities, especially as they relate to the health of slum dwellers, with a
view to understanding how existing vulnerabilities are currently
being exacerbated by changing climate conditions to cause changes
in the health trends in informal human settlements such as slums in
Accra. TagegdEnd
TagegdH12. Climate and health in Ghana gTeagdnEd
dgTgaePGhana is faced with several climate-associated disasters and
events which have had and continue to have significant adverse
impacts on public health. In the past few years, several disasters have
been witnessed in different parts of the country, mostly in the cities
and urban areas [9]. These include floods, drought, and fire outbreaks.
In most instances, when these disasters struck, the immediate con-
cern has always been the provision of relief items and safe shelters to
victims after which they are left to their respective fates [9]. This is
particularly the case in urban Accra, where flood events have become
recurring and disastrous during rainy seasons [10].daegEgdTn
TaeggdnEd . Damte, B.O. Manteaw and C. Wrigley-Asante The Journal of Climate Change and Health 10 (2023) 100189aTgdgeP he frequency of flooding in Accra is believed to have increased
over the last decade as rainfall trends have changed [11]. These
changes have manifested in disruption in community lives and are
believed to have increased the prevalence of disease burdens from
malaria, diarrhea and other water-borne diseases in local communi-
ties. Mumuni [12] affirms such changes by observing that diarrhea
has been one of the top ten public health concerns in Ghana in the
last two decades. This is also true for cholera and other sanitation
and hygiene-related diseases. While these have become critical pub-
lic health concerns in urban poor settings [12], the situation does not
seem to have attracted the needed attention. ndggTeaEd
aTgdgePAs climate change impacts become more pronounced and verifi-
able in local communities, it has also become increasingly clear that
excess moisture, thus flood events, are also causing extensive direct
and indirect health challenges. Some effects that have become com-
mon across Ghana include food insecurity, water quality and scarcity,
ecosystem disruption, mental health stresses and population dis-
placement [13]. The situation is dire in some instances, but even
more so is the disturbing fact that current projections signal even
more ominous future conditions with more significant impacts if not
proactively addressed. gTagdeEnd
ePgTgadChanges in climate variables are expected to cause increased inci-
dences of diseases such as malaria, measles, skin and other respira-
tory diseases [14]. Temperature, for instance, is projected to increase
with concomitant increases in heat waves which will affect people
who are at risk of heat-related health disease conditions. Honda et al.
[15] observe that current conditions converge ominously with pro-
jected climate changes to make Ghana susceptible to several climate-
related health effects based on annual increases in temperature and
precipitation trends.aTggendEd
HaeggTd13. Study context TaeggdnEd
gTagedP he study was conducted in the Greater Accra region which is cur-
rently the most populous region according to the 2021 Population
and Housing Census (PHC) and doubles as the region in which Gha-
na’s capital, Accra, is situated. It focuses specifically on the Greater
Accra Metropolitan Area (GAMA), which constitutes approximately
33% of the Greater Accra region’s total land surface and is the most
densely populated area, serving as a home to about 3.7 million inhab-
itants. The GAMA region covers approximately 96% of the Greater
Accra region’s total population [16].TaeggdnEd
gTagedPGAMA is positioned in the dry coastal equatorial climatic zone
with two rainy seasons. The first season starts in March and ends in
July, whilst the second season starts in September and ends in
November [10]. Rainfall is mostly intensive with short storms which
normally cause flooding in most parts of the region. Mean monthly
temperature ranges from 24.7°C in August to 33°C in March, with an
annual average of 26.8°C [17].gTagedEnd
TaggedP he city of Accra, located within the borders of GAMA, has dry
periods in January, February, and December. Most rainfall (rainy sea-
son) is seen in May and June; on average June is the wettest month
with average monthly values between 152 and 254 mm [18]. Coastal
savannah shrubs scattered with thickets mainly cover the region.
However, it is believed that much of the area was once covered with
dense forest which has been lost due to climate change and other
human activities [19].ndggTeaEd
aTgdgePBy 2012, GAMA had metamorphosed into twelve (12) autono-
mous but physically and functionally integrated administrative divi-
sions [18]. Two administrative areas, Accra Metropolitan Assembly
(AMA) and La-Nkwantanang Municipal Assembly, were selected for
study out of the twelve. Four slum communities were considered for
the study within the GAMA region. TaeggdnEd
gTagedP he selection of the various slum communities was guided by Pal-
ler’s [20] classification of slums, where slums were classified accord-
ing to their indigeneity, extra-legality and purchasing power. The3
aTgTgnegddEagdePselected communities for this study also meet the description of slum
areas giving by UN-Habitat [21] and, indeed, this provided a best fit
description considering dynamism in character, settlements, impacts
and economic activities. eEgTgadnd
Taeggd1H4. Methodology aTggendEd
adggTeH42 .1. Study design eEgTgadnd
TgagePd his paper employed the concurrent triangulation mixed-method
strategy and was performed between February and March 2020. Data
collection activities included administering of questionnaires, inter-
view guides and focus group discussions that were carried out simul-
taneously, to validate the adverse effect of climate change on health
among slum dwellers in Accra. TgageEdnd
Tagge2dH4.2. Sampling adggTeEdn
TgagePdA simple random sampling was used to select the studied districts
(Accra Metropolitan Assembly and La-Nkwantanang Madina Munici-
pality). Ablekuma South and Ashiedu Keteke were the 2 sub-metros
the study considered within AMA. Two slum communities, Agbog-
bloshie and Old Fadama, were selected from Ablekuma South sub-
metro, and Jamestown was selected from Ashiedu Keteke sub-metro.
Madina Redco Point 5 slum area was also chosen from La Nkwanta-
nang Municipality. aTggendEd
TaeggdSP tudy participants, comprising dwellers from all the selected com-
munities, were sampled utilizing convenience sampling methods. A
convenience sampling technique was used because it was quick, easy
and convenient, utilizing participants that were readily available at
the moment of the data collection exercise. Health practitioners
including nurses, pharmacists, and medical doctors within the two
districts also were sampled using purposive sampling and snow-ball-
ing methods. This was necessary to ascertain the influence that cli-
mate change has on health from their perspective. TaggEednd
TgagedH24.3. Data collection gTagdeEnd
ePgTgadSurveys, in-depth interviews, and focus group discussions consti-
tuted our data collection mechanisms. Structured questionnaires
were used as the only quantitative instrument to investigate the
impacts of climate change on health among slum dwellers of various
communities. These structured questionnaires considered rainfall,
temperature, wind and humidity as the common climate variables
for the study. A total of 120 questionnaires were administered to the
sampled population for the study. adggTeEnd
gTagdePAs noted, to achieve the objectives of a concurrent triangulation
mixed-method approach, a well-organized in-depth interview and
focus group discussions (FGDs) also were deployed to complement,
confirm, and corroborate quantitative analysis of the study. There
were 2 sessions of FGDs conducted with between 7 and 9 members
in each. The two separate discussions were organized for adult males
and females of 30 years and above at Agbogbloshie. These discussions
were significant and advantageous in consolidating respective expe-
riences, opinions, and worldviews of climate change impacts on
health among slum dwellers. Additionally, 8 in-depth interviews
were held with health practitioners in the studied districts to explore
issues pertaining to knowledge on climate change including climate
change impacts and health-related challenges of climate change,
among others. ETeadgdgn
TgagPedAll interviews and discussions were tape-recorded with permis-
sion of participants. The themes for the FGDs and in-depth interviews
included, but were not limited to, knowledge and perception of cli-
mate change, observed climate extreme events in the various com-
munities, climate induced health impacts, and recommendations.
Focus Group Discussions were conducted in local languages (Ga and
TaegEgdnd . Damte, B.O. Manteaw and C. Wrigley-Asante The Journal of Climate Change and Health 10 (2023) 100189
agTeddnEg Table 1
Socio-demographic characteristics.
Socio-Demographic Variables Frequency Percentage (%)
Communities
Madina Redco 26 21.7TadgggaeddTEgneP wi, which are the two most common languages spoken). The in-
depth interviews were conducted in English because this category
of participants included medical doctors, nurses, pharmacists, and
other health practitioners who have obtained high levels of edu-
cation. eEdTgadgnJames Town 35 29.2
Old Fadama 20 16.7
Agbobloshie 39 32.5
Gender
Male 69 57.5
Female 51 42.5
Age Group
20-25 years 21 17.5
26-30 years 27 22.5
31-35 years 24 20.0
36-40 years 6 5.0
>40years 42 35.0
Level of Education
No Formal Education 14 11.7
Primary 21 17.5
JHS 55 45.8
SHS 21 17.5
Tertiary 9 7.5
Marital Status
Single 53 44.2
Married 59 49.2
Divorced 4 3.3aTgdgeH42 .4. Data analysis TaggendEd
TaeggdDP ata were coded and processed with the aid of Statistical Package
for Social Sciences (SPSS) Version 22. Descriptive statistical formats
including pie charts and bar graphs were generated and the results
were transformed and presented using frequency distribution and
percentage cross tabulation tables. TgagedEnd
dgTIaegP nterviews and Focus Group Discussions were transcribed into
scripts and analyzed using thematic content technique in line with
the themes of the survey findings to support, confirm and strengthen
the results of the study. Audio recordings in the local languages were
transcribed directly into English and then read multiple times to cor-
rect errors. This activity became imperative to check and ensure con-
sistency, accuracy and quality of the data. Narratives and direct
quotations were also used as part of the analyses to support and vali-
date results of the survey [22−23].ETeadgdgnWidowed 4 3.3
Source: Field data, (2020)
Ta4gHgde2 .5. Limitation of the Study gTeagdnEd
dgTgaeP he sampling technique (convenience sampling method) used in
obtaining data for the study made use of the respondents and partici-
pants readily available at the time of data collection. However, this
may not be a true reflection of the intended sample with first-hand
information about the topic. Future studies should utilize probability
sampling methods which carefully select and give equal representa-
tion to different members of the studied population. Also, this paper
focused on low income high density areas in the city of Accra; there-
fore, future studies should focus on areas that are not slums for a
comparative assessment. daegEgdTnTaeggd1H5. Results eagTgdnEd
PTeaggd he outcome of the data analyses is presented chronologically.
The first set of findings displays the demographic characteristics of
participants. The second aspect of the findings establishes and
describes extreme climate change consequences that are commonly
experienced in slum communities in Accra, including the frequency
of flood and drought occurrences. The study then assesses the causal
factors underlying the effects of extreme climate change events that
affect slum dwellers. The final set of results explores climate-induced
health impacts in slums in Accra. TaggendEd
aTggePdAs shown in Table 1, 120 respondents from four slum communi-
ties in Accra were included in the quantitative data collection. This
was comprised of 39 people (32.5%) from Agbogbloshie, 35 people
(29.2%) from Jamestown, 26 respondents (21.7%) from Madina Redco,
and 20 respondents (16.7%) from Old Fadama. eagTgdnEd
PTeaggdOut of the 120 respondents, 57.5% (69) were male slum dwellers
while 42.5% (51) were female. In terms of age groups, 35% were above
the age of 40 years, 22.5% were 26-30 years, 20% were 31-35 years,
17.5% were 20-25 years, and 5% were 36-40 years of age. TaggendEd
aTggePdAccording to field data obtained from slum communities, 55
respondents (45.8%) had only attained Junior High School (JHS) edu-
cation. Twenty-one (17.5%) have had their education up to Senior
High School level, 21 (17.5%) had attained primary education, 14
(11.7%) have had no formal education, and 9 respondents (7.5%) had
attained tertiary education. Fifty-nine of the total respondents
(49.2%) were married whilst 53 (44.2%) were single. TadgEgden4
aTgdg2eH5.1. Climate extreme events in slum areas of Accra TaegEgdnd
TgadgePExtreme climate events which were reported in the study
included periods of high temperature, torrential rains and floods, and
droughts. Respondents and participants in the study identified and
expressed much distress over these extreme events (floods, droughts
and dry spells) as the major life-threatening climate occurrences in
their communities. TaggedEnd
TaggedP5.1.1. Frequency of extreme climate events in slum communities TgadgeEnd
gTeagdPIn analyzing extreme climate events, three key descriptive varia-
bles regarding frequency were used in this study and defined as fol-
lows: Frequent (the event occurred many times within a year or was
experienced more than three times in year); Occasional (the event
did not occur regularly or two or three times in a year); and Uncom-
mon (the event occurred rarely or only once in a year).angdgeTEd
aTggedP able 2 shows the frequency of occurrence of climate extreme
events (flooding and drought and dry spells) among slum communi-
ties in Accra. As flooding in Accra has been one of the major climate
associated problems faced by residents, with records indicating that
about 83 lives were lost directly from floods, and 178,750 people
were displaced between 2000 and 2012 in Accra [10], it was important
to establish the rate of its occurrence in order to understand the situa-
tion. Responses were varied; however, the majority of slum dwellers
interviewed (69.2%) reported an occasional occurrence of flooding;
19.2% indicated that their experience of flood events was frequent;
whilst 11.7% of slum dwellers reported rare incidents of flooding.
reflecting topographical differences within the communities.agTgedEnd
TaggedPfFndings from the various slum communities in Accra suggest that
flooding is one of the most common weather events bedeviling slum
residents. It is also clear from observation and local history that
impacts of floods on these communities tend to be severe and disas-
trous, mostly due to overcrowding and lack of access to basic services
such as water and proper sanitation [26]. These findings were con-
firmed in different ways by some residents during focus group dis-
cussions. For instance, a male respondent from Agbogbloshie
reported during the focus group discussion that flooding always
occurs in the community following heavy rainfall. Similarly, a female
resident in Agbogloshie explained that floods occur in that
agTgneEdd . Damte, B.O. Manteaw and C. Wrigley-Asante The Journal of Climate Change and Health 10 (2023) 100189
dgdegaTnE Table 2
Frequency of flood occurrence in slum communities in Accra.
Climate Extreme Events Frequency of Occurrence (%) Total Total Number
Percentage of of Responses
Frequent Occasional Uncommon Occurrence
Flood 19%, (23) 69%, (83) 12%, (14) 100 120
Drought and Dry Spells 33%, (39) 58%, (70) 9%, (11) 100 120
Source: Field data, (2020).TadgEgdenTgagedcP ommunity as a result of heavy rains and poor drainage systems in
the community. dgTgaeEnd
PTeaggd he views expressed by the respondents were summed up by one
male respondent as follows:
“. . .Indeed! the change in climate brings about flood; for instance,
when the rain falls for about an hour or two, most parts of the com-
munity if not all get flooded, restricting movements and ceasing eco-
nomic activities. . . you take a look at this area, we do not work in
offices [white collar jobs], we engage in trading, so such floods
directly affect our livelihoods.”
(Adult-Male FGD).
TaggedEdn
TagegdP his view validates observations made by other respondents in all
the slum communities studied, Agbogbloshie, Old Fadama, James-
town and Madina Redco. In all these communities, while floods fol-
low heavy and intense downpours, some of their impacts are
exacerbated by the lack of proper drains and the pervasiveness of
choked drains as a result of improperly disposed solid waste. The
general view is that when rainfall is less intense many of the slum
communities do not experience flooding, which implies the intensity
of rain and obstructions to running rainwater are the main causes of
flooding in these communities TgagednEd
TaggedPIn addition to floods, droughts and dry spells were other cli-
mate events experienced by residents in these slum communities.
As seen in Table 1, 58% of respondents mentioned that they occa-
sionally experienced droughts and dry spells, 33% experienced
these events more frequently and 11.9% reported that droughts
and dry spells are not common events to them. Droughts and dry
spells are either regularly or sporadically experienced in these
communities and are perceived as indications of climate change
impacts. Most residents have noticed the current warm and harsh
weather conditions and they interpret this condition from the
perspective of increased temperatures as witnessed through the
heat of the scorching sun. TgadgeEnd
PTeaggdOther participants observed that droughts and dry spells are
observed realities in their environment, and these have signifi-
cant impacts on individuals and the entire community. For
instance, a male participant during FGD noted the significant
changes as follows:
“. . . even as we are seated here we are experiencing the heat; we are
sweating and do not need anyone to convince us that there are
changes going on in the environment. It is not even 12:00 noon, so
imagine what will happen after 1:00 pm. It is a very serious sit-
uation. . .. the dry spells are prolonged, and it makes the atmosphere
very dry with less moisture. It also brings about poor air quality
which affects our breathing.”
(Adult-Male FGD)
TaggdeEnd
aTggePdSimilarly, a female participant affirmed her experiences and
observations of droughts and dry spells in her community as follows:
“. . .as for the drought and dry spells, it is frequent in this area and is
causing us to sweat profusely and have other heat related problems.”
geTaEgndd (Adult-Female FGD)5
Taeggd2H5.2. Factors causing extreme climate event effects in slum communities
of Accra TaggendEd
aTggePdAfter respondents and stakeholders reported floods, droughts and
dry spells as the major climate extreme events they experienced and
observed, the study sought to investigate the key causes of their
effects. Results showed that factors such as heavy rainfall, storm
surges, poor drainage systems, and lack of vegetation cover were per-
ceived as the main causes of flooding events. TaeggdnEd
TaggPed he survey revealed that about 66.7% of participants attributed
flooding events in slum communities to poor drainage systems and
choked drains. Unconventional waste management practices in slum
areas in Accra and incidence of flooding are correlated; most parts of
Accra lack proper waste management practices and as a result, vol-
umes of solid waste are not collected, with a good part of the waste
ending up in community drains [27]. This causes blockages during
rains and impedes runoff. About 20% of respondents attributed floods
to heavy rains because many parts of Accra experience extreme
flooding events following heavy rainfall. This situation has been cor-
roborated by Ludlow [28], who observed that excessive water from
rainfall usually overflows the boundaries of the drainage channel sys-
tems in Accra which causes flooding in local communities. dgTgaeEnd
gTagdePFrom authors’ observations and interactions with slum dwellers, it
became clear that most slum dwellers have concerns about pro-
longed dry spells and associated pollution and air quality issues.
While most of them could not explain the causes of such incidents in
any scientific terms, a few were of the view that industrial production
processes and vehicular emissions may have a part to play. Most
importantly, most of them believed that the constant burning of
waste, especially electronic wastes and scrap metals, at nearby dump
sites and all over the city of Accra, were major contributory factors to
their predicament. TagdgeEnd
gTaged5H2 .3. Climate-induced health impacts in slums in Accra aTggedEnd
dgTgaePHealth effects of climate change are not evenly distributed [29].
The distribution of the greatest health burden is almost opposite to
the contribution of greenhouse gas emissions [30], and deleterious
health outcomes are likely to be greatest in low-income countries
and among vulnerable people living in urban areas [31]. Not surpris-
ingly, therefore, many slum communities, including those in this
study, seem to be suffering from impacts of climate change in ways
that have significant implications for dwellers’ health, as reflected in
the responses from the study communities. dgTgaeEdn
T5adgegP .3.1. Perceived health effects of climate change gTagdeEnd
eagTgdP hrough interviews and discussions, participants were asked to
identify and explain how climate change variables (temperature and
rainfall) and climate extreme events (floods and droughts) affect their
health. Diverse views were solicited with emphasis on what they
believe are causes of some of the health challenges they experience
in their communities. Many respondents identified frequent and
heavy rainfall patterns as well as increasing day and nighttime tem-
peratures as the two main climate elements that affect their health.
For instance, some participants shared their experiences which
TaeggdnEd . Damte, B.O. Manteaw and C. Wrigley-Asante The Journal of Climate Change and Health 10 (2023) 100189TargggaeddTEgnedP anged from excessive sweating, dehydration, body rashes to head-
aches as explained by a male participant during the FGD:
“When the weather is hot, I become dehydrated; it weakens the
body system. Also changes in temperature bring about body
rashes, headaches, and malaria. Even just 3 days ago my small boy
told me about rashes on his back and I had to get him medication”
(Adult-Male FGD)
gTeagdnEd
gTeagdSP imilarly, a female participant indicated the adverse impact of
intense heat as follows:
“High temperature does not help us to grow well because the heat
drains all the water from us (dehydration). It also causes heat rashes,
and we do not breathe well because of poor air quality. Most of us
have constant colds and coughs.”
(Adult-Female FGD).
gTeagdnEd
agTgePdRainfall was also stated to be one of the variables impacting the
health of slum residents in Accra. Participants were of the view that
in as much as excess rainfall results in floods, they also have observed
that infrequent rainfall or the lack of rainfall has been a major con-
cern since these conditions also come with significant health implica-
tions for them as noted by a male respondent:
“First of all, the water we drink here is tap water and the source is
from the Weija river, so if we don’t receive rainfall as expected to
increase the volume of our source of water, we look for alternative
sources of water for drinking and other domestic uses. These alterna-
tives are purchased and they are expensive considering my income. I
can’t afford them for my household. We therefore use any water we
get, irrespective of source and quality, and that tends to cause diar-
rhea as well as other diseases for us.”
(Adult-Male FGD).
gTeagdnEd
gTeagdPIt was also clear from interactions that residents observed that
variable weather, especially very intense rainfall which results in
flooding, spreads both solid and liquid waste materials in the com-
munity that contributes significantly to some of their health chal-
lenges. The situation is further worsened by the poor drainage
systems in the communities coupled with indiscriminant disposal of
waste and fecal matter as explained by a male respondent:
“. . .Our gutters are small and mostly choked with refuse and plastic
bags, so when rain falls the water cannot flow freely. In some cases,
they become stagnant and breeding places for mosquitoes to cause
malaria. . . the rains carry and spread fecal material and refuse in the
environment because we have sanitation problems and poor drain-
age systems. This makes the quality of water very poor causing diar-
rhea and cholera.”
(Adult-Male FGD).
EdeggTdanaTgdgeP5.3.2. The impacts of climate extreme events on healthTgageEdnd
TaggPedApart from climate variables impacting the health of slum dwell-
ers directly, the manifestation of these climate variables also brings
about other health consequences. TaeggdnEd
aTggedPSeveral health impacts of flooding events were described through
questionnaires, interviews and discussions conducted on the field. As
shown in Table 2, about 58.3% of subjects stated that flooding affected
them through depression from loss and damage of property. People
who have experienced flooding may suffer from sustained increases
in common mental disorders [37]. 26.7% also faced challenges of
infectious diseases such as malaria, cholera, and diarrhea. The reality
remains that the vulnerability of the urban poor, and in this context
slum dwellers, increases their exposure to extreme climate events
and climate-induced disease in their communities [38]. A small6
aTgTgnegddEagdePpercentage (5%) stated that they knew of people who have lost their
lives directly or indirectly related to floods. Focus group discussions
validated some of the findings from questionnaires obtained from
the field. They supported the fact that flooding events cause diseases
and put pressure on socio-economic activities. For instance, a female
participant described the situation in her community as follows:
“When a flood event occurs in my area, the remaining water from the
flood mostly breeds mosquitoes and my observation is that there is
always an increase in mosquitoes and the number of malaria inci-
dences in households. Also, flooding restricts our movements because
the whole area becomes muddy and dirty causing the easy spread of
diseases in our overcrowded communities.”
(Adult-Female FGD)
adggTeEnd
gTagdePIn the same community, a male participant also explained the sit-
uation as follows:
“. . .yes, flooding in this area cause malaria, typhoid, diarrhea and
others in my family and even the entire community because after
flooding, it leaves behind stagnant waters and my children are
mostly found playing in those waters and the next thing is facing
health problems.”
(Adult-Male FGD).
ETeadgdgn
TagdgePAs shown in Table 3 participants reported several effects of
droughts and dry spells on slum health. Heat-related diseases (heat
strokes, heat rashes and skin disease) had the highest impacts among
slum dwellers, followed by depression from loss and damage of prop-
erty (fire outbreaks). Infectious disease was the next health conse-
quence of droughts and dry spells on slum residents. Heart disease
and loss of life were reported least frequently. About 46% of the
respondents indicated heat-related problems as their major climate-
induced problem whilst 30.5% also experienced depression. Infec-
tious diseases accounted for 16.7%. About 4.3% respondents indicated
loss of life in relatives whilst 1.5% indicated heart disease. ETeadgdgn
TagdgePOther slum dwellers expressed their opinions to support and vali-
date the findings on the implications of drought and dry spells on
their health through FGDs. Both male and female participants in the
FGDs highlighted how the dry weather conditions impacts on their
health as follows:
“. . .the absence of rain and dry weather bring about dust and dirt
causing respiratory diseases like catarrh cold, flu, asthma and body
weakness. I for example, when I am exposed to dust, I catch cold eas-
ily. These events can also result in rashes and boils and sometimes I
suffer from rashes like boils”
(Adult-Male FGD)
“. . .. due to the frequent occurrence of drought and dry spells, I do not
sleep well and when I walk for a short distance I feel very tired and
weak and sweat profusely. It sometimes causes heat stroke, rashes
and boils to my body.”
(Adult-Female FGD)
eEgTgadnd
TgagePd he experiences of these slum dwellers to climate risks have
become pervasive and are characterized by drought and heat trap-
ping, water shortages and air quality deterioration, with its conse-
quent impact on the health of slum dwellers. Some respondents also
indicated going through depression as a result of loss and damage of
properties from floods and fire. Many of the slum dwellers had expe-
rienced these incidents or knew of someone who had created a sense
of mental burden due to loss or the threat of future such occurrence. TgagedEnd
ePgTgadHealth professionals from the study communities were asked if
climate change and the extreme events have resulted in any health
complications. Even though most of them were not very familiar
with the science of climate change, they were able to provide some
degnETdag . Damte, B.O. Manteaw and C. Wrigley-Asante The Journal of Climate Change and Health 10 (2023) 100189
TgagedEnd Table 3
Impacts of climate extreme events (flood, drought and spells) on slum health.
Climate Extreme Events Impacts of flooding on health of slum residents (%)
Flood events Loss of lives Depression from loss or damage of properties Infectious Diseases others Missing responses
5%, (6) 58%, (69) 26.7%, (32) 6.3%, (8) 4%, (5)
Total 100%, (120)
Impacts of drought and dry spells (%)
Drought and Dry Spells Loss of lives Depression from loss or damage properties Infectious diseases Heat related diseases Heart diseases Missing responses
4.3%, (5) 30.5%, (37) 16.7%, (20) 45.8%, (55) 1.5%, (2) 1-2%, (1)
Total 100%, (120)
Source: Field data, (2020).TadgEgdenTgagedPinsights which indicated their awareness of how sudden and extreme
“weather” changes or variations are deepening health burdens. For
instance, links were made between increase in temperature and skin
rashes as well as respiratory challenges as described by a health pro-
fessional as follows:
“. . .yes, increased pollution leads to air pollution and water contami-
nation which also brings about different diseases such as cholera and
asthma, Again, frequent incidents of high temperatures, flooding and
drought also reduce human immunity to make it easier for some
harmful organisms to survive and cause diseases.”
(Health Professional-Pharmacist)
ETeaggdnd
TaegPgd hus even though the residents and the health professionals could
not proffer direct scientific explanations for the current changes that
they observe in their environments, they were certain that tempera-
ture and rainfall variability have some impacts on the health of slum
dwellers. Common climate-related (temperature and precipitation)
diseases or health effects mentioned were dehydration, body weak-
ness, skin disorders, heat rashes, frequent headaches, malaria, chol-
era, asthma and other respiratory problems. The lack of proper
sanitation and drainage infrastructure also were mentioned as under-
lying factors that contribute to both the emergence and spread of dis-
eases in slum communities (Table 4). daegEgdTnTadgEgden Table 4
Disease slum dwellers were diagnosed of and health records.
Disease Conditions Diagnosed in
Various Diseases
Diagnosed with Infectious Disease (Malaria, Cholera, Diarrhe
Yes
No
Total
Diagnosed with respiratory Disease (Asthma, Pneumonia, Lu
Yes
No
Total
Diagnosed with Heat Strokes and Skin Rashes
Yes
No
Total
Diagnosed with Physical injury
Yes
No
Total
Source: Field data, (2020)
Disease Data Obtained from Two Health Facilities in La-N
(Source: compiled from La-Nkwantanang Municipal Healt
Health Facility Disease
Kekele Polyclinic Malaria (Infec
Skin disease
Respiratory
Madina Polyclinic (Rawlings Circle) Malaria (Infec
Skin disease
Respiratory d
7
Ta5gHgde2 .4. Climate-related diseases diagnosed in the past 2 years (2018-2020) TaegEgdnd
TIadgegP n exploring the effects of climate change on health, it was
observed that climate change can contribute to disease outbreaks
that compound existing health challenges. To further validate and
make a case that people who live in slum communities are more vul-
nerable or susceptible to climate related health risks, respondents
were asked to indicate some of the climate-related diseases they
have suffered or been diagnosed with in the past two years (2018-
2020). This was necessary to allow deeper explorations of partici-
pants’ awareness and understanding levels, and also confirm with
disease records obtained from the Health Directorate. Table 4 shows
responses of various diseases diagnosed in slum dwellers in the past
2 years (2018-2020). The table also provides information on health
records compiled from the La-Nkwantanang Municipal Health Direc-
torate data sheet. TaggdeEnd
aTggePdWithin the past two years, most slum dwellers (70%) noted that
they have suffered or been diagnosed with some infectious or para-
sitic diseases such as malaria, cholera, and diarrhea. A little over half
(54.2%) of the total population were diagnosed with respiratory con-
ditions and about 66% were diagnosed with heat strokes and skin
rashes. 35% of respondents suffered from physical injuries. These
data indicate how changing climatic conditions are affectingthe Past 2 Years (2018-2020)
Frequency Percentage (%) (N=120)
a)
84 70.0
36 30.0
120 100
ng Disease
65 54.2
55 45.8
120 100
79 65.8
41 34.2
120 100
42 35.0
78 65.0
120 100
kwantanang Madina
h Directorate data sheet)
Year 2018 Year 2019
tious) 1682 1468
1261 1482
2683 3146
tious) 1101 2011
183 272
isease 613 830
TaeggdnEd . Damte, B.O. Manteaw and C. Wrigley-Asante The Journal of Climate Change and Health 10 (2023) 100189TadgggaendTEgedPvulnerable people in the slum communities where they live. While all
their health ailments may not be attributed to climate change
impacts, there are clear interlinkages, especially as they relate to fre-
quent and intense rainfall and increasing temperatures. ndggTeaEd
aTgdgePDisease data from two (2) hospitals within La-Nkwantanang Mad-
ina municipality were obtained to ascertain how hospital records
confirm observations and responses from participants from the study
communities. As shown in Table 4, diseases recorded in the health
facilities that provide health assistance to urban dwellers living in
and around the study communities correspond with what partici-
pants reported. . eEdTgadgn
TgagHed16. Discussion EaeggTdnd
TaeggdP he paper examined the reported impacts of climate change
on health in selected slum communities in and around the city of
Accra. Two dimensions of climate-induced health impacts
emerged, namely, direct and indirect impacts. Direct effects of cli-
mate change on health among both male and female slum dwell-
ers have been established, through direct impacts of climate
variables (temperature and rainfall) on the health of individuals
[40]. As direct consequences of either increased moisture or tem-
perature, it was also observed that these variables influence the
incidence of malaria [41], diarrhea, cholera, and sanitation
-related health problems. A lot of these problems are a conse-
quence of choked gutters, poor drainage and hygiene problems
which are exacerbated by climate variables. These observations
are very much in line with the claim that occasional intense rain-
fall after extended period of droughts can result in pathogen
increases and disease outbreaks such as malaria and cholera [36]. gTagedEnd
TaggedP he findings in this study showed that climate elements including
torrential rainfall and periods of high temperatures give rise to floods
and drought which most slum dwellers reported as the major life-
threatening climate impacts in the study area. These challenges also
were evident in a similar study by Haines et. al. [24] showing that cli-
mate change threatens health especially for people living in dismal
areas. They noted increased floods, droughts and changes in distribu-
tion of vector-borne and water-borne diseases as means through
which climate change endangers health. eEgTgadnd
TaeggdPSimilarly, Mastrangelo et. al. [32] stressed that high temperatures
and resultant heatwaves are becoming dangerous, especially among
urban poor with limited access to immediate medical attention. A
study by Bouma [33] showed a direct link between temperature and
some climate-sensitive diseases such as malaria transmission and
cholera, as increasing temperatures affect the life-cycle of disease-
causing pathogens and bacteria. Malaria-transmitting mosquitoes
thrive in temperatures that exceed 33°C−39°C, and in the setting of
floods which promote mosquito breeding sites [34,39]. Extreme var-
iations in temperatures also affect the reproduction and incubation
period of pathogens [35]. Respondents in most of the communities
surveyed in the current study confirmed these observations as a com-
mon reality. gTagdeEnd
AdggTeaP ccra has been declared as the most populous among regions
according to the Population and Housing Census (PHC) 2021. The cat-
astrophic nature of flooding events observed in slum communities,
along with population increases and a surge in urbanization, are
likely to continue to contribute to poor sanitation, destruction of
property, and even more deaths. The occurrence of extreme climate
events, such as floods and droughts, are expected to increase with
the progression of climate change, with severe effects on the vulnera-
ble urban poor [25]. Our observations also indicated that infectious,
respiratory, and skin diseases were the most common diseases slum
dwellers have experienced over the past two years, which was con-
firmed with disease-rate data obtained from health centers through
the Municipal Health Directorate in the La-Nkwantanang Madina
Municipality. ETeadgdgn8
aTgdgeP he reality in Ghana, as in many African countries, is that climate
change presents many health challenges which affect various regions
at different levels [43], especially the poor living in over-crowded
slum conditions in urban settings. These communities are vulnerable
and face high risks of exposure to climate-relataed hazards and con-
tracting various diseases and other health challenges. Addititonally,
decrease in water availability and deteriorating water quality reduces
access to drinking water in ways that negatively affect the health of
the urban poor [45]. Further, because of women’s roles in procuring
the household water supply and their responsibililty for domestic
chores and other care-giving roles, they may be at particular risk of
water-related diseases including diarrhea and cholera in urban slum
areas, with pregnant women and children being most susceptible
[45- 46]. ETeadgdgnTaeggd1H7. Conclusions TaggEednd
TaggdePGhana and Africa’s surging urbanization makes addressing climate
change-related health effects imperative as increasing migration,
population expansion and the lack of adequate and affordable hous-
ing are turning cities into slums which increases the risk of disease
emergence. Most city authorities have struggled to cope with the
demands of safe urbanization [42]. Housing, sanitation, infrastruc-
ture, and health reflect critical urban development issues. Health
effects, however, can remain silent as they are typically under-
reported. Healthcare also is inadequate or absent for the urban poor.
The challenge of providing healthcare is enormous without agree-
ment on best practice, given that people in slum communities are at
constant risk of eviction and relocation [44].dgTgaeEnd
gTagdeP his study aimed to bring attention not only to the implications of
climate impacts on the health of slum dwellers, but also on the larger
implications of climate change on the health, safety, and well-being
of whole communities. The study reveals the diversity of impacts of
climate change on the health of slum dwellers in urban Accra, includ-
ing direct and indirect impacts and their relationship to climate sen-
sitive conditions such as dehydration, weakness, skin and heat
rashes, headache, malaria, respiratory diseases, and diarrhea [32].
These impacts present urgent challenges at the nexus of climate
change, health, and urbanization. Addressing them should include
upgrading the living conditions of slum communities to promote
proper health conditions and health-influencing behaviors for slum
dwellers. TadgEgdenTaAgHgde1 uthor Agreement Statement ETeaggdnd
TWadgegP e the undersigned declare that this manuscript is original, has
not been published before and is not currently being considered for
publication elsewhere. eagTgdnEd
gTeagdWP e confirm that the manuscript has been read and approved by
all named authors and that there are no other persons who satisfied
the criteria for authorship but are not listed. We further confirm that
the order of authors listed in the manuscript has been approved by
all of us. We understand that the Corresponding Author is the sole
contact for the Editorial process. He/she is responsible for communi-
cating with the other authors about progress, submissions of revi-
sions and final approval of proofs. daegEgdTnaTgdgeHD1 eclaration of interests eEgTgadnd
TgagePd he authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influ-
ence the work reported in this paper. ETeadgdgn
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