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Cavanaugha AC, Baumgartner JC, Bixby H, Schmidt AM, Agyei-Mensah S, Annim SK, Anum J, Arku R, Bennett J, Berkhout F, Ezzati M, Mintah SE, Owusu G, Tetteh JD, Robinson BE. Strangers in a strange land: mapping household and neighbourhood associations with improved wellbeing outcomes in Accra, Ghana. Cities 2023; 143:104584. [PMID: 37829151 PMCID: PMC7615188 DOI: 10.1016/j.cities.2023.104584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Urban poverty is not limited to informal settlements, rather it extends throughout cities, with the poor and affluent often living in close proximity. Using a novel dataset derived from the full Ghanaian Census, we investigate how neighbourhood versus household socio-economic status (SES) relates to a set of household development outcomes (related to housing quality, energy, water and sanitation, and information technology) in Accra, Ghana. We then assess "stranger" households' outcomes within neighbourhoods: do poor households fare better in affluent neighbourhoods, and are affluent households negatively impacted by being in poor neighbourhoods? Through a simple generalized linear model we estimate the variance components associated with household and neighbourhood status for our outcome measures. Household SES is more closely associated with 13 of the 16 outcomes assessed compared to the neighbourhood average SES. Second, for 9 outcomes poor households in affluent areas fair better, and the affluent in poor areas are worse off. For two outcomes, poor households have worse outcomes in affluent areas, and the affluent have better outcomes in poor areas, on average. For three outcomes "stranger" households do worse in strange neighbourhoods. We discuss implications for mixed development and how to direct resources through households versus location-based targets.
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Affiliation(s)
| | - Jill C. Baumgartner
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Honor Bixby
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Alexandra M. Schmidt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | | | | | - Raphael Arku
- Department of Environmental Health Sciences, University of Massachusetts, USA
| | - James Bennett
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Frans Berkhout
- Department of Geography, King’s College London, London, UK
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | | | - George Owusu
- Department of Geography, University of Ghana, Legon, Ghana
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Tetteh JD, Templeton MR, Cavanaugh A, Bixby H, Owusu G, Yidana SM, Moulds S, Robinson B, Baumgartner J, Annim SK, Quartey R, Mintah SE, Bawah AA, Arku RE, Ezzati M, Agyei-Mensah S. Spatial heterogeneity in drinking water sources in the Greater Accra Metropolitan Area (GAMA), Ghana. Popul Environ 2022; 44:46-76. [PMID: 35974746 PMCID: PMC9371963 DOI: 10.1007/s11111-022-00407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
Universal access to safe drinking water is essential to population health and well-being, as recognized in the Sustainable Development Goals (SDG). To develop targeted policies which improve urban access to improved water and ensure equity, there is the need to understand the spatial heterogeneity in drinking water sources and the factors underlying these patterns. Using the Shannon Entropy Index and the Index of Concentration at the Extremes at the enumeration area level, we analyzed census data to examine the spatial heterogeneity in drinking water sources and neighborhood income in the Greater Accra Metropolitan Area (GAMA), the largest urban agglomeration in Ghana. GAMA has been a laboratory for studying urban growth, economic security, and other concomitant socio-environmental and demographic issues in the recent past. The current study adds to this literature by telling a different story about the spatial heterogeneity of GAMA's water landscape at the enumeration area level. The findings of the study reveal considerable geographical heterogeneity and inequality in drinking water sources not evidenced in previous studies. We conclude that heterogeneity is neither good nor bad in GAMA judging by the dominance of both piped water sources and sachet water (machine-sealed 500-ml plastic bag of drinking water). The lessons from this study can be used to inform the planning of appropriate localized solutions targeted at providing piped water sources in neighborhoods lacking these services and to monitor progress in achieving universal access to improved drinking water as recognized in the SDG 6 and improving population health and well-being.
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Affiliation(s)
- Jacob Doku Tetteh
- Department of Geography and Resource Development, University of Ghana, P.O. Box LG 59, Legon-Accra, Ghana
| | - Michael R. Templeton
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | | | - Honor Bixby
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - George Owusu
- Institute of Statistical Social and Economic Research, University of Ghana, Accra, Ghana
| | | | - Simon Moulds
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Brian Robinson
- Department of Geography, McGill University, Montreal, Canada
| | - Jill Baumgartner
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | | | | | | | - Ayaga Agula Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Raphael E. Arku
- Department of Environmental Health Sciences, University of Massachusetts Amherst, Amherst, USA
| | - Majid Ezzati
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Samuel Agyei-Mensah
- Department of Geography and Resource Development, University of Ghana, P.O. Box LG 59, Legon-Accra, Ghana
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Bixby H, Bennett JE, Bawah AA, Arku RE, Annim SK, Anum JD, Mintah SE, Schmidt AM, Agyei-Asabere C, Robinson BE, Cavanaugh A, Agyei-Mensah S, Owusu G, Ezzati M, Baumgartner J. Quantifying within-city inequalities in child mortality across neighbourhoods in Accra, Ghana: a Bayesian spatial analysis. BMJ Open 2022; 12:e054030. [PMID: 35027422 PMCID: PMC8762100 DOI: 10.1136/bmjopen-2021-054030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Countries in sub-Saharan Africa suffer the highest rates of child mortality worldwide. Urban areas tend to have lower mortality than rural areas, but these comparisons likely mask large within-city inequalities. We aimed to estimate rates of under-five mortality (U5M) at the neighbourhood level for Ghana's Greater Accra Metropolitan Area (GAMA) and measure the extent of intraurban inequalities. METHODS We accessed data on >700 000 women aged 25-49 years living in GAMA using the most recent Ghana census (2010). We summarised counts of child births and deaths by five-year age group of women and neighbourhood (n=406) and applied indirect demographic methods to convert the summaries to yearly probabilities of death before age five years. We fitted a Bayesian spatiotemporal model to the neighbourhood U5M probabilities to obtain estimates for the year 2010 and examined their correlations with indicators of neighbourhood living and socioeconomic conditions. RESULTS U5M varied almost five-fold across neighbourhoods in GAMA in 2010, ranging from 28 (95% credible interval (CrI) 8 to 63) to 138 (95% CrI 111 to 167) deaths per 1000 live births. U5M was highest in neighbourhoods of the central urban core and industrial areas, with an average of 95 deaths per 1000 live births across these neighbourhoods. Peri-urban neighbourhoods performed better, on average, but rates varied more across neighbourhoods compared with neighbourhoods in the central urban areas. U5M was negatively correlated with multiple indicators of improved living and socioeconomic conditions among peri-urban neighbourhoods. Among urban neighbourhoods, correlations with these factors were weaker or, in some cases, reversed, including with median household consumption and women's schooling. CONCLUSION Reducing child mortality in high-burden urban neighbourhoods in GAMA, where a substantial portion of the urban population resides, should be prioritised as part of continued efforts to meet the Sustainable Development Goal national target of less than 25 deaths per 1000 live births.
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Affiliation(s)
- Honor Bixby
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
| | - James E Bennett
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Ayaga A Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Raphael E Arku
- Department of Environmental Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Samuel K Annim
- Ghana Statistical Service, Accra, Ghana
- University of Cape Coast, Cape Coast, Ghana
| | | | | | - Alexandra M Schmidt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Brian E Robinson
- Department of Geography, McGill University, Montreal, Québec, Canada
| | - Alicia Cavanaugh
- Department of Geography, McGill University, Montreal, Québec, Canada
| | - Samuel Agyei-Mensah
- Department of Geography and Resource Development, University of Ghana, Legon, Greater Accra, Ghana
| | - George Owusu
- Institute of Statistical, Social and Economic Research, University of Ghana, Accra, Ghana
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Jill Baumgartner
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
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Arku RE, Bennett JE, Castro MC, Agyeman-Duah K, Mintah SE, Ware JH, Nyarko P, Spengler JD, Agyei-Mensah S, Ezzati M. Geographical Inequalities and Social and Environmental Risk Factors for Under-Five Mortality in Ghana in 2000 and 2010: Bayesian Spatial Analysis of Census Data. PLoS Med 2016; 13:e1002038. [PMID: 27327774 PMCID: PMC4915620 DOI: 10.1371/journal.pmed.1002038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 04/21/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Under-five mortality is declining in Ghana and many other countries. Very few studies have measured under-five mortality-and its social and environmental risk factors-at fine spatial resolutions, which is relevant for policy purposes. Our aim was to estimate under-five mortality and its social and environmental risk factors at the district level in Ghana. METHODS AND FINDINGS We used 10% random samples of Ghana's 2000 and 2010 National Population and Housing Censuses. We applied indirect demographic methods and a Bayesian spatial model to the information on total number of children ever born and children surviving to estimate under-five mortality (probability of dying by 5 y of age, 5q0) for each of Ghana's 110 districts. We also used the census data to estimate the distributions of households or persons in each district in terms of fuel used for cooking, sanitation facility, drinking water source, and parental education. Median district 5q0 declined from 99 deaths per 1,000 live births in 2000 to 70 in 2010. The decline ranged from <5% in some northern districts, where 5q0 had been higher in 2000, to >40% in southern districts, where it had been lower in 2000, exacerbating existing inequalities. Primary education increased in men and women, and more households had access to improved water and sanitation and cleaner cooking fuels. Higher use of liquefied petroleum gas for cooking was associated with lower 5q0 in multivariate analysis. CONCLUSIONS Under-five mortality has declined in all of Ghana's districts, but the cross-district inequality in mortality has increased. There is a need for additional data, including on healthcare, and additional environmental and socioeconomic measurements, to understand the reasons for the variations in mortality levels and trends.
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Affiliation(s)
- Raphael E. Arku
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - James E. Bennett
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Marcia C. Castro
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | | | | | - James H. Ware
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | | | - John D. Spengler
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Samuel Agyei-Mensah
- Department of Geography and Resource Development, University of Ghana, Legon, Ghana
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom
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