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 the 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.

Diarrhoeal diseases remain a significant cause of morbidity and mortality, particularly in poor urban communities in the Global South. Studies on food access and safety have however not considered the sources of discrete food categories and their propensity to harbour and transmit diarrhoeal disease pathogens in poor urban settings. We sought to contribute to knowledge on urban food environment and enteric infections by interrogating the sources and categories of common foods and their tendency to transmit diarrhoea in low-income communities in Accra. We modelled the likelihood of diarrhoea transmission through specific food categories sourced from home or out of home after controlling for alternate transmission pathways and barriers. We used structured interviews where households that participated in the study were selected through a multi-stage systematic sampling approach. We utilized data on 506 households from 3 low-income settlements in Accra. These settlements have socio-economic characteristics mimicking typical low-income communities in the Global South. The results showed that the incidence of diarrhoea in a household is explained by type and source of food, source of drinking water, wealth and the presence of children below five years in the household. Rice-based staples which were consumed by 94.5% of respondents in the week preceding the survey had a higher likelihood of transmitting diarrhoeal diseases when consumed out of home than when eaten at home. Sources of hand-served dumpling-type foods categorized as “staple balls” had a nuanced relationship with incidence of diarrhoea. These findings reinforce the need for due diligence in addressing peculiar needs of people in vulnerable conditions of food environment in poor urban settlements in order to reap a co-benefit of reduced incidence of diarrhoea while striving to achieve the global development goal on ending hunger.

This article draws on data from 552 women interviewed in the 2007 Ghana Maternal Health Survey to examine the association between motivations for women's pregnancy terminations and the safety of methods used. Women's reasons for induced abortions represented their vulnerability types at the critical time of decision making. Different motivations can result in taking various forms of action with the most vulnerable potentially resorting to the most harmful behaviors. Analysis of survey data pointed to spacing/delaying births as the main reason for abortion. Furthermore, women were more likely to terminate pregnancies unsafely if their main motivation for abortion was financial constraints. Especially among rural women, abortions for any reason were more likely associated with safe methods than if for financial reasons. These findings suggest a theme of vulnerability, resulting from poverty, as the motivations for women to resort to harmful abortion methods. Therefore, interventions formulated to reduce instances of unsafe pregnancy terminations should target reducing poverty and capacity building with the aim of economic advancement, in addition to curbing the root of the problem: unintended pregnancy.

All regions of the world through the twentieth century have undergone absolute transformations in peoples' lives: they live longer, have fewer children, and are much more likely to live in towns and cities. While 7

Sub-Saharan Africa is among the regions that contribute least to global climate change, yet it is among the most vulnerable to its impacts due to low levels of economic and technological development. The frequency and magnitude of extreme weather events in the region are rising at a faster rate than the population capacity to deal with the attendant disasters. This paper interrogates some emerging and existing evidence of the potential for extreme weather events to obviate countries' attainment of the Sustainable Development Goals (SDGs). Whilst previous studies have assessed the vulnerabilities of sub-Saharan African (SSA) countries to extreme weather events on specific sectors, a comprehensive assessment of the implications of these extreme events for attaining the SDGs remains largely untouched. This paper assesses the impacts of flooding, extreme heat and drought on five key SDGs—Zero hunger (Goal 2), Good health and well-being (Goal 3), Quality education (Goal 4), Clean water and sanitation (Goal 6), and Sustainable cities and communities (Goal 11). Based on empirical cases from different SSA country contexts, and guided by the SDG targets and indicators, we discuss the main interactions between extreme weather events and different SDGs, emerging with a framework for the climate change—sustainable development nexus. Such an assessment, with regard to specific national and local case studies, would inform policy formulation and implementation, research and investment toward sustainable development in the region. Integrating resilence strategies into national development policies will offer sub-Saharan African countries the opportunity to reduce the impacts of extreme weather events on attaining their targets for sustainable development towards Agenda 2030.