Sustainable development advocates for a balance between socio-economic development and the environment in the pursuit of human advancement. In Africa, high population growth and inadequate infrastructure in urban areas exert pressure on the environment and this threatens the health and wellbeing of urban residents. The population of the African continent until the 1960s was predominantly rural. This scenario has taken a swift turn and some of the major shifts in the global urbanisation process are taking place on the continent. Factors including natural increase in the population, rural-urban migration, strife and hunger leading to the internal displacement of populations have exacerbated the urbanisation process in Africa. The situation has been worsened by the imposition of Western development policies, including structural adjustment programmes on African nations, which has eroded the subsistence base of rural agricultural communities and further ignited rural urban migration. The failure of industry to absorb the increasing labour force has created massive unemployment and deepening poverty crisis in urban centres. Inadequate provision of infrastructure and services to meet the growth in urban populations has resulted in inefficient spatial development of urban centres, the proliferation of squatter settlements, inadequate basic amenities including potable water, sanitation and waste disposal. Poor environmental sanitation has resulted in the upsurge of infectious diseases and deteriorating urban health. Urban populations in Africa are also the worst affected by newly emerging diseases, particularly HIV/AIDS. The poor bear a disproportionately large share of the problems due to their particular vulnerability to environmental and health risks.

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The study examines environmental problems and adverse impacts on the health of urban households in the Accra metropolitan area, Ghana. Accra is faced with severe inadequacy of urban infrastructure in the face of rapid population growth in the metropolis. More than half of the city's population do not have access to solid waste collection services. Only 39.8% of households have indoor pipe and over 35.0% of households depend on unsanitary public latrines whilst 2.5% do not have access to toilet facilities. Human excrement, garbage and wastewater are usually deposited in surface drains, open spaces and streams in poor neighbourhoods. The resultant poor sanitation has serious health impacts as more than half of reported diseases are related to poor environmental sanitation. The majority of households depend on solid fuels for cooking and this leads to indoor air pollution and high incidence of respiratory infections. Poor households bear a disproportionately large share of the burden of environmental health hazards than their wealthy counterparts, due to their particular vulnerability resulting from inadequate access to environmental health facilities and services.

Indoor air pollution resulting from the combustion of solid fuels has been identified as a major health threat in the developing world. This study examines how the choice of cooking fuel, place of cooking and behavioural risk factors affect respiratory health infections in Accra, Ghana. About 65.3% of respondents use charcoal and 4.2% use unprocessed wood. A total of 241 (25.4%) respondents who cook had had respiratory health symptoms in the two weeks preceding the study. Household socioeconomic status and educational attainment of respondents were found to have a significant impact on respiratory health through their particular influence on the choice of cooking fuel. Households that use wood and charcoal have a high incidence of respiratory health symptoms. The poor are more affected by respiratory health problems due to their heavy dependence on solid fuels as compared with their wealthy counterparts. Households that cook in multiple purpose rooms are more affected by respiratory health problems than those that cook outdoors. There is a positive correlation between the presence of children in the kitchen during cooking and the incidence of respiratory health symptoms among children (r=0.31, p<0.0001). Poverty and lack of education and awareness are the major factors affecting the choice of cooking fuel, place of cooking and respiratory health in Accra.

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