Quantifying within-city inequalities in child mortality across neighbourhoods in Accra, Ghana: a Bayesian spatial analysis

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

Micro-scale transformations in sustainability practices: Insights from new migrant populations in growing urban settlements

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordData availability; Data will be made available on request.Development that is inclusive and sustainable requires significant social and environmental transformations from current trajectories, building on demographic realities such as changing profiles of populations, and increased levels of mobility. Migration is a major driving force of urbanisation in all global regions, partly facilitated through emerging technologies and declining costs of movement and communication. Social transformations associated with increased migration are highly uneven but include shifts in the location of economic activities, major urban growth, and changing individual incentives and social constraints on sustainability trajectories. Yet, there is limited empirical evidence on how observed population movements can both challenge and promote sustainable transformations. This paper examines how migration transforms places and societies, by providing new evidence on the behaviours and practices of individuals who are part of such transformations as they assimilate, converge or remain distinctive to prior populations. Focusing on individuals in rapidly expanding cities in the Global South, this study uses new biographical life-history survey data from Accra, Ghana, to examine the barriers and enablers of sustainability practices among diverse types of migrants and a sample of non-migrants. The study uses data from 1,163 individuals: international migrants from the West African sub-region (5 5 9), internal migrants (2 9 9), and non-migrants (3 0 5) in Accra. The findings show that sustainability practices established before migration are predictors of current sustainability practices, including proactive recycling, conservation activities, and choice of mode of transportation, but that there is some convergence between behaviours, reflecting assimilation, place attachment and other factors. Internal migrants in Accra exhibit stronger sustainability practices than international migrants. Individual levels of poverty, poor infrastructural development, and perceptions about life satisfaction in the neighbourhood negatively affect sustainability practices among all respondents. These results suggest that poverty and social exclusion are critical to addressing sustainability issues in urban contexts. It is important for policy makers to address issues of urban poverty, cumulative deprivation, and inequality as strong barriers to the adoption of sustainability practices in urban areas.Belmont ForumNORFACE Joint Research Programme on Transformations to SustainabilityISSCEuropean Union Horizon 202