Journal of Urban Health

, Volume 89, Issue 6, pp 977–991 | Cite as

Mapping Urban Malaria and Diarrhea Mortality in Accra, Ghana: Evidence of Vulnerabilities and Implications for Urban Health Policy

  • Julius N. FobilEmail author
  • Christian Levers
  • Tobia Lakes
  • Wibke Loag
  • Alexander Kraemer
  • Juergen May


Historic increase in urban population numbers in the face of shrinking urban economies and declining social services has meant that a large proportion of the urban population lives in precarious urban conditions, which provide the grounds for high urban health risks in low income countries. This study aims to identify, investigate, and contrast the spatial patterns of vulnerability and risk of two major causes of mortality, viz malaria and diarrhea mortalities, in order to optimize resource allocation for effective urban environmental management and improvement in urban health. A spatial cluster analysis of the observed urban malaria and diarrhea mortalities for the whole city of Accra was conducted. We obtained routinely reported mortality data for the period 1998–2002 from the Ghana Vital Registration System (VRS), computed the fraction of deaths due to malaria and diarrhea at the census cluster level, and analyzed and visualized the data with Geographic Information System (GIS, ArcMap 9.3.1). Regions of identified hotspots, cold spots, and excess mortalities were observed to be associated with some socioeconomic and neighborhood urban environmental conditions, suggesting uneven distribution of risk factors for both urban malaria and diarrhea in areas of rapid urban transformation. Case–control and/or longitudinal studies seeking to understand the individual level factors which mediate socioenvironmental conditions in explaining the observed excess urban mortalities and to establish the full range of risk factors might benefit from initial vulnerability mapping and excess risk analysis using geostatistical approaches. This is key to evidence-based urban health policy reforms in rapidly urbanizing areas in low income economies.


Malaria Diarrhea Hotspots Urban vulnerabilities Health risk Spatial autocorrelation Cluster-level mortality 



Funding sources

Funding for this study was generously provided jointly by the Government of Ghana, through the GetFund Scholarship, and the German Government, through the DAAD Scholarship.

Authors' contribution

Conception and design by JNF, AK, and JM. Data collection and analysis were done by JNF, CL, TL, and WL. Drafting and revision of the manuscript were done all by authors.


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Copyright information

© The New York Academy of Medicine 2012

Authors and Affiliations

  • Julius N. Fobil
    • 1
    • 2
    • 3
    Email author
  • Christian Levers
    • 4
  • Tobia Lakes
    • 4
  • Wibke Loag
    • 1
  • Alexander Kraemer
    • 2
  • Juergen May
    • 1
  1. 1.Infectious Disease EpidemiologyBernhard Nocht Institute for Tropical MedicineHamburgGermany
  2. 2.Department of Public Health Medicine, School of Public HealthUniversity of BielefeldBielefeldGermany
  3. 3.Department of Biological, Environmental & Occupational Health Sciences, School of Public HealthUniversity of GhanaLegonGhana
  4. 4.Department of Geography, Geomatics LabHumboldt University zu Berlin, GermanyBerlinGermany

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