Health, Poverty, and Place in Accra, Ghana


This project followed directly from our research in Egypt on the Arab Fertility Transition, and was initially inspired by funding received by project Co-PI Dr. Allan Hill from the World Health Organization, the US Agency for International Development, and the Fulbright New Century Scholars Award (Allan G. Hill, Principal Investigator)to conduct a Women’s Health Study of Accra. We then received R21 and R01 funding support from the National Institute of Child Health and Human Development (John R. Weeks, Principal Investigator) to expand the scope of that research through a detailed analysis of spatial disparities in health in Accra, Ghana. The broad aim was to provide a model for the interpretation of urban health inequalities in cities in poor countries by combining survey data with census data, remotely sensed imagery, and qualitative field work. The application of remotely sensed imagery to the project was enhanced by a follow-on grant from the Interdisciplinary Research in Earth Science (IDS) program of NASA (Douglas Stow, Principal Investigator). The work was also facilitated by two NSF Doctoral Research Improvement Grants (John R. Weeks, Principal Investigator). Overall, the project was a collaborative effort between the International Population Center at San Diego State University, the Harvard Center for Population and Development Studies within the Harvard H.T. Chen School of Public Health, the Department of Geography at Georgetown University, and the Center for Remote Sensing and GIS (CERGIS) at the University of Ghana, Legon.

Sory I. Toure, Douglas A. Stow, Keith C. Clarke, and John R. Weeks, “Patterns of Land Cover and Land Use Change within the Two Major Metropolitan Areas of Ghana,” Geocarto International,,  2018.

Sory I. Toure, Douglas A. Stow, Hsiao-chien Shih, John R. Weeks, and David Lopez-Carr, “Land Cover and Land Use Change Analysis Using Multi-Spectral Resolution Data and Object-Based Image Analysis,” Remote Sensing of Environment, 210:259-268, 2018.

Magdalena Benza, John R. Weeks, Douglas A. Stow, David López-Carr, and Keith C. Clarke, “Fertility and Urban Context: A Case Study from Ghana, West Africa, Using Remotely Sensed Imagery and GIS,” Population, Space and Place, 23(8), 2017.

Lloyd Coulter, Douglas A Stow, Yu-Hsin Tsai, Nicholas Ibanez, Hsiao-chien Shih, Andrew Kerr, Magdalena Benza, John R. Weeks, and Foster Mensah, “Classification and assessment of land cover and land use change in southern Ghana using dense stacks of Landsat 7 ETM+ imagery,” Remote Sensing of Environment, 184:396-409, 2016.

Magdalena Benza, John R. Weeks, Douglas A. Stow, David López-Carr, and Keith C. Clarke, “A Pattern-Based Definition of Urban Context Using Remote Sensing and GIS,” Remote Sensing of Environment, 183(15):250-264, 2016.

David Lopez-Carr, Kevin M. Mwenda, Narcisa G. Pricope, Phaedon C. Kyriakidis, Marta M. Jankowska, John Weeks, Chris Funk, Gregory Husak, and Joel Michaelsen (2016). Climate-Related Child Undernutrition in the Lake Victoria Basin: An Integrated Spatial Analysis of Health Surveys, NDVI, and Precipitation Data. IEEE Journal of Selected Topics in Applied Earth Observations and Remote Sensing

Magdalena Benza, John R. Weeks, Douglas A. Stow, David López-Carr, Keith C. Clarke  (2016). A pattern-based definition of urban context using remote sensing and GIS. Remote Sensing of Environment 183 (2016) 250–264

Stephen E. S. Crook, Li An, John R. Weeks & Douglas A. Stow (2016). Latent Trajectory Modeling of Spatiotemporal Relationships Between Land Cover and Land Use, Socioeconomics, and Obesity in Ghana. Spatial Demography DOI 10.1007/s40980-016-0024-6

Douglas A. Stow, John R. Weeks, Hsiao-chien Shih, Lloyd L. Coulter, Harry Johnson, Yu-Hsin Tsai, Andrew Kerr, Magdalena Benza, Foster Mensah (2016). Inter-regional pattern of urbanization in southern Ghana in the first decade of the new millennium. Applied Geography 71 (2016) 32–43

Sory Toure, Douglas Stow, Hsiang-chien Shih, Lloyd Coulter, John Weeks, Ryan Engstrom and Avery Sandborn, ” An object-based temporal inversion approach to urban land use change analysis,” Remote Sensing Letters 7(5): 503-512, 2016.

Ryan Engstrom, Avery Sandborn, Qin Yu, Jason Burgdorfer, Douglas Stow, John Weeks, and Jordan Graesser (2015). Mapping Slums Using Spatial Features in Accra, Ghana Joint Urban Remote Sensing Event, Lausanne, Switzerland

Hsiao-chien Shih, Douglas A. Stow, John R. Weeks, and Lloyd Coulter, “Determining the Type and Starting Time of Land Cover and Land Use Change in Ghana Based on Discrete Analysis of Dense Landsat Image Time Series,” IEEE Journal of Selected Topics in Applied Earth Observations and Remote Sensing (JSTARS), 9(5):2064-2073, 2015.

Jankowska, M., Stoler, J., Ofiesh, C., Rain, D., & Weeks, J. (2015). Agency, access, and Anopheles: neighborhood health perceptions and the implications for community health interventions in Accra, Ghana. Global Health Action, 8. doi:

Justin Stoler, Raymond A. Tutu, & Kiana Winslow, Piped water flows but sachet consumption grows: The paradoxical drinking water landscape of an urban slum in Ashaiman, Ghana, Habitat International 47 (2015) 52–60

Anna Carla Lopez-Carr, Marta M. Jankowska, Justin Stoler, Caetlin Ofiesh, David Rain, and John R. Weeks, “Agency, Access, and Anopheles: Neighborhood health perceptions and the implications for community health interventions in Accra, Ghana,” Global Health Action, 8 (, 2015.

Douglas A. Stow, Hsiao-Chien Shih & Lloyd L. Coulter (2014) Discrete Classification Approach to Land Cover and Land Use Change Identification Based on Landsat Image Time Sequences, Remote Sensing Letters, 5:10, 922-931, DOI: 10.1080/2150704X.2014.976883

Slawa Rokicki, Livia Montana, and Günther Fink, Impact of Migration on Fertility and Abortion: Evidence From the Household and Welfare Study of Accra, Demography 51:2229-2254, 2014.

Arthur Getis, Analytically Derived Neighborhoods in a Rapidly Growing West African City: The Case of Accra, Ghana, Habitat International, doi: 10.1016/j.habitatint.2014.06.021, 2014.

Justin Stoler, Raymond A. Tutu, Hawa Ahmed, Lady Asantewa Frimpong, & Mohammed Bello. Sachet Water Quality and Brand Reputation in Two Low-Income Urban Communities in Greater Accra, Ghana. American Journal of Tropical Medicine and Hygiene 90(2): 272-278, 2014.

Ryan Engstrom, Caetlin Ofiesh, David Rain, Henry Jewell, and John Weeks, Defining Neighborhood Boundaries for Urban Health Research in Developing Countries: A Case Study of Accra, Ghana Journal of Maps 9(1): 36–42, 2013.

John R. Weeks, Allan G. Hill, and Justin Stoler, Editors, Spatial Inequalities: Health, Poverty, and Place in Accra (Dordrecht: Springer Publishing), 2013.

Marta M. Jankowska, Magdalena Benza, & John R. Weeks. Estimating Spatial Inequalities of Urban Child Mortality.Demographic Research 28(2): 33-62, 2013.

Sory I. Toure, Douglas A. Stow, John R. Weeks, & Sunil Kumar. Histogram Curve Matching Approaches for Object-based Image Classification of Land Cover and Land Use.Photogrammetric Engineering & Remote Sensing 79(5): 433-440, 2013.

Justin Stoler, John R. Weeks JR, & Richard Appiah Otoo. Drinking Water in Transition: A Multilevel Cross-sectional Analysis of Sachet Water Consumption in Accra. PLoS ONE 8(6): e67257. doi:10.1371/journal.pone.0067257, 2013.

Douglas A. Stow, John R. Weeks, Sory Toure, Lloyd L. Coulter, Christopher D. Lippitt, & Eric Ashcroft. Urban Vegetation Cover and Vegetation Change in Accra, Ghana: Connection to Housing Quality. The Professional Geographer tbd(tbd): 1-15, 2012.

Gregory M. Verutes, Magdalena B. Fiocco, John R. Weeks, & Lloyd L. Coulter. Health, poverty, and place in Accra, Ghana: mapping neighborhoods. Journal of Maps tbd(tbd): 1-5, 2012. (click here for additional maps)

Günther Fink, John R. Weeks, & Allan G. Hill. Income and Health in Accra, Ghana: Results from a Time Use and Health Study. The American Journal of Tropical Medicine and Hygiene 87(4): 608-615, 2012.

Justin Stoler, John R. Weeks & Günther Fink. Sachet drinking water in Ghana’s Accra-Tema metropolitan area: past, present, and future. Journal of Water, Sanitation and Hygiene for Development 2(4): 223-240, 2012.

Günther Fink, Raphael Arku, & Livia Montana. The Health of the Poor: Women Living in Informal Settlements. Ghana Medical Journal 46(2): 104-112, 2012.

Victoria de Menil, Akwasi Osei, Nedialka Douptcheva, Allan G. Hill, Peter Yaro and Ama de-Graft Aikins. Symptoms of Common Mental Disorders and Their Correlates Among Women in Accra, Ghana: A Population Based Survey. Ghana Medical Journal 46(2): 95-103, 2012.

Catherine Donovan, Banafsheh Siadat, & James Frimpong. Seasonal and Socio-Economic Variations in Clinicaland Self-Reported Malaria in Accra, Ghana: Evidence from Facility Data and a Community Survey. Ghana Medical Journal 46(2): 85-94, 2012.

Nathan J. Blanchet, Günther Fink, & Isaac Osei-Akoto. The Effect of Ghana’s National Health Insurance Scheme on Health Care Utilisation. Ghana Medical Journal 46(2): 75-84, 2012.

Rachel M. Benkeser, Richard. Biritwum & Allan G. Hill. Prevalence of Overweight and Obesity and Perception of Healthy and Desirable Body Size in Urban, Ghanain Women. Ghana Medical Journal 46(2): 66-75, 2012.

Richard M. Adanu, Joseph Seffah, John K. Anarfi, Naomi Lince and Kelly Blanchard. Sexual and Reproductive Health in Accra, Ghana. Ghana Medical Journal 46(2): 58-65, 2012.

Rudolph Darko, Richard M. Adanu, Rosemary B. Duda, Nedialka Douptcheva, & Allan G. Hill. The Health of Adult Women in Accra, Ghana: Self-Reporting and Objective Assessments 2008-2009. Ghana Medical Journal 46(2): 50-57, 2012.

Rudolph Darko & Allan G. Hill. The Health of Adult Women in Accra. Ghana Medical Journal 46(2): 49, 2012.

John R. Weeks, Arthur Getis, Douglas A. Stow, Allan G. Hill, David Rain, Ryan Engstrom, Justin Stoler, Christopher Lippitt, Marta Jankowska, Anna Carla Lopez-Carr, Lloyd Coulter, & Caetlin Ofiesh. Connecting the Dots Between Health, Poverty and Place in Accra, Ghana. Annals of the Association of American Geographers 102(5): 932-941, 2012.

Justin Stoler, Dean Daniels, John R. Weeks, Douglas A. Stow, Lloyd L. Coulter, and Brian Karl Finch. Assessing the Utility of Satellite Imagery with Differing Spatial Resolutions for Deriving Proxy Measures of Slum Presence in Accra, Ghana. GIScience & Remote Sensing, 49(1): 31-52, 2012.

Douglas A. Stow, Sory I. Toure, Christopher D. Lippitt, Caitlin L. Lippitt, and Chung-rui Lee. Frequency distribution signatures and classification of within-object pixels. International Journal of Applied Earth Observation and Geoinformation 15(1): 49-56, 2012.

Christopher Lippit, Lloyd Coulter, Mary Freeman, Jeffrey LaMantia-Bishop, Wyson Pang, and Douglas Stow. The Effect of Input Data Transformations on Object Based Image Classification. Remote Sensing Letters, 3(1): 21-29, 2012.

Justin Stoler, Günther Fink, John R. Weeks, Richard Appiah Otoo, Joseph A. Ampofo, Allan G. Hill. When urban taps run dry: Sachet water consumption and health effects in low income neighborhoods of Accra, Ghana. Health & Place, 18(2): 250-262, 2012.

Yu Hsin Tsai, Douglas Stow and John Weeks. Comparison of Object-Based Image Analysis Approaches to Mapping New Buildings in Accra, Ghana Using Multi-Temporal QuickBird Satellite Imagery. Remote Sensing. 12(3): 2707-2726, 2011

Duque, Juan C., Jared Aldstadt, Ermilson Velasquez, Jose L. Franco, Alejandro Betancourt. A computationally efficient method for delineating irregularly shaped spatial clusters. Journal of Geographic Systems. 13(4): 355-372, 2011

Marta M. Jankowska, John R. Weeks, and Ryan Engstrom Do the Most Vulnerable People Live in the Worst Slums? A Spatial Analysis of Accra, Ghana. Annals of GIS 17(4): 221-235, 2011.

WHSA-II Writing Team. Women’s Health Study of Accra, Wave II (2008-2009). Technical Publication No. 91. Legon, Accra: Isser Technical Publication Series, 2011.

David Rain, Ryan Engstrom, Christianna Ludlow, and Sarah Antos. Accra, Ghana: A City Vulnerable to Flooding and Drought-Inducted Migration. Background paper for Chapter 4 in UN-Habitat, Cities and Climate Change: Global Report on Human Settlements, 2011.

John R. Weeks. Defining Urban Areas. Chapter 3 in Remote Sensing of Urban and Suburban Areas. Tarek Rashed and Carston Juergens (eds.), New York: Kluwer Press, 2010.

Douglas Stow, Christopher Lippit, and John R. Weeks. Delineation of Neighborhoods of Accra, Ghana Based on QuickBird Satellite Data. Photogrammetric Engineering and Remote Sensing, 76(8): 907-914, 2010. PMCID: PMC2916229

John R. Weeks, Arthur Getis, Allan G. Hill, Samuel Agyei-Mensah, and David Rain. Neighborhoods and Fertility in Accra, Ghana: An AMOEBA-based Approach. Annals of the Association of American Geographers, 100(3): 558-578, 2010. [PMC- in process]

Justin Stoler, John R. Weeks, Arthur Getis, and Allan G. Hill. Distance Threshold for the Effect of Urban Agriculture on Elevated Self-reported Malaria Prevalence in Accra, Ghana. American Journal of Tropical Medicine and Hygiene, 80(4): 547-554, 2009.

Douglas A. Stow, Anna Carla Lopez, Christopher Lippitt, Sarah Hinton, and John R. Weeks. Object-based classification of residential land use within Accra, Ghana based on QuickBird satellite data. International Journal of Remote Sensing, 28(22): 5167-5173, 2007.

Tarek Rashed, John R. Weeks, Helen Coulclelis, and Martin Herold. An Integrative Remote Sensing Model for Place-Based Urban Vulnerability Analysis. Chapter 9 in Victor Mesev, Editor, The Integration of RS and GIS. New York: John Wiley & Son, 2007.

John R. Weeks, Allan G. Hill, Douglas A. Stow, Arthur Getis, and Debbie Fugate. Can We Spot a Neighborhood From the Ground? Defining Neighborhood Structure in Accra, Ghana. GeoJournal, 69(1-2): 9-22, 2007.

Jared Alstadt and Arthur Getis. Using AMOEBA to Create a Spatial Weights Matrix and Identify Spatial Clusters. Geographic analysis, 38:327-334, 2006.

John R. Weeks, Allan G. Hill, Arthur Getis, and Douglas A. Stow. Ethnic Residential Patterns as Predictors of Intra-Urban Child Mortality Inequality in Accra, Ghana. Urban Geography, 27(6): 526-548, 2006.

Core Project Team

PI –    Dr. John R. Weeks (SDSU)
Co-PI – Dr. Allan Hill (Harvard)
Co-PI – Dr. Arthur Getis  (SDSU)
Co-PI – Dr. Douglas A. Stow (SDSU)
Co-PI – Dr. Li An (SDSU)
Co-PI – Dr. David Lopez-Carr (UCSB)
Co-PI – Dr. David Rain  (George Washington University)
Co-PI – Dr. Ryan Engstrom  (George Washington University)
Co-PI – Dr. Samuel Agyei-Mensah (University of Ghana)
Co-PI – Foster Mensah (University of Ghana)
Post-Doc Researcher – Dr. Anna Carla Lopez (SDSU)
Research Specialist – Lloyd Coulter (SDSU)
Consultants – Dr. Deborah Balk (CUNY), Dr. Mark Montgomery (Population Council), Dr. S.V. Subramanian (Harvard)

Graduate Student Researchers

Dr. Debbie Fugate, Dr. Justin Stoler, Dr. Chris Lippitt, Dr. Magdalena Benza , Dr. Marta Jankowska, Dr. Sory Toure, Sean Taugher, Cindy Tsai, Hsiao-chien Shih, Madeline Tuller, and Milo Vejraska, Sarah Hinton, Meredith Albert Gerhardt, Dean Daniels, Gregg Verutes, Chung-Rui Lee, and Jeanie Gaudette