Agency, access, and Anopheles: neighborhood health perceptions and the implications for community health interventions in Accra, Ghana.

Background: Social and environmental factors are increasingly recognized for their ability to influence health outcomes at both individual and neighborhood scales in the developing urban world. Yet issues of spatial heterogeneity in these complex environments may obscure unique elements of neighborhood life that may be protective or harmful to human health. Resident perceptions of neighborhood effects on health may help to fill gaps in our interpretation of household survey results and better inform how to plan and execute neighborhood-level health interventions.

Defining Neighborhood Boundaries for Urban Health Research in Developing Countries: A Case Study of Accra, Ghana.

The neighborhood has been used as a sampling unit for exploring variations in health outcomes. In a variety of studies census tracts or ZIP codes have been used as proxies for neighborhoods because the boundaries are pre-defined units for which other data are readily available. However these spatial units can be arbitrary and do not account for social-cultural behaviors and identities that are significant to residents.

Connecting the Dots Between Health, Poverty and Place in Accra, Ghana.

West Africa has a rapidly growing population, an increasing fraction of which lives in urban informal settlements characterized by inadequate infrastructure and relatively high health risks. Little is known, however, about the spatial or health characteristics of cities in this region or about the spatial inequalities in health within them. In this article we show how we have been creating a data-rich field laboratory in Accra, Ghana, to connect the dots between health, poverty, and place in a large city in West Africa.

Neighborhoods and Fertility in Accra, Ghana: An AMOEBA-based Approach.

Fertility levels remain high in most of sub-Saharan Africa, despite recent declines, and even in a large capital city such as Accra, Ghana, women are having children at a pace that is well above replacement level and this will contribute to significant levels of future population growth in the city. Our purpose in this paper is to evaluate the way in which neighborhood context may shape reproductive behavior in Accra. In the process, we introduce several important innovations to the understanding of intra-urban fertility levels in a sub-Saharan African city: (1) despite the near explosion of work on neighborhoods as a spatial unit of analysis, very little of this research has been conducted outside of the richer countries; (2) we characterize neighborhoods on the basis of local knowledge of what we call "vernacular neighborhoods"; (3) we then define what we call "organic neighborhoods" using a new clustering tool-the AMOEBA algorithm-to create these neighborhoods; and then (4) we evaluate and explain which of the neighborhood concepts has the largest measurable contextual effect on an individual woman's reproductive behavior.