Health experts sound an alarm over the dramatic increase in deaths and illnesses caused by Ghana’s growing air pollution.

Air pollution-induced illnesses including pneumonia, acute respiratory failure, asthma, heart failure, stroke and cancer were the leading causes of death in 2022 – the last year where data is available.

For four years, hypertension and acute respiratory tract infections have been the leading cause of outpatient cases in Accra, according to data from the Ghana Health Service.

The biggest culprit is Ghana’s ageing, highly polluting fleet of vehicles.

The transport sector made up of 3.2 million vehicles as of 2022, is the leading producer of air pollution, according to the Ministry of Transport’s recently released National Electric Vehicle Policy.

Ghana’s vehicle fleet is dominated by old and highly polluting vehicles that make up more than 95 per cent of domestic transport services.

Old vehicles releasing harmful pollutants have helped push Ghana’s air pollution to levels eleven times those recommended by the World Health Organisation.

“This is a wake-up call,” says Dr Carl Stephen Osei, Programme Manager, Occupational and Environmental Health Unit of the Ghana Health Service.

“Facilities are recording new induced asthmatic cases. Those with existing conditions are exacerbated due to high exposure. There is enough evidence to show that diesel-powered vehicle fumes have been classified as carcinogenic and cause lung cancers. These gases and particulate matter are killing many people silently.”

Sensors Show Dangerous Levels on Routes

To assess the level of air pollution commuters in the Greater Accra Metropolitan Area are exposed to, Afri-SET– the air quality sensor evaluation and training facility in the Department of Physics, University of Ghana and the Ghana News Agency, surveyed air pollution in May 2024.

Journalists carried Atmotube Pro low-cost air quality sensors on round trips using commercial minibuses, known as “trotro”, sedan cars used as taxis, and ride-hailing cars, from the major Tema Station, in Accra Central, to and fro 10 routes during morning and evening rush hours.

As an average, the sensors showed levels in the range of “moderate” to “unhealthy for sensitive groups”.

However, for many parts of the trips, the pollution levels spiked to the “severely polluted” range meaning even healthy people can experience adverse symptoms.

Those high levels spikes were observed along the routes: Tema Station to Adentan, Odorkor, Ablekuma, Achimota, Newtown, Spintex, Amasaman, Kaneshie, Achimota, Kwabenya, Korle-Bu, and Nungua.

The findings alarmed some passengers on the route.

“I am exposed to danger!” exclaims Jonathan Frimpong, an officer at the Ministry of Trade and Industry, after seeing the sensor register ‘severely polluted’. “I need to check my lungs because I have done this for two years.”

All people who commute to work at the Central Business District of Accra and back in trotros and taxi without air conditioning are exposed to high levels of dirty air, especially during the rush hours, according to Dr. Allison Hughes, the Facility Manager for Afri-SET.

After analysing the data, he says commuters’ exposure are high during the rush hours between 0600 hours and 1000 hours as well as 1600 hours and 1800 hours.

It shows that cyclists, riders, street hawkers and pedestrians are exposed to even higher levels of pollution.

Commuters are largely unaware of the serious dangers they face. On a recent morning trip, Godfred Addo held the door of his trotro, with one hand.

The other was firmly gripping his nose to block his nostrils. But as he attempted to do his job as a conductor – beckoning passengers to the commercial vehicle – he was forced to surrender his grip. At once the dark smoke from the tailpipe of another trotro flooded his nose, mouth and eyes.

“Mostly, I catch a cold, or feel dizzy after such incidents,” says the 20-year-old who does an average of eight round trips a day from Odorkor to the Tema Station, inhaling soot and toxic chemicals.

“When pollution breaks in traffic, you cannot see anything. There is no escape for anyone. Passengers struggle to breathe, covering their noses with handkerchiefs. I know it is dangerous, but there is no option for me, so I don’t add it to my worries. Fumes from cars is a pandemic, and it is everywhere on the road.”

Among the long line of workers waiting to board passenger buses one morning at Amasaman bus station was Georgina Awuah.

She tells GNA that it takes about two and a half hours from her home to work and the same on her journey back each day, exposing her to many hours of dangerous emissions.

“By the time I get to work my energy level is reduced for the day’s work,” Awuah says.

“At 1500 hours or 1600 hours I am thinking of getting back home. The reason is if I delay, I will have to wait for like an hour before catching a bus. Working under such circumstances feels like a punishment.”

Long commutes and poor-quality air are contributing to mental health problems too. A study published on JAMA Network, an American-based health platform found that long-term exposure to multiple air pollutants is associated with increased risk of depression and anxiety.

“Spending hours in vehicular traffic and being exposed to dirty air has some impacts,” says Dr Reginald Quansah, a senior lecturer at the University of Ghana School of Public Health. “Some studies have proposed some mechanisms justifying this. Stress is just one of them.”

Economic Burden on workers and the nation

Workers’ constant exposure to dirty air also has a strong economic burden on workers and the country.

“In the short and medium term, workers spend money buying cold and cough related drugs, medical tests and suffer loss of man hours if hospitalised. It has an impact on their pocket, especially those low earners,” says Dr Elvis Kyere-Gyeabour, the Breathe Cities Portfolio Manager in Ghana.

For workers under insurance, not all treatments for ischemic heart disease, lung cancer, stroke, as well as pneumonia in children are covered. The costs can add up to the equivalent of twice the annual earnings of some patients.

And the costs also increase in retirement. “There is enough evidence that many workers exposed to high levels of air pollution during their productive years acquire chronic upper respiratory infection and cardiovascular diseases. Some retirees are required to undergo nebulisation every day using their retirement benefits,” says Dr Kyere-Gyeabour.

The productivity loss hurts the economy and the National Health Insurance Scheme. The economic cost of air pollution is estimated at US$2.5 Billion or roughly 4.2 per cent of the country’s 2017 Gross Domestic Product according to a World Bank report.

Reducing pollution, promoting quality air

Ghana is looking at phasing out fossil fuel-powered vehicles altogether over the next 21 years, according to a projection in the National Electric Vehicle Policy but the industry says it will need immense government support even for that slow transition.

“We are the largest polluting sector, and we are ready to go electric but government needs to build the infrastructure and other structures before,” says Mr Mark Amoamah, National President of the Chartered Institute of Transport – Ghana.

Reducing emissions from the transport sector before the phase-out will depend on several interventions starting with a review of regulations, awareness, and strict enforcement of regulations, according to experts.

“As we speak, a police officer cannot arrest a driver whose car is emitting so much. This is because they do not have any instrument to measure the (emissions) level,” says Emmanuel Appoh, Executive Director of Envirofit, an environmental consulting firm and a former Director at the Environmental Protection Agency.

“But this will change when the Motor Traffic Regulation 2024 is passed and people are sensitised, and institutions are strengthened and supported. For instance, every vehicle will need to test for tailpipe emission and get a certificate. With this, a police officer will have the tool to crack down on dirty vehicles.”

Dr Daniel Tutu Benefoh, Ghana’s Focal Person of the United Nations Framework Convention on Climate Change, also wants to see government services decentralised and moved to different parts of Ghana so workers don’t have to commute so long in dirty air.

“The colonial system centralised government services and provided housing for workers,” Dr Benefoh notes. “But this failed after independence. The acquired lands where workers lived are being commercialised, while many middle and junior officers live far off and travel hours to work.”

Dr Benefoh, who leads Ghana’s Mitigation, Greenhouse Gas Inventory and Reporting Program, suggests that organisations deploy buses to pick up workers from designated points to reduce the number of vehicles on the road contributing to pollution.

“Ghana needs an efficient bus system with dedicated line,” he emphasises.

While waiting for the many plans to manifest, he advises workers to wear N95 nose masks anytime they are on the road and also avoid rush hours, if possible.

The Ghana AIDS Commission has identified the failure of couples to disclose their HIV status to each other as a major contributor to the rising HIV infection rates in the country.

According to Dr. Kyeremeh Atuahene, Director General of the Commission, the lack of disclosure among couples, combined with the discontinuation of medication by some HIV-positive individuals, are key factors driving the spike in infections.

“The fear of the husband or wife deserting them leads some not to disclose their status. Some are afraid their spouse may discover they are taking daily medication, leading them to hide or discontinue their medicines.”

Dr. Atuahene emphasised that women are disproportionately more susceptible to HIV infection than men, urging women to take proactive measures to protect themselves from contracting the virus.

He stressed the importance of women prioritising their health and well-being by getting tested regularly, practising safe sex, and adhering to treatment regimens if diagnosed with HIV.

“Women must be aware that they are more vulnerable and therefore they should protect themselves. The transmission rate from woman to man is just about 2% whereas it is more than 12 % for a man. That is why women should not gamble with their health and their lives by just accepting that ‘if he will give them more money to have sex without a condom it’s okay for me’.

“It shouldn’t be okay for you, especially when you might have the untreated sexually transmitted disease, that can also heighten the chance of you getting HIV,” he entreated.

“Dr. Atuahene elaborated that the mucous membrane lining the vagina is significantly more delicate and susceptible to irritation than its male counterpart, making women more prone to HIV infection due to the increased fragility of their genital tract tissue.

“When a female has sex with a man, penile sex and the man ejaculates, the sperm which might contain HIV particles may remain in her for quite some time, whereas that of the male you hardly can see that.

“Secondly, the surface area of the vagina is much wider than that of the male and thirdly the mucus membrane of the vagina is much more fragile than of the male.”

The Commission reported that in 2023, an estimated 334,095 people in Ghana were living with HIV, comprising:

– 115,891 males
– 218,204 females

Breaking down the demographics:

– Children under 14: 17,550
– Adolescents (10-19): 16,381
– Young adults (15-24): 33,245
– Adults (15 and older): 316,545

The First Lady, Mrs Rebecca Akufo-Addo, has urged a united front to fight HIV stigma, promote human rights, and ensure fair access to HIV prevention services for all.

She emphasised that issues such as discrimination, stigma, lack of access to healthcare, and socioeconomic disparity need to be addressed for Ghana to achieve effective HIV prevention.

“These barriers do not only worsen the spread of HIV but also perpetuate inequality and injustice, it is imperative that we address these barriers head-on with courage and determination if we are to succeed in our mission,” she said.

Mrs Akufo-Addo was speaking at the 2024 National HIV Prevention Summit in Accra on Thursday.

She said eradicating HIV stigma and discrimination called for a coordinated effort from all facets of society.

The summit was on the theme “Breaking Barriers, Building Bridges, Uniting for Effective HIV Response”

Mrs. Akufo-Addo stressed the need to give communities the knowledge, resources, and support they need to take charge of their health and well-being and protect themselves and their loved ones from HIV.

She said society must urgently and fully implement HIV prevention measures and make sure that everyone who needs them receives them.

Innovations in HIV prevention for all categories of persons currently include long-acting injectables, the vagina ring treatment and prevention of mother-to-child transmission protocols, which have been enhanced with highly effective antiretroviral medications and point-of-care screening devices.

Dr Kyeremeh Atuahene, Director General of the Ghana AIDS Commission said the fight against HIV and AIDS response was at a crucial stage, with scientific tools and proven strategies to eliminate the disease readily available to combat global economic challenges.

Insufficient financing, noncompliance with preventive measures, and persistent stigma and discrimination, he claimed, were preventing Ghana from providing the basic HIV prevention, treatment, care, and support services that are required to bring the epidemic under control by 2030.

Dr. Atuahene said HIV is acquired and transmitted daily in every community in Ghana.

“We have to talk about HIV prevention because new infections are very high since the sexual behaviours that drive HIV transmission and acquisition are increasingly pervasive with rising levels of high-risk sexual activities among both men and women in every region,” he said.

Dr. Atuahene said Ghana must prioritize the HIV prevention roadmap to establish a comprehensive national approach for preventative interventions and programmatic scalability, which would the country to meet the 2025 Global AIDS Targets.

He said in efforts to reduce new infections, the GAC intends to provide people-centred prevention models of care to those at high risk of acquiring HIV.

This year’s HIV Prevention Summit is expected to create a platform for stakeholders to develop a national agenda to prevent the disease.

Dr Atuahene said the summit would finalize the milestones developed by the national HIV prevention coalition during the 2025 HIV Prevention Road Map Review and Milestone Setting Workshop earlier in the year.

“Considering this, the summit will explore innovative technologies, and foster collaborations to strengthen HIV prevention strategies in Ghana while solidifying accountability mechanisms for HIV prevention progress,” he said.