Health Impacts and Coping Strategies for Extreme Indoor Temperatures in Vulnerable Urban Communities in Sekondi-Takoradi, Ghana

Abstract

This paper explores the health impacts and coping strategies for dealing with extreme indoor temperatures among vulnerable urban communities in Sekondi-Takoradi, Ghana. It examines the groups most affected, key vulnerability factors, and the health impacts of extreme temperatures, along with residents’ adaptation strategies. Data were gathered through surveys, focus group discussions, participants’ observations, and expert interviews. The findings reveal that extreme indoor temperatures lead to health challenges such as heat stress, rashes, dehydration, dizziness, skin irritation, and exacerbated respiratory conditions. Children, the elderly, and pregnant women are particularly vulnerable due to their limited physiological and socio-economic resilience. Although natural ventilation and electric fans are commonly used coping strategies, power outages and high electricity costs limit their effectiveness. The paper emphasizes the need for a multi-dimensional approach to improve housing infrastructure, develop affordable cooling technologies, and incorporate green spaces into urban housing. It also underscores the importance of inclusive strategies to address vulnerability factors and strengthen resilience among vulnerable populations, offering insights into the long-term health and socio-economic consequences of extreme temperatures.

Full text

Vol.:(0123456789)
Urban Forum
https://doi.org/10.1007/s12132-024-09528-z
Health Impacts andCoping Strategies forExtreme
Indoor Temperatures inVulnerable Urban Communities
inSekondi‑Takoradi, Ghana
EbenezerF.Amankwaa1 · MorrisGborieAmpomah1
Accepted: 4 November 2024
© The Author(s), under exclusive licence to Springer Nature B.V. 2024
Abstract
This paper explores the health impacts and coping strategies for dealing with
extreme indoor temperatures among vulnerable urban communities in Sekondi-
Takoradi, Ghana. It examines the groups most affected, key vulnerability factors,
and the health impacts of extreme temperatures, along with residents’ adaptation
strategies. Data were gathered through surveys, focus group discussions, partici-
pants’ observations, and expert interviews. The findings reveal that extreme indoor
temperatures lead to health challenges such as heat stress, rashes, dehydration, diz-
ziness, skin irritation, and exacerbated respiratory conditions. Children, the elderly,
and pregnant women are particularly vulnerable due to their limited physiological
and socio-economic resilience. Although natural ventilation and electric fans are
commonly used coping strategies, power outages and high electricity costs limit
their effectiveness. The paper emphasizes the need for a multi-dimensional approach
to improve housing infrastructure, develop affordable cooling technologies, and
incorporate green spaces into urban housing. It also underscores the importance of
inclusive strategies to address vulnerability factors and strengthen resilience among
vulnerable populations, offering insights into the long-term health and socio-eco-
nomic consequences of extreme temperatures.
Keywords Extreme heat· Heat Stress· Vulnerability· Health Impacts· Low-income
communities· Sekondi-Takoradi
* Ebenezer F. Amankwaa
efamankwaa@ug.edu.gh; e.amankwaa2@lboro.ac.uk
Morris Gborie Ampomah
mgampomah001@st.ug.edu.gh
1 Department ofGeography andResource Development, University ofGhana, Accra, Ghana

E.F.Amankwaa, M.G.Ampomah
Introduction
Extreme indoor temperatures are a growing global issue, particularly in low-
and middle-income regions such as sub-Saharan Africa, where climate change
is worsening the situation (Wilby etal., 2021). As global temperatures rise due
to climate change, extreme indoor heat events are becoming more frequent and
severe, posing serious threats to public health and well-being. Millions of vulner-
able urban inhabitants are exposed to life-threatening heat levels, often with lim-
ited resources or capacity to cope (Zhao etal., 2015). Birch etal. (2022) estimate
that from 2011 to 2020 there were between 12,000 and 19,000 heat-related child
deaths annually in Africa, with low-income communities bearing the brunt of this
burden. Although few studies directly link indoor temperature exposure to mor-
tality due to the large population sizes needed to detect such impacts, the correla-
tion between indoor and outdoor temperatures is well established (Turner et al.,
2012; Zhang etal., 2014). The vast body of research linking outdoor temperature
exposure to health outcomes – such as increased mortality and morbidity – also
applies to indoor conditions (Ebi etal., 2021). This is particularly relevant in low-
income urban areas where individuals, especially older persons, young children,
and those with pre-existing health conditions, spend a significant amount of time
indoors (Bidassey-Manilal etal., 2016).
In Ghana and much of West Africa, several factors intensify the impacts of
extreme heat within low-income urban communities. Informal urbanization, poor
housing infrastructure, high population densities, and the urban heat island effect
create environments where indoor temperatures mirror or even exceed outdoor
temperatures, exacerbating health risks (Gough etal., 2019; Kayaga etal., 2021).
The lack of access to cooling technologies, such as air conditioning or effective
ventilation systems, further limits the ability of residents to mitigate the effects of
high heat. This is particularly problematic in cities like Sekondi-Takoradi, where
average temperatures regularly exceed 30°C, creating hazardous indoor condi-
tions that contribute to heat stress, dehydration, and exacerbation of respiratory
and cardiovascular diseases (Cheng etal., 2019; Codjoe etal., 2020).
Existing research predominantly focuses on outdoor temperatures and their
direct health effects, including increased mortality from heatwaves and chronic
health conditions and their coping strategies (Ebi etal., 2021; Jay et al., 2021).
However, there is a clear research gap in understanding how these dynamics play
out in indoor environments, especially in low-income urban settings where peo-
ple spend a significant portion of their time inside poorly ventilated and insu-
lated homes. Our paper addresses this gap by investigating the health impacts
of extreme indoor temperatures on vulnerable populations in Sekondi-Takoradi,
Ghana, alongside their coping strategies and how these are disaggregated by age,
gender, and occupation. It explores how factors such as poor housing quality,
socio-economic limitations, and inadequate access to cooling solutions exacer-
bate these risks.
Building upon existing literature, this study examines not only the health
impacts and coping strategies for high indoor temperatures but also the

Health Impacts andCoping Strategies forExtreme Indoor…
socio-economic and environmental conditions that amplify vulnerability. It pro-
vides a localized understanding of the indoor heat-health relationship, highlight-
ing the critical need for affordable, sustainable interventions to improve thermal
comfort in low-income urban communities. By doing so, this research contributes
to the broader conversation on climate adaptation and public health in Ghana and
other regions facing similar challenges. The paper is organised as follows. After
reviewing relevant literature and describing the study context and methods, the
next sections present evidence on vulnerable groups, vulnerability factors, associ-
ated health impacts, and adaptive mechanisms employed by poor urban residents.
It ends with some concluding remarks and implications for policy and practice.
Extreme Heat andHealth Nexus: AHealth Belief Model Perspective
As one of the most widely applied theories of health behaviour (Jones etal., 2015),
the Health Belief Model (HBM) postulates that people’s health behaviours are influ-
enced by six constructs: their perceived risk susceptibility, risk severity, benefits to
action, barriers to action, self-efficacy, and cues to action (Champion & Skinner,
2008). Through the lens of the Health Belief Model (HBM), we can better under-
stand how extreme indoor temperatures influence health outcomes. Vulnerable pop-
ulations in low-income urban settings often underestimate their susceptibility to the
adverse effects of heat or may lack awareness of the severity of the risks involved.
This is compounded by environmental factors such as poor building orientation,
poor ventilation and a lack of green spaces, which increase heat absorption and ele-
vate indoor temperatures (Gyasi-Addo, 2021; Makaka & Meyer, 2006). These chal-
lenges are further worsened by the urban heat island effect which is exacerbated by
climate change (Raymond etal., 2020), high population densities, and low-quality
building materials that trap heat and make indoor environments unbearable (Amank-
waa, 2017; Oteng-Ababio etal., 2017), worsening heat risks.
Residents’ perceived benefits of cooling strategies are often limited by socio-eco-
nomic barriers. Financial constraints mean that households lack access to energy-
efficient cooling technologies (Parkes etal., 2019). Many rely on natural ventilation
or electric fans, but power outages and high energy costs restrict their effective-
ness. This inability to afford cooling exacerbates energy poverty forcing house-
holds to choose between energy for cooling and other essential needs (Amankwaa
etal., 2024; Kez et al., 2024). As a result, their exposure to extreme temperatures
increases, leading to heat-related illnesses such as heat stress and heat exhaustion,
especially among the elderly, children, and those with pre-existing health condi-
tions (Wright etal., 2017). Prolonged exposure to extreme heat also worsens respira-
tory conditions like asthma and cardiovascular issues including high blood pressure
(Stotz etal., 2014). These health risks align with the Health Belief Model’s con-
cepts of perceived severity and cues to action, as residents recognize the debilitat-
ing impacts but may feel helpless to take action due to socio-economic constraints.
Furthermore, limited access to healthcare services for treating heat-related illnesses
compounds these vulnerabilities, creating a cycle of poor health outcomes(Codjoe
etal., 2020).

E.F.Amankwaa, M.G.Ampomah
Mental health is another critical aspect, often under-researched but increasingly
recognized. Extreme heat can lead to sleep disturbances, cognitive impairments,
anxiety, and depressive symptoms (Cruz etal., 2020; Monroe etal., 2015). For low-
income residents already dealing with financial stressors and poor living conditions,
the additional burden of heat can heighten feelings of frustration, irritability, and
helplessness (Sharpe & Davison, 2021). This emotional strain can further erode
social relations, leading to increased conflicts and reduced self-efficacy and quality
of life within households and communities (Van Lange etal., 2017).
The economic implications of extreme heat in low-income urban areas are equally
severe. Residents often experience reduced productivity, particularly those work-
ing from home or in informal sectors where cooling is not readily available amidst
erraticpower outages(Amankwaa etal., 2024; Gough et al., 2019). Heat-related ill-
nesses lead to higher healthcare costs, exacerbating the financial strain on households
already struggling to meet basic needs. This combination of reduced productivity and
increased healthcare expenses deepens the cycle of poverty, making it even more chal-
lenging for these communities to improve their living conditions (Parkes etal., 2019).
In essence, the intersection of environmental, socio-economic, and health factors
creates a complex matrix of vulnerabilities (Blay etal., 2023). The Health Belief
Model helps us understand why residents may not always take adequate protective
measures against heat, as their ability to act is constrained by socio-economic reali-
ties. Targeted interventions are therefore necessary to improve awareness, reduce
barriers to effective cooling strategies, and address the broader environmental and
socio-economic drivers of heat-related health risks (Fagbamigbe etal., 2022; Mosi
etal., 2021).
Study Setting
The research was conducted in Sekondi-Takoradi, a twin city in Ghana known for its
historical significance and economic prominence. Sekondi, the older city, developed
around Dutch Fort Orange in 1642 and thrived with the construction of a railroad in
1903, which connected its hinterland resources. Takoradi, established around Dutch
Fort Witsen in 1665, is home to Ghana’s first deepwater seaport, built in 1928.
Together, these cities form the Sekondi-Takoradi metropolis, located at coordinates
4°55’00"N and 1°46’00"W (see Fig. 1). Today, Sekondi-Takoradi is informally
called the “Oil City of Ghana” due to the significant oil discoveries in the Western
Region, attracting a global influx of people (Oteng-Ababio, 2016). The city experi-
ences a tropical climate with a marked rainy season and a short dry period. Classi-
fied as having an Am climate under the Köppen-Geiger system, temperatures range
from approximately 25.8°C to 33°C and an annual rainfall of about 1366mm (53.8
inches) (Yankson etal., 2017). Situated near the equator, Sekondi-Takoradi experi-
ences consistently high heat and humidity, creating uncomfortable and often danger-
ous indoor environments.
According to the 2021 Population and Housing Census, the Western Region has
a population of 2,060,585, with Sekondi-Takoradi Metropolis housing 245,382 resi-
dents. The population is almost evenly split between 119,344 males and 126,038

Health Impacts andCoping Strategies forExtreme Indoor…
females, with a population density of 3,797.4 people per square kilometre. The
metropolis contains 73,967 households, with an average household size of 3.2
members. Rapid urbanization, high population density, and inadequate infrastruc-
ture worsen the effects of extreme heat, especially for poor urban residents who
Fig. 1 Map of the study area. Source: Authors own construct (2024)
Fig. 2 Low-income building types and materials in Sekondi-Takoradi. Source: Authors (2023)

E.F.Amankwaa, M.G.Ampomah
lack adequate ventilation and cooling solutions. Many homes are poorly ventilated
and built from heat-retaining materials, resulting in high indoor temperatures (see
Fig.2). The lack of green spaces and vegetation in the city further contributes to ris-
ing temperatures, as there are fewer natural cooling mechanisms provided by trees
and plants.
Sekondi boasts a rich cultural heritage and historical landmarks (Eshun
et al., 2015), such as Sekondi European Town, with its colonial-era buildings
constructed by the British. It remains a bustling commercial hub with a thriv-
ing coastal economy, driven by fishing and trade. Sekondi’s fishing harbour, the
largest in Ghana, employs thousands of people who are exposed to high temper-
atures during their daily activities. Likewise, Takoradi’s harbour and industries,
which support timber and cocoa export, face similar challenges from extreme
heat. The city’s infrastructure is strained by rapid population growth and fre-
quent, intensifying heat events, leading to reduced productivity and increased
health risks for workers across key economic sectors.
Methods
To gain a well-rounded understanding of the health effects of extreme indoor
temperatures on vulnerable communities, a mixed-methods research design was
employed. This approach included surveys, focus group discussions, expert inter-
views, and participant observation, which enabled data triangulation and a nuanced
exploration of urban precariousness (see Esson et al., 2016, 2020; Gough etal.,
2015; Yankson etal., 2017).
The research design was implemented in two stages. First, transect walks and a
reconnaissance survey were used to map and classify different zones within Sekondi
Zongo, a low-income community that is representative of the broader demographic
in the Sekondi-Takoradi metropolis. During the transect walks, data was collected
on housing types, building materials, ventilation systems, green spaces, and other
environmental factors contributing to indoor heat conditions. These on-the-ground
observations informed the zonation of the community, facilitating more targeted
data collection and providing insights into how these variables affect residents’ heat
exposure and coping strategies.
A simple random sampling technique was then employed to survey 100 partici-
pants from different parts of Sekondi Zongo based on household availability and
willingness to participate. The structured survey questionnaire comprised four sec-
tions: demographics, vulnerability factors and vulnerable groups, health effects, and
coping strategies. In addition, two focus group discussions (FGDs) were held – one
with male and female youth (aged 18–35 years) and another with elderly males and
females (aged 36–70 years) – each lasting around 45–60min with six to eight par-
ticipants. Table1 summarises the survey and focus group discussion participants.
Three semi-structured, in-depth expert interviews were conducted with health pro-
fessionals, lasting 30 to 60min. Research ethics clearance was granted by the Uni-
versity of Ghana Ethics Committee for Humanities (ECH 129/ 22–23).

Health Impacts andCoping Strategies forExtreme Indoor…
The second stage involved informal interactions and participant observations,
which focused on how residents negotiated the impacts of extreme heat on their
health. Participants included youth, the elderly, and individuals with pre-existing
health conditions whose well-being was directly affected by extreme heat exposure.
These engagements provided deeper insights into the health implications of extreme
temperatures and helped illuminate the lived experiences of vulnerable populations
(Amankwaa & Gough, 2022, 2023). Detailed ethnographic fieldnotes were main-
tained and subsequently analysed using NVivo 11. All interviews were recorded and
transcribed verbatim, with translations from Twi to English where necessary. The
transcripts were analysed in NVivo using coding to identify categories, themes and
trends. Quantitative data was analyzed using descriptive statistics in SPSS 23 and
the results were presented in tables.
Results andDiscussion onHealth Impacts andCoping Strategies
forExtreme heat
This section presents the study’s findings, categorised into three thematic
areas: (1) vulnerable groups and vulnerability factors, (2) health impacts of
extreme indoor temperatures, and (3) coping strategies employed by low-income
communities.
Table 1 Summary of study
participants Characteristics Survey (N = 100) FGD (N = 14)
Gender
Female 54% 50%
Male 46% 50%
Age Distribution
Under 18 years 6% N/A
18–25 years 24% 50% (Youth Group)
26–35 years 24% 50% (Youth Group)
36–45 years 19% 40% (Elderly Group)
46–55 years 18% 40% (Elderly Group)
Above 55 years 9% 20% (Elderly Group)
Table 2 Vulnerable groups to
extreme heat Category Frequency Percent (%)
Elderly 50 50
Children 17 17
Pregnant women 13 13
People with chronic illnesses 12 12
Persons with disabilities 8 8

E.F.Amankwaa, M.G.Ampomah
Vulnerable Groups andVulnerability Factors
The paper identified key demographic groups most at risk from the health effects of
extreme indoor temperatures (Table2). The elderly comprised 50% of the identified
at-risk population, primarily due to their diminished ability to regulate body tem-
perature and the higher prevalence of chronic health conditions such as cardiovas-
cular and respiratory diseases. This aligns with existing research showing that older
adults are physiologically more susceptible to heat stress due to age-related declines
in thermoregulation, including reduced sweating and impaired cardiovascular func-
tion (Meade etal., 2020). Children accounted for 17% of the vulnerable population.
However, it is important to clarify that, based on thermophysiological evidence,
children over the age of seven are not inherently at higher risk of heat stress than
adults (Naughton & Carlson, 2008). Their vulnerability may instead stem from other
factors, such as behaviour, reduced ability to recognize and respond to heat stress,
and their reliance on caregivers for protection. Nevertheless, children under the age
of seven may still experience increased vulnerability due to their developing physi-
ological systems, which can make them more prone to heat-related illnesses (Blom
etal., 2022).
Pregnant women represented 13% of the at-risk population. The additional strain
placed on the body during pregnancy, including increased metabolic heat production
and changes in cardiovascular function, makes pregnant women more susceptible
to heat stress. This can increase the risk of adverse health outcomes for both the
mother and the fetus, such as dehydration, preterm birth, and complications during
labour (McElroy etal., 2021). Individuals with chronic illnesses (12%) and persons
with disabilities (8%) were also highly vulnerable due to their pre-existing health
conditions. High temperatures can exacerbate chronic illnesses such as asthma, dia-
betes, and heart disease. At the same time, individuals with disabilities may face
mobility and access challenges that hinder their ability to seek cooler environments.
These findings emphasize the importance of targeted interventions for these high-
risk groups, which must consider both physiological vulnerabilities and socio-envi-
ronmental factors that may increase their exposure to extreme indoor temperatures
(Kenny etal., 2024).
The paper identified several key factors contributing to the vulnerability of resi-
dents in low-income urban communities in Sekondi-Takoradi to the health effects
of extreme temperatures. Respondents rated these factors on a 5-point scale where
Table 3 Vulnerability factors contributing to extreme heat impacts
Item Strongly
disagree
Disagree Neutral Agree Strongly agree
Pre-existing health condition 0 21 9 23 47
Old age 0 9 23 26 42
Poverty/financial constraints 0 9 25 25 41
Lack of adequate housing 11 16 13 31 29
Limited access to cooling technology 9 10 30 19 32

Health Impacts andCoping Strategies forExtreme Indoor…
1 = Strongly Disagree and 5 = Strongly Agree. The factors included pre-existing
health conditions, old age, poverty/financial constraints, limited access to cooling
technology, and lack of adequate housing (Table3).
More than two-thirds of respondents (70%) agreed or strongly agreed that pre-
existing health conditions heightened their vulnerability to extreme indoor tem-
peratures, with only 21% disagreed, and 9% remained neutral. This consensus
underscores the critical role that underlying health status plays in determining sus-
ceptibility to the adverse effects of extreme heat. Individuals with chronic illnesses,
such as asthma, diabetes, and cardiovascular diseases, are particularly at risk, as
exposure to high temperatures can exacerbate these conditions. As noted by Kenny
etal. (2024), pre-existing medical conditions significantly amplify the health risks
posed by heatwaves, particularly among those with compromised cardiovascular or
respiratory systems, making heat exposure a critical public health issue for popula-
tions already burdened with chronic diseases. Similarly, more than two-thirds (68%)
of participants acknowledged that old age was a key contributing factor to vulner-
ability, with 23% remaining neutral and only 9% disagreeing. Elderly individuals are
especially prone to heat-related illnesses due to their decreased ability to regulate
body temperature and the higher prevalence of pre-existing health conditions.
Poverty and financial constraints also emerged as major factors, with two-thirds
(66%) of respondents strongly agreeing or agreeing that economic hardship exacer-
bated health vulnerability. A quarter of respondents (25%) remained neutral, while
9% disagreed. Financial limitations restrict access to cooling technologies and
adequate housing. Qualitative data offered deeper insights into how poverty mag-
nifies vulnerability. For instance, Monica, a registered nurse, noted: “The financial
strength is not there so people open the windows until bedtime to cool their homes,
before they close them. Others stay out late into the night for the temperature to cool
down before going inside to sleep.” Similarly, Issaka an elderly community member
explained that “those without money are the most affected by the heat since they
have no option but to sleep in the heat like that because they cannot afford even
basic cooling devices.” This link between poverty and vulnerability highlights the
need for economic interventions and affordable solutions to mitigate the effects of
extreme heat (Parkes etal., 2019).
Inadequate housing was another major vulnerability factor, with 60% of partici-
pants agreeing that poor-quality building materials and construction practices signif-
icantly contributed to elevated indoor temperatures. Many houses in Sekondi Zongo
are made from materials like corrugated metal roofs and sandcrete or cement blocks,
which trap heat and lack proper insulation and ventilation. The absence of ceiling
insulation combined with security concerns that prevent natural ventilation, exacer-
bates the situation, making homes unbearably hot (Berger etal., 2022).
Interestingly, half of respondents (51%) strongly agreed or agreed that limited
access to cooling technologies was a significant factor. This suggests that issues,
such as poor housing quality and economic constraints are seen as more pressing.
While cooling devices like fans and air conditioners could help, their cost and the
expense of electricity make them inaccessible to many low-income households.
Expert interviews revealed that poor ventilation is a major issue. Many homes
lack proper air circulation due to absent or blocked windows, privacy and security

E.F.Amankwaa, M.G.Ampomah
concerns, and the dense arrangement of buildings. As Eugenia, a community nurse,
observed: “There is little to no ventilation due to the lack of space, and some of us
lack windows that allow cross ventilation.” This trapped heat raises indoor tempera-
tures, making living conditions uncomfortable and unhealthy.
These findings align with previous research (Raymond etal., 2020; Wilby etal.,
2021) that suggests city-wide temperature measurements and often underreport the
elevated extreme indoor temperatures experienced in low-income areas. The results
highlight the complex nature of vulnerability to extreme heat in Sekondi-Takoradi,
emphasising the need for comprehensive strategies that address the various contrib-
uting factors and enhance community resilience to cope with the rising threat of
extreme temperatures.
Health Effects
The paper revealed significant health impacts of extreme temperatures on low-
income residents in Sekondi-Takoradi. An overwhelming 95% of respondents
reported experiencing health issues due to exposure to extreme indoor temperatures,
highlighting the severity of this problem in the community. To better understand
these impacts, participants rated their experiences of health effects on a scale from 1
(Strongly Disagree) to 5 (Strongly Agree) (see Table4).
A striking 84% of respondents agreed or strongly agreed that they experienced
heat stress due to heat exposure. This widespread acknowledgement underscores
heat stress as a major health issue in the community, affecting residents across
various demographic groups. Dehydration was similarly prevalent, with 81% of
respondents identifying it as a major health concern linked to high temperatures.
Both conditions present significant risks, particularly for vulnerable groups such
as the elderly, young children, and pregnant women, who are more susceptible to
heat-related health issues due to reduced thermoregulation and other physiological
factors (Ebi etal., 2021; Meade etal., 2020). Disaggregating the findings by demo-
graphic group, older adults were more likely to report severe heat-related symptoms
such as dizziness and dehydration, reflecting their increased vulnerability to extreme
temperatures. According to Dr Kwame, a local health practitioner, “Heat stress is a
common issue, especially during the hottest months. Many residents, with pre-exist-
ing conditions, come [to the health facility] with symptoms of severe dehydration,
Table 4 Health effects of extreme indoor temperatures
Item Strongly
disagree
Disagree Neutral Agree Strongly agree
Heat stress 0 0 16 41 43
Dehydration 0 0 19 60 21
Skin irritation/rashes 0 0 14 45 41
Respiratory problem 0 0 24 45 31
Dizziness 11 20 27 15 27
Other 10 11 30 22 27

Health Impacts andCoping Strategies forExtreme Indoor…
which can lead to more serious conditions if not treated promptly.” This emphasizes
the immediate health risks of heat stress and dehydration, which can escalate into
more severe outcomes like dizziness and heatstroke if residents lack access to ade-
quate hydration and cooling measures (Zhao etal., 2015).
Interestingly, dizziness was a less frequently reported symptom, with only 42% of
participants agreeing or strongly agreeing that it was linked to heat exposure, while
31% disagreed. In contrast, skin irritation, particularly in the form of heat rashes,
was widely acknowledged. For women, especially those engaged in caregiving or
domestic work, the challenges of heat were compounded by their frequent presence
indoors. A significant percentage of women reported skin irritation, with 86% agree-
ing or strongly agreeing that they experienced heat rashes due to prolonged exposure
to high temperatures. Monica, a registered general nurse noted, “Heat rashes are
common, especially in children and women who are home for long periods without
adequate ventilation, which can become quite severe if untreated.” Heat rashes occur
when sweat ducts become blocked and swell, often due to poor ventilation, and can
result in discomfort if neglected. Other environmental and socio-economic factors
such as lack of access to water and poor hygiene also contribute to rashes. Pregnant
women were particularly affected, as the physiological stress of pregnancy intensi-
fied the heat’s effects, making access to cooling solutions even more critical (McEl-
roy etal., 2021). This emphasizes the need for improved housing conditions and
better ventilation to reduce the incidence of such heat-related skin issues.
Respiratory problems were another major health concern, with 76% of respond-
ents agreeing or strongly agreeing that these issues were exacerbated by extreme
temperatures. Among older respondents, 67% agreed that they experienced respira-
tory problems during periods of extreme heat. Interviews with health experts con-
firmed that respiratory diseases, such as asthma and chronic obstructive pulmonary
disease, were more frequent during hotter periods, often due to poor air quality. Dr.
Kwame indicated:
We’ve noticed an increase in respiratory cases, such as asthma and respira-
tory tract infections, especially during hotter periods. Poor air quality indoors,
worsened by extreme heat, is a significant contributing factor, especially
among older patients with pre-existing conditions.
The link between high temperatures and respiratory conditions is consistent with
previous studies, which suggest that high indoor temperatures can aggravate respira-
tory diseases, particularly in poorly ventilated environments (Stotz etal., 2014).
The mental health impacts of extreme temperatures were less uniformly acknowl-
edged. While nearly half (49%) of respondents agreed or strongly agreed that condi-
tions such as sleeplessness, anxiety, and aggression were linked to extreme heat, over
a quarter (30) remained neutral. Eugenia, a community nurse, pointed out, “Many
people do not know that extreme heat can seriously affect mental health. We’ve seen
increased cases of anxiety, sleep disturbances, and even aggression, which are often
overlooked but significantly impact daily life.” Extreme heat can disrupt cognitive
function and lead to emotional stress, increasing aggression and anxiety and even
elevating alcohol consumption, especially in environments where cooling methods
are unavailable (Ebi etal., 2021; Sharpe & Davison, 2021; Van Lange etal., 2017).

E.F.Amankwaa, M.G.Ampomah
Poor sleep caused by heat further impairs daily functioning, which can exacerbate
feelings of frustration and aggression.
The findings of this study align with prior research showing that extreme tem-
peratures can lead to severe health impacts, including increased hospitalization and
mortality rates, especially among vulnerable groups like the elderly, young children,
and those with chronic conditions (Kovats etal., 2004; Turner et al., 2012). The
inclusion of elderly respondents in the study is particularly important, as older per-
sons are widely recognized as being at high risk from heat exposure due to their
reduced thermoregulatory capacity and the prevalence of age-related chronic condi-
tions. They often experience heightened vulnerability to respiratory problems due to
diminished lung function and other chronic health conditions (Meade etal., 2020).
While children over the age of seven are not physiologically more vulnerable to heat
than adults, their risk may be elevated by factors such as behavioural patterns and
dependence on caregivers (Kenny etal., 2024).
The high levels of reported heat impacts among residents, including working-age
adults, underscore that even generally healthy populations are not immune to the
health effects of extreme temperatures. The findings emphasise the need for compre-
hensive strategies to address both the physical and mental health challenges posed
by extreme heat among vulnerable populations. Improving socio-economic develop-
ment such as housing conditions, enhancing ventilation, increasing access to cooling
technologies, and providing healthcare services are critical steps to mitigate these
health risks. As rightly noted by Ebi etal. (2021), climate change is interacting with
major trends, such as population growth and ageing, urbanisation, and socioeco-
nomic development, that either exacerbate or ameliorate heat-related hazards.
Coping Strategies
The findings on coping strategies for dealing with extreme indoor temperatures
reveal diverse methods employed by low-income residents in Sekondi-Takoradi
(Table 5). The data disaggregated by age, gender, and occupation illustrates how
different demographic groups adapt to the heat. While all respondents experienced
heat-related challenges, there are distinct variations in how men, women, youth, and
the elderly cope with the conditions, as well as significant barriers to implementing
effective cooling strategies.
Table 5 Coping strategies to extreme indoor temperatures
Item Less effective Effective Neutral Very effective Most effective
Natural ventilation 0 9 18 22 51
Sleeping outside 0 20 22 29 29
Use of electric fan 0 29 16 35 20
Seeking relief in public spaces 9 20 17 27 27
Sitting under tree shade 5 31 19 24 21
Other 5 30 35 20 10

Health Impacts andCoping Strategies forExtreme Indoor…
Natural ventilation emerged as the most favoured strategy among participants,
with 73% rating it as highly effective. This method, which involves increas-
ing airflow through open windows and doors, was particularly popular among
younger adults and men engaged in outdoor activities. For the youth, natural
ventilation serves as a low-cost, sustainable option, though its limitations were
acknowledged, especially when outdoor temperatures also rise. As Ebo, a male
youth stated, “We keep windows open during the day to let in the breeze, but it’s
not always enough. When the heat is intense, the rooms and compound become
unbearable so we sweat a lot.” Older adults, especially the elderly, contrasted
current housing designs with traditional architecture, highlighting how modern,
cramped and densely packed houses reduce natural airflow (Makaka & Meyer,
2006). Auntie Yaa, a 66-year-old elderly woman reflected, “Back in the day, our
homes were built with big windows and high ceilings to stay cool. Now, houses
are too cramped.”
Sleeping outdoors was another popular strategy, with 58% of participants finding
it effective. This method was particularly favoured by the youth, who used com-
munal spaces like courtyards for relief, although they faced safety concerns such
as mosquitoes and theft (Monroe etal., 2015). For instance, Adjoa, a 21-year-old
single mother bemoaned, “We take mats and sleep outside, but you have to deal with
mosquitoes, even with mosquito nets. Others too complain of theft.” Elderly partici-
pants, like Wofa Kofi, a 58-year elderly male, also resorted to this method, despite
the discomfort, as it provided better air quality during the night. However, barri-
ers like security and health risks, such as exposure to mosquitoes, were prominent
among this group.
Electric fans were considered effective by 55% of participants, with more reliance
among the youth and women. However, the cost of electricity and frequent power
outages limited their usage. Esi, a 19 year-old female, intimated, “Fans are our best
friends, but when the power goes out, it’s a real struggle.” Older respondents, like
Auntie Aba, a 65-year-old woman, also used fans sparingly due to high electricity
costs, underscoring the financial barriers to this coping strategy. Previous research
shows that indoor fan use is beneficial up to ~ 40–45°C and 60% relative humidity;
beyond these limits, there are increased risks of dehydration (Jay etal., 2015).
Seeking relief in public spaces like malls, libraries, and community centres was
considered effective by 74% of the respondents. This strategy, common among the
youth, offers a temporary escape from the heat, especially in air-conditioned envi-
ronments. Jojo, a youth activist, recounted how they cool off at the mall sometimes
leading to unplanned spending. The elderly often use community centres for cool-
ing and leisure but face challenges like overcrowding, encountering people and
unwanted personal conversations that invade their privacy, which can discourage
them from using these spaces despite their cooling benefits. Sitting under tree shade
to stay cool received mixed reviews, with 76% of participants rating this option as
effective. Ebo indicated how the youth enjoy the natural cooling provided by tree
shade, making it a preferred gathering spot. Similarly, the elderly used the green
spaces to avoid the sweltering heat indoors. Even though tree shade reduces insola-
tion, this option is not always feasible within the dense urban fabric of informal set-
tlements (Wilby etal., 2021).

E.F.Amankwaa, M.G.Ampomah
The elderly and individuals with chronic conditions reported higher usage of
improvised methods such as wet cloths and towels, frequent cold showers, and soak-
ing feet in water to stay cool. These strategies were effective but limited in their
reach for long-term cooling (Berger et al., 2022). Adjoa a middle-aged vendor
recalled how “We use wet towels to make our kids stay cool at night and take fre-
quent cold showers to cool down ourselves.” Wofa Kofi, an elderly resident, noted,
“I keep a basin of water and dip my feet in it to stay cool. It helps a lot.” These meth-
ods illustrate the reliance on low-cost and easily accessible resources, particularly
among older populations with limited mobility.
The barriers identified varied significantly across different demographic groups.
Young people were generally more adept at navigating these challenges, while
older adults encountered greater difficulties. Women, particularly those involved in
domestic work or caregiving, often resorted to coping strategies that involved stay-
ing indoors, where temperatures could become unbearable (Gough et al., 2019).
Disaggregated data revealed that women were more likely to rely on fans and impro-
vised cooling methods, but their consistent access to these strategies was limited
by economic constraints. Pregnant women faced additional challenges, as the physi-
ological stress of pregnancy exacerbated the effects of heat (McElroy etal., 2021),
making access to cooling solutions even more crucial.
Recent studies on heat coping strategies in low-income settings (Berger et al.,
2022; Jay etal., 2021) underscore the effectiveness of passive cooling methods like
natural ventilation and highlight the limitations of fan usage in areas with high rela-
tive humidity. In urban settings, socio-economic constraints, such as electricity costs
and infrastructure, significantly affect the choice and sustainability of cooling strate-
gies (Kenny etal., 2024). This study supports prior ones by showing how economic
limitations shape coping strategies in Sekondi-Takoradi, with respondents relying on
low-cost options such as natural ventilation and water-based cooling methods (Mon-
roe etal., 2015), particularly among vulnerable groups like the elderly and women.
Conclusion andPolicy Recommendations
This paper highlights the pressing challenges posed by extreme indoor tempera-
tures in low-income urban communities in Sekondi-Takoradi, Ghana, emphasizing
the disproportionate impact on vulnerable populations. Through an analysis of vul-
nerable groups, contributing factors, health effects, and coping strategies, the find-
ings provide critical insights into the livedexperiences of these communities. The
paper reveals that children, the elderly, pregnant women, individuals with chronic
illnesses, and persons with disabilities are particularly at risk. These groups lack the
physiological and socio-economic resilience to cope with prolonged heat exposure,
making them more susceptible to heat-related health issues (Wright et al., 2017).
Children and the elderly, for example, face difficulties in regulating body tempera-
ture, while individuals with chronic illnesses experience exacerbated symptoms
under extreme heat (Naughton & Carlson, 2008).
Several factors exacerbate the vulnerability of these communities to high tem-
peratures, including poverty, poor urban planning, and inadequate housing. Densely

Health Impacts andCoping Strategies forExtreme Indoor…
packed buildings with limited ventilation and the use of heat-retaining materials
worsen the impact of extreme heat, as does the absence of green spaces. Health
impacts range from heat stress and dehydration to more severe conditions such as
respiratory problems and heat rashes, underscoring the serious consequences of
inadequate infrastructure in these environments (Codjoe et al., 2020). Residents
employ various coping strategies to mitigate the effects of extreme temperatures,
but these strategies are often constrained by socio-economic challenges. Natural
ventilation is the most commonly used method, followed by sleeping outside, using
electric fans, seeking relief in public spaces, and sitting under tree shade. However,
these strategies are not without barriers: power outages, high electricity costs, over-
crowded public spaces, and safety concerns limit their effectiveness. Additionally,
age, gender, and occupation influence the choice and effectiveness of coping strate-
gies, with older adults and women often facing greater constraints due to financial or
physical limitations.
Addressing these challenges requires a multi-faceted and integrated approach.
Policymakers must prioritize the development of climate-resilient housing that
incorporates proper ventilation, heat-reflective materials, and traditional materi-
als and designs that promote natural cooling (Roberts etal., 2022). Urban planning
should also focus on reducing the urban heat island effect through the creation of
green spaces, which provide natural cooling and improve air quality. In addition,
affordable and energy-efficient cooling technologies tailored to low-income commu-
nities are essential. Policy interventions should focus on reducing the financial bur-
den associated with cooling strategies. Subsidies for electricity use during peak heat
periods and investment in community-based cooling centres could provide afford-
able and accessible relief. While initiatives like the Ghana Energy Commission’s
energy-efficient building design project are a step in the right direction, further
efforts are needed to ensure widespread adoption. Investments in sustainable infra-
structure and healthcare services, alongside community engagement, can empower
residents to adopt better heat management strategies. This should consider the
unique needs of vulnerable populations, such as the elderly, children, and pregnant
women, who face heightened risks in extreme heat conditions.
Finally, the barriers to effective coping strategies, such as inadequate infrastruc-
ture, high costs, and poor urban design, must be addressed through targeted policy
recommendations that promote transformative and affordable solutions (Pahl-Wostl
et al., 2023). By adopting holistic policies and practices, Ghana can create safer,
healthier living environments for its most vulnerable populations, reducing the
adverse effects of extreme temperatures on public health and well-being. Policies
informed by the lived experiences of residents will be crucial for creating sustain-
able and equitable cooling solutions in low-income urban areas. This will require
policymakers, urban planners, and community leaders to collaborate and coordinate
effectively to implement these measures in a targeted fashion and ensure that vulner-
able residents benefit from improved resilience to extreme heat.
Acknowledgements The authors are greatly indebted to all our participants who allowed us into their
homes and health facilities to undertake this research. We are thankful to the two anonymous reviewers
for their useful comments.

E.F.Amankwaa, M.G.Ampomah
Funding The authors did not receive support from any organization for the publication of this article.
Data Availability Data used for the research will be provided upon request.
Declarations
Conflict of Interest The authors declare no potential conflicts of interest with respect to the research, au-
thorship, and/or publication of this article.
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