Exploring the relationship between neighborhood environments and noncommunicable disease status varying urban contexts in Ghana: the role of gender

Keywords: neighborhood environment, non-communicable diseases, space-time mobility, chronic disease, gender
Abstract Type: Paper Abstract

Abstract

Uncertainties around exposures in non-residential contexts complicate the understanding of environmental exposures and health. In many low- and middle-income countries including Ghana, poor city planning creates a situation where workspaces and economic activities (formal and informal) are concentrated around congested central business districts. Poor transportation networks and long commute times further create a situation where many urban dwellers spend significant amounts of time away from their residential neighborhoods. Failure to account for these dynamics in place-based studies contributes to the uncertain geographic context problem (UGCoP). We used cross-sectional data and fitted multilevel complementary log-log regression models to a sample of 1377 respondents to examine the relationship between time spent in residential neighborhoods and non-communicable diseases (NCDs) status and whether this relationship differed by gender in three Ghanaian cities. We found that male respondents who were mostly away from their residential neighborhoods, were there a few days a week, or were there most days of the week were about 2 times likely to be diagnosed with NCDs compared to those who spend the entire week in their residential neighborhoods. Longer stay in neighborhood was associated with women’s likelihood of being diagnosed with NCDs. Unlike men, higher wealth status increased women’s likelihood of being diagnosed with NCDs but increased vegetable consumption acts as a buffer. To tease out prevailing nuances within populations, we argue that place-based researchers not only embrace the UGCoP, but that they analyze this problem at sub-group levels (i.e., gender) rather than merely controlling for them in statistical models.