title: Access to health in city slum dwellers: The case of Sodom and Gomorrah in Accra, Ghana.
abstract: BACKGROUND
  Rapid rural-urban migration of people to cities is a reality around the globe that has increased city slum dwellers. Sodom and Gomorrah is a city slum located in the heart of Accra, Ghana. Like other slums, it lacks basic amenities necessary for dwellers' quality of life. This study describes residents' access to health and factors associated with the use of healthcarefacilities.
  
  
  METHODS
  Questionnaires were administered in systematically selected shacks across the entire slum. Data on demographic characteristics, existent health facilities and number of users, health-insured residents and knowledge of common diseases were collected.
  
  
  RESULTS
  Majority of the residents were from the northern parts of Ghana, relative to the south and a few of them come from other parts of West Africa. Seventy-one percent of residents had never visited a health facility in the last 5 years. When necessary, they access health care from drug stores (61.1%) or hospitals (33.1%). Residents' age, educational status, income, health knowledge and membership of National Health Insurance Scheme were significantly (p &lt; 0.05) associated with the use of healthcare facilities. Younger residents and those without National Health Insurance Scheme membership, formal education, no knowledge of common illnesses and regular income were significantly less likely to use a healthcare facility. For most residents, neither distance (73.2%) nor transportation to health facilities was a problem (74.1%).
  
  
  CONCLUSIONS
  Conditions of profound environmental hazards, overcrowding, poor-quality housing and lack of health care in Sodom and Gomorrah pose grave threats to the health of the inhabitants. Multisectoral interventions and resource mobilisation championed by the Ministry of Local Government and Rural Development are needed to alter the trend.
authors.affiliation: Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology. feoansah@yahoo.com.
authors.forename: Frances E
authors.initials: FE
authors.lastname: Owusu-Ansah
authors.forename: Harry
authors.initials: H
authors.lastname: Tagbor
authors.forename: Mabel Afi
authors.initials: MA
authors.lastname: Togbe
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D011204:Poverty Areas; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Ghana.; Slum dwellers; Sodom and Gomorra; access; health