KEJETIA MARKET, Kumasi — Akosua Frimpong arrives at this busy central market before dawn. By 6am, she has arranged her foodstuffs on the median strip — tomatoes, onions, yams, okra, garden eggs — hawking them to pedestrians and drivers passing by. By evening, she will have stood there 14 hours, breathing in whatever the traffic brings.
Akosua knows the air is not good. The burning in her eyes and the tightening in her throat tell the 34-year-old that much. What she doesn’t know is that with every breath she inhales six distinct pollutants — microscopic killers that experts say are destroying her lungs, damaging her heart, and shortening her life.
“The smoke from the buses makes me cough, and my eyes burn by afternoon,” Akosua says in Twi, her voice already hoarse in the morning cool. “But I have to be here — this is where the customers are.”
No one has ever told Akosua what she is breathing. No one has warned her that rush hours — when she is always present — are the most dangerous times. No one has told her that stepping just 10 metres back from the kerb could cut her exposure by nearly half. Her doctor calls it chronic bronchitis. No one has connected it to her work.
“I grew up helping my mother sell here,” she says. “She died five years ago from what they said was pneumonia. She coughed just like I do now.” Akosua now wonders whether to let her six-year-old daughter Ama come to help after school. When Ama does visit, Akosua tries to position her further from the road — but cannot always manage it. Ama has already developed the same cough.
Akosua’s daily ordeal is not unique to her corner of Kejetia. It is replicated across every major road in Ghana’s cities — and backed by a growing body of research. A study published in the Journal of Exposure Science & Environmental Epidemiology examined 236 street traders working along six major traffic routes in Accra and found consistent evidence that exposure to PM2.5 – the smallest and most deadly pollution particles – among street traders significantly raises the odds of respiratory and cardiovascular symptoms. Coughing, chest pains, rapid heartbeat, and dizziness are among them. Compared to office workers, street traders were measurably more likely to report sharp chest pains, fainting spells, and irregular heartbeat.
The pattern extends across the sub-region. A pilot study in Nairobi — among the first to measure occupational air pollution exposure in sub-Saharan Africa — found that street vendors working along busy roadways had PM2.5 exposure levels comparable to garage mechanics, with black carbon and re-suspended road dust identified as major contributors. The researchers concluded that the large share of urban residents who walk or work along roadsides would benefit substantially from regulations targeting diesel emissions and dust.
The science on pedestrian exposure is equally stark. One study found that inhalation of ultrafine particles was 30 times higher when walking alongside traffic than when driving with windows closed. Car ventilation systems filter pollutants for vehicle occupants; pedestrians have no such protection. Their only option is to change where or when they walk — choices that Akosua and millions like her simply cannot make.
“This is an environmental justice crisis,” says Dr Elvis Kyere Gyeabour, an environmental health expert at the UK-based Clean Air Fund. “The people who walk because they must — who cannot afford vehicles — receive the highest pollution exposure while receiving the least information about how to protect themselves. Simple guidance could reduce exposure by 30 to 40 per cent. But we are not sharing it.”
Twenty-eight-year-old Adwoa Amoakowaa hangs from her tro-tro door eight to 10 hours daily, collecting fares as her vehicle crawls through Kumasi traffic. She occupies what experts say is perhaps the single most dangerous job for pollution exposure in the city — standing at exhaust level in dense, stop-start traffic.
“My throat hurts every day, and I am always tired,” she says during a brief stop at Asafo market station.
What Adwoa did not know when this reporter first met her was that she was two months pregnant. (She would share this news in the weeks after.) The carbon monoxide she inhales reduces oxygen delivery to her brain, her heart — and to her developing child. Pollution particles enter her bloodstream and cross the placental barrier. Research links maternal air pollution exposure to low birth weight, premature birth, developmental delays, and elevated childhood asthma risk.
Adwoa has not told her employer she is pregnant, afraid of losing her income precisely when she needs it most. So she is still hanging from the tro-tro door, still breathing exhaust for 10 hours a day. When asked whether she would change her circumstances if she fully understood the risks, she was quiet for a long moment.
“I would try,” she finally said. “But there is not much choice for people like me, is there? We do what we must to survive.”
Air pollution is rising rapidly in Ghana’s growing cities, driven by population growth, worsening traffic congestion, open burning of waste, and the widespread use of polluting fuels. A systematic review of PM2.5 exposure at traffic hotspots in Accra found average concentrations of 61.3 micrograms per cubic metre — far exceeding WHO guidelines — with the importation of ageing, poorly maintained vehicles identified as a key driver. The health toll is severe: air pollution is now linked to over 32,000 deaths a year in Ghana, making it one of the country’s leading public health threats.
“We are seeing women in their 20s and 30s with Chronic Obstructive Pulmonary Disease — which we used to see only in elderly smokers,” says Dr Sandra Owusu-Kwarteng, a pulmonologist at Komfo Anokye Teaching Hospital. “When I take their histories, many are or were street vendors, hawkers, market women, tro-tro mates. They have spent years breathing traffic pollution at its most concentrated. Many of these cases are preventable. But they were never warned.”
The pollutants work in devastating synergy. Fine particulate matter penetrates the lungs and enters the bloodstream, causing cardiac and respiratory disease. Nitrogen dioxide damages airways and worsens asthma. Carbon monoxide reduces oxygen delivery throughout the body. Black carbon embeds in lung tissue and is linked to cancer. Ground-level ozone causes chest pain and irreversible lung scarring. Sulphur dioxide triggers dangerous breathing attacks in asthmatics. During rush hour, pedestrians absorb all six simultaneously, at concentrations that routinely exceed WHO safety thresholds.
The elderly, immunosuppressed and children are the most vulnerable. Doctors have seen a disturbing rise in impacted children.
“Paediatric asthma rates are climbing, and we are seeing it concentrated in children who live or spend significant time near major roads,” Dr Owusu-Kwarteng adds. “A child’s lungs are still developing. The damage from early pollution exposure is permanent.”
Ghana’s Environmental Protection Authority does monitor air quality — but the data rarely reaches those most at risk. “We have the monitoring infrastructure, but translating readings into public guidance for vulnerable groups remains a gap we are working to close,” says Selina Amoah, Head of Quality Assurance at the EPA. “Roadside workers and pedestrians need targeted information, and we recognise that.”
International cities have long acted on this threat. London posts real-time pollution alerts at bus stops. New York City advises vulnerable residents to limit outdoor activity on high-pollution days. Singapore educates schoolchildren on safer walking routes and issues specific warnings to pregnant women.
Ghana’s new air quality legislation — Legislative Instrument 2507, passed in July 2025 — is an important step. But experts say it falls short. The law focuses on emissions standards and enforcement. It contains no public education component, no requirement for pollution warnings, and no mandate to inform vulnerable populations.
“The law is important, but it is only half the solution,” says Dr Gyeabour. “You can regulate emissions all you want, but while vehicles are being brought into compliance — which takes years — millions of people are breathing dangerous levels every single day.”
The knowledge that could protect Akosua, Adwoa, and millions like them already exists. Walking 10 metres from the kerb cuts exposure by 30 to 40 per cent. Rush-hour pollution runs three to four times higher than midday levels. An N95 nose mask reduces particulate inhalation by 95 per cent. Cities across the world use this knowledge to protect their pedestrians.
Ghana’s government has not yet made that life-saving information a priority.
And in that silence, as evening rush hour thickens the air above Kejetia, Akosua coughs into her wrapper and keeps selling — unwarned, unprotected, one invisible breath at a time.
This story was produced in collaboration with New Narratives as part of the Clean Air Reporting Project. Funding was provided by the Clean Air Fund. The funder had no say in the story’s content.
BY KINGSLEY E. HOPE
Follow our WhatsApp Channel now! https://whatsapp.com/channel/0029VbAjG7g3gvWajUAEX12Q
