Occupational heat exposure and self-reported heat-related outcomes among female head porters (Kayayei) in Accra, Ghana

Female head porters (Kayayei) in Accra undertake strenuous load-carrying work under prolonged outdoor heat exposure, yet occupational heat-related illness in this group remains poorly documented. This study examined occupational heat exposure and its associations with self-reported health and livelihood outcomes among Kayayei in Accra. A mixed-methods cross-sectional study was conducted among 222 Kayayei in Makola and Agbogbloshie markets. Structured questionnaires captured work conditions, sun exposure, heat-related symptoms, menstrual irregularities, missed work due to heat, and healthcare utilisation. Multivariable logistic regression models were used to examine associations between occupational exposure indicators and selected outcomes. Qualitative interviews with five key informants complemented the quantitative findings. Most participants reported working more than 8 h/day (84.7%) and under direct sun exposure (96.4%). A high proportion (96.8%) reported at least one heat-related symptom, with headaches (85.6%), muscle cramps (74.8%), heat rashes (62.6%), and dizziness (59.0%) being the most common. Menstrual irregularities were reported by 75.1% of respondents, and 93.2% reported missing work due to heat-related symptoms. Working more than 8 h/day was consistently associated with higher odds of reported heat-related illness, menstrual irregularities, missed work, and healthcare utilisation. Several estimates had wide confidence intervals, indicating limited precision. Kayayei experience substantial occupational heat exposure alongside a high burden of self-reported heat-related symptoms and work disruption. Longer working hours were consistently associated with multiple reported outcomes. These findings highlight the need for further longitudinal and intervention-based research and suggest that shaded workspaces, rest opportunities, and improved occupational support may be relevant areas for action in informal urban labour settings .