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Despite the benefits of walking as a means of travelling, walking can be quite hazardous. Pedestrian-vehicle crashes remain a major concern in Ghana as they account for the highest percentage of fatalities. The objective of this study is to determine the effect of both natural and built environmental features on pedestrian-vehicle crash severity in Ghana. The study is based on an extensive pedestrian-vehicle crash dataset extracted from the National Road Traffic Accident Database at the Building and Road Research Institute (BRRI) of the Council for Scientific and Industrial Research (CSIR), Ghana. Using a multinomial logit modelling framework, possible determinants of pedestrian-vehicle crash severity were identified. The study found that fatal crashes are likely to occur during unclear weather conditions, on weekends, at night time where there are no lights, on curved and inclined roads, on untarred roads, at mid-blocks and on wider roads. The developed model and its interpretations will make important contributions to road crash analysis and prevention in Ghana with the possibility of extension to other developing countries. These contributing factors could inform policy makers on road design and operational improvements. [ABSTRACT FROM AUTHOR]