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This paper examines (i) the state of environmental conditions in two low-income urban communities in Accra, Ghana, using a Participatory Rapid Assessment (PRA) method, and (ii) changes in the environmental conditions in the two low-income communities over the years using the PRA method. The PRA was augmented with qualitative interviews with selected heads of household and other stakeholders from the study communities. The results showed that environmental conditions in the two study communities were poor as indicated by the computed average scores for the environmental problem areas. However, conditions were poorer in Chorkor compared to La. The paper recommends that local governments units in Ghana must prioritise sustained, improved, and reliable funding for Water, Sanitation, and Hygiene (WASH) to ensure undisruptive implementation of environmental health programs and policies. This must be accompanied with improved community education and sensitization on proper sanitary practices, which have the potential to mitigate the effects of disease epidemics such as cholera in the two communities. The study also provides important perspectives on differentials in environmental conditions in low-income communities in urban Ghana. [ABSTRACT FROM AUTHOR]