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Although there is a strong relationship between housing and transportation (H+T) spending, traditional housing affordability estimates from sub-Saharan Africa exclude transportation costs. Also, the H+T literature has few case studies from small cities and developing countries. This dearth of research makes it difficult to understand the housing burden and provide workable solutions. This paper measures H+T affordability in Koforidua, Ghana, based on rental and transportation costs. A household survey comprising 600 renting households was conducted and analyzed using group comparisons and Ordinary Least Square regressions. The results showed that H+T consumes approximately 56% of household income. This is a huge household burden considering the high unemployment rates in developing countries. Household income and size are significantly associated with H+T spending. Interestingly, smaller households have a marginal propensity to spend on H+T than larger households due to dependency ratio and housing choices. We recommend transport and housing subsidies, and affordable housing to ameliorate the H+T burden. Other policy recommendations and actions have been discussed to guide policymakers. [ABSTRACT FROM AUTHOR]