Objectives: Injuries and mortality resulting from pedestrian road traffic crashes are a major public health problem in Ghana. This study investigated risk factors for road transport-related injury among pedestrians in rural Ghana. Design: Case study design using qualitative data. Method: In-depth interviews were conducted with pedestrians. Thematic analysis was used to analyse the responses. Results: Findings showed that participants considered road design, roadside trading, inconsiderate driving, pedestrian traffic behaviour, low pedestrian crash risk perception and parental negligence as important determinants of road transport-related injury among pedestrians in rural Ghana. Conclusion: These findings suggest that safe pedestrian road environments and health-enhancing traffic attitudes and behaviour may help reduce the pedestrian crash problem in rural Ghana.