Pedestrian fatalities constitute 42% of road traffic fatalities in Ghana, and 68% of the total pedestrian fatalities are related to pedestrian crossing facilities and behaviour. This study examines the state of pedestrian crossing facilities (crosswalks) and behaviour on urban roads in Ghana, and its consequences on pedestrian safety, using New Juaben Municipality as a case study area. A 5-year road traffic collision data, information on the condition and utilisation of crosswalks and pedestrians’ perceptions of crosswalks located at different land uses were collected and analysed. Findings show that 98% of pedestrian collisions occurred in locations further away from crosswalks. In addition, accessibility of the crosswalks was a challenge to many urban residents, particularly the disabled, children and pregnant women. Pedestrian behaviour was found to be central to the numbers and extent of pedestrian collisions. Major factors associated with pedestrian behaviour include time of walking, fatigue, place of walking, inappropriate crossing points and the influence of alcohol and drugs. This study concludes that pedestrian safety appurtenances should be installed to encourage pedestrian and driver compliance, as well as public education campaigns to encourage behavioural change amongst pedestrians and drivers.