Coastal zones, despite their contribution to global economies, continue to suffer the negative impacts of climate variability, which limit the livelihoods of people, particularly small-scale fishermen. This study examined climate variability, coastal livelihoods, and the influence of ocean change on the total annual fish catch in Ghana’s Coastal Savannah zone. The mixed-methods approach was used to analyze primary data (semi-structured questionnaires and interviews), secondary data (sea surface temperature (SST) and salinity (SSS), and fish catch), and statistical tests (chi-square, binary logistic regression, and multiple regression). Findings revealed a significant increase in climate variability awareness among fishermen, attributed to the influence of broadcast media. However, they lack sufficient information regarding the transformation of cities, the urbanization process, and its impact on the global climate. Increasing temperatures and sea level rise emerged as the most prevalent impacts of climate variability over the past two decades in the zone. Although the fishermen lack awareness regarding the changes in SSS and their effects on fish, the findings of the multiple regression analysis established that changes in SSS exert a more pronounced effect on the decreasing fishing catch in the zone compared to those in SST. Empirical fish catch records supported the fishermen’s claim of a substantial decrease in total fish catch in the zone over the past 20 years. Aside from climate variability impacts, the involvement of many people and light fishing emerged as additional factors contributing to the decreasing fish catch in the zone. High premix fuel prices or shortages and “saiko” activities were the main obstacles that hindered the fishermen’s activities. “Saiko” is an unlawful activity in which foreign industrial trawlers sell fish directly to Ghanaian canoes or small-scale fishermen at sea. The fishermen lack sufficient means of supporting their livelihoods, as there is a lack of viable alternative livelihood options. Additionally, the majority of the fishermen experience symptoms of fever and headaches. The binary logistic regression analysis showed that the fishermen’s income insufficiency could be substantially reduced if they were to have their own houses, canoes, or fish all year. This situation highlights the need for heightened support from policymakers for improved sustainable livelihood prospects as well as health and well-being.