The prevalence and determinants of non-communicable diseases among Ghanaian adults: A survey at a secondary healthcare level

Hosea Boakye; Albert Atabila; Thomas Hinneh; Martin Ackah; Folasade Ojo-Benys; Ajediran I. Bello

doi:10.1371/journal.pone.0281310

Abstract

The current epidemiological transition of diseases in Ghana necessitates understanding their burden and the associated context-specific risk factors to inform disease prevention strategies. To determine the prevalence and determinants of selected Non-Communicable Diseases (NCDs) among patients seeking healthcare services in a secondary health facility in Ghana. A facility-based survey was conducted among adult patients 18 years and above between May and July 2021, using a multi-stage sampling approach. Data regarding the prevalence of NCDs, participants’ socio-demographics and lifestyle factors of NCDs were obtained using Modified STEPwise Approach to NCD Risk Factor Surveillance (STEPS). The Chi-square test and regression analysis were performed to identify the risk factors of NCDs at P < 0.05. The participants comprised 480 patients with a mean age of 37.7±16.5 years, and 57.7% (277/480) of them were females. The overall prevalence of the selected NCDs was 26.7% (CI = 0.23–0.31), of which hypertension (22.7%) was the most prevalent. More than half (54.2%) of the participants engaged in alcohol consumption and 54% were physically inactive. The odds of developing NCDs were higher in females (CI = 1.32–4.10, P = 0.004), older adults (CI = 4.11–20.68, P <0.001), overweight/obese adults (CI = 1.65–4.70, P < 0.001), family history (CI = 0.15–0.46, P<0.001), and alcohol consumption (CI = 0.12–0.40, P < 0.001). There was an overall high prevalence of NCDs, strongly influenced by the participants’ age, sex, BMI, alcohol consumption, and family history. These determinants should be highlighted as part of the campaign for preventive action plans.

Citation: Boakye H, Atabila A, Hinneh T, Ackah M, Ojo-Benys F, Bello AI (2023) The prevalence and determinants of non-communicable diseases among Ghanaian adults: A survey at a secondary healthcare level. PLoS ONE 18(2): e0281310. https://doi.org/10.1371/journal.pone.0281310

Editor: Innocent Ijezie Chukwuonye, Federal Medical Centre Umuahia, NIGERIA

Received: October 11, 2022; Accepted: January 20, 2023; Published: February 8, 2023

Copyright: © 2023 Boakye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interest exist.

Introduction

Non-communicable diseases (NCDs) have become diseases of public health concern, significantly affecting populations and health systems. Previously, NCDs were thought to be diseases of affluence, probably due to low levels of awareness and control rates among the less advantaged groups [1]. Today, NCDs account for about 71% of deaths globally every year, and has been reported to be higher than infectious diseases [2]. Of 41 million people who died from NCD-associated death, more than 15 million of them are between the ages of 30 and 69 years, thus constituting the productive population [3].

Countries in sub-Saharan Africa are at the centre of the raging consequences of NCDs [4, 5]. Nearly 77% of all NCD-related deaths occur in Low- and Middle-Income Countries (LMICs) [3]. More significantly, about 85% of all premature deaths caused by NCDs, also occur in LMICs [6]. In addition, there is a considerable increase in Disability-Adjusted Life-Years (DALYs) from 90.6 million DALYs in 1990 to 151.3 million DALYs in 2017 as a results of NCDs [7]. Undeniably, the Africa Region is undergoing an epidemiological transition regarding the burden of diseases. The fragile nature of the health systems in Africa coupled with the scarcity of capital and human resources for healthcare delivery system, are the potential factors undermining the implementation of sustainable health interventions.

Cardiovascular diseases and diabetes contribute to the largest national NCD burden in Ghana [8]. Indeed, about 65% of deaths in Ghana are associated with NCDs [9]. In the last decade, the population dynamics of Ghana has changed significantly owing to the gains in health systems strengthening interventions. The rising burden of NCDs in the country is associated with increasing population, improvement in life expectancy and the rising NCD risk factors [10]. Non-communicable diseases are related in a common pathway with notable risk factors such as unhealthy diets, physical inactivity, tobacco use, and harmful alcohol use. The World Health Organization Global Health Risk Estimation Report identified the following as the leading risk factors of global mortality: obesity (5%), physical inactivity (6%), raised blood glucose (6%), and tobacco use (9%) with hypertension alone, accounting for about 13% [11].

Evidence on NCDs prevalence and the associated risk factors informs primary health care strengthening and orientation towards prevention and treatment strategies. The secondary health care facilities are commonly patronized by individuals presented with various NCDs in Ghana. While the primary health care system is still undergoing transformation, it may be worthwhile to determine the risk factors influencing the NCDs prevalence at the secondary health care level. Studies on NCDs prevalence and their determinants tend to focus largely on cardiovascular diseases and diabetes [12–14], without corresponding attention to other forms of NCDs. Besides, there is a wide variation in methodologies and settings regarding the previous studies on risk factors and prevalence of NCDs in Ghana.

The present study adopted a holistic approach to examine the prevalence of selected NCDs (hypertension, diabetes, heart diseases, dyslipidemia, stroke, chronic obstructive pulmonary disease and cancer) and risk factors (physical inactivity, harmful use of alcohol, smoking and sedentary lifestyle) among adults attending a district hospital in Ghana.

Method

Study design/setting

We conducted a prospective, cross-sectional and institution-based survey among adults accessing healthcare services at Ledzokuku-Krowor Municipal Assembly (LEKMA) Hospital in the Greater Accra Region of Ghana. Adult patients were recruited from the hospital’s OPD during the time of data collection. The LEKMA Hospital is a 140-bed capacity facility and offers general and specialised services. It records an average adult outpatient attendance of about 8000 of all ages in a month. About 6000 of such attendants are adults aged 18 years and above. The study was conducted at the outpatient department (OPD) of the District Hospital from 8^th May to 31^st July 2021. The 2020 review of total attendants with NCDs indicated upward trend of the OPD reported cases, which favours the choice of the hospital for this study.

Participants’ recruitment and sampling strategies

The study included all persons from 18 to 64 years old who attend the OPD of LEKMA Hospital and gave their consent to freely participate. We excluded the following categories of persons from the study: Those who were wheelchair bound and could not participate in the recommended PA level, persons with cognitive or communication impairments, persons who were undergoing an exercise programme prescribed by a health professional for therapeutic benefits, as well as pregnant women.

A multi-staged sampling method was adopted to recruit the participants. Using a stratified sampling technique, the participants were divided into three strata using age intervals (i.e., 18–34, 35–49, and 50–64). We further utilized a quota sampling strategy based on the 2021 outpatient attendance data available in the District Health Information Management Systems (DHIMS) in the ratio of 4.5:3.5:2, respectively. In the final stage of the recruitment, a simple random sampling technique was adopted to select eligible participants through balloting using wrapped pieces of paper with the inscription YES or NO from a container. The wrapped pieces of paper were kept in an opaque box and made available on each day of data collection. The participants’ recruitment process is available on the flow chart in Fig 1.

Download:

Fig 1. Flow chart for the recruitment of participants.

https://doi.org/10.1371/journal.pone.0281310.g001

Sample size estimation

Using the Taro Yamane method (1976) n = N/(1 + N e^2) where N is the total population, given as the average outpatient attendance for April, May and June (N = 6253), and e is the precision level (level of significance (0.05)). The authors estimated the minimum sample size of n = 376.

Study measures

Outcome variable.

The main outcome variable was the prevalence of NCDs among the participants reporting to LEKMA hospital. They responded to the question: ’Have you been previously diagnosed with any of the following conditions (hypertension, diabetes, dyslipidemia, heart attacks, stroke, cancers and Chronic Obstructive Pulmonary Disease’)?. The binary responses were; Yes = 1 and No = 0.

Exposure variables.

The exposure variables were categorized as; socio-demographic (age, sex, marital status, education, number of children, occupation, tribe, residence, body mass index (BMI), and monthly income) and lifestyle factors such as alcohol consumption, smoking status, physical activity level, and sedentary behavior.

Data collection

Questionnaire.

The study adopted and modified the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) tool to explore variables relating to the risks of NCDs in Ghana [15] as well as the Global Physical Activity Questionnaire (GPAQ) to measure the physical activity level and sedentary behavior among the participants. The domains of the questionnaire were categorised into socio-demographic characteristics of participants, lifestyle factors, self-reported NCD status, and NCD risk factor assessment. The questionnaires have successfully been used in previous studies in Ghana with good internal and external validity [16, 17].

Procedure.

This study was approved by the Ghana Health Service Ethical Review Committee on Research involving Human Subjects (GHS-ECR 026/08/21). Permission was sought from the Management and Head of the OPD of the LEKMA Hospital. Written informed consent was obtained from study participants before enrolment. The participants were made aware of the voluntariness of the study and they were made aware that they could withdraw at any time without any consequences. Three Research Assistants collected the data after two days of training prior to the exercise. The method of data collection was researcher-administered to elicit the required information from the eligible participants. All the participants were contacted after going through hospital registry while waiting for their turn to see the doctor. After explaining the rationale of the study, those who agreed to take part in the study balloted by picking wrapped pieces of paper in an opaque container. Those who picked ‘YES’ were given the informed-consent form to sign or thumb-print. The research assistants then administered the questionnaire which lasted for about 10–15 minutes. Covid-19 protocols were adhered to by wearing facemasks and social distancing throughout the data collections.

Statistical analysis

All the data collected were entered directly into Microsoft Excel version 2016, cleaned, coded, and imported into Stata IC 16 for analysis. We descriptively presented the results using frequencies, percentages, mean and standard deviation (SD). Bivariate analysis was performed using Chi-square to test the association between NCDs, socio-demographic characteristics and risk factors. To compare the magnitude of the risk factors, the variables that were statistically significant in the above test were entered into the multivariable logistic regression to estimate the adjusted Odds Ratio (AOR). A significant level was set at P < 0.05 with corresponding 95% Confidence Interval (CI) for all the statistical tests.

Results and discussion

Demographics

Out of the 500 copies of the questionnaires administered, 480 copies were validly completed and were used for the final data analysis. Two hundred and three (42.3%) were males and 277 (57.7%) were females. Their ages ranged from 18 to 64 years with a mean age of 37.7±16.5 years. The highest proportion of the respondents (46.5%) were from the age group 18–34 years., and most of them were from the Ga-Adangbe (41.3%) and Akan (33.8%) tribes. Two hundred and twenty-nine (47.7%) were in marital union, and 94% of the respondents had formal or vocational education, with 30 (6%) having no formal education.

As regards the participants’ employment status, 406 (84.6%) were employed, while 74 (15.4%) were unemployed. The monthly income level of respondents was dichotomised into above and below 1000 Ghana Cedis. A greater number of the respondents fall below 1000 Ghana Cedis, (316; 65.8%) compared to 164 (34.2%) who earned above 1000 Ghana Cedis as shown in Table 1.

Download:

Table 1. Socio-demographic characteristics of participants (n = 480).

https://doi.org/10.1371/journal.pone.0281310.t001

Prevalence of NCD Risk factor.

Family history. The prevalence of NCD risk factors is presented in Table 2. Overall, more than half (58%) of the respondents exhibited a family history of one or more NCDs. Out of this, 142 (50.7%) reported one, 98(35%) reported two, 22(7.9%) reported three, 11 (3.9%) reported four and 7(2.5%) reported five risk factors.

Download:

Table 2. Prevalence of NCDs and risk factors among adult population in LEKMAH by sex (n = 480).

https://doi.org/10.1371/journal.pone.0281310.t002

Alcohol consumption. Two hundred and sixty (54.2%) have ever taken alcohol in their lifetime Table 2. Almost 53% of the participants who had taken alcohol before were females.

Smoking. The prevalence of smoking was 9.4%, of which males constitute 73% of those smoking Table 2. There was a statistically significant association between the history of smoking and sex. However, smoking had no significant association with suffering from an NCD Table 4.

Physical inactivity. Similarly, almost 54% of the respondents were also physically inactive. More than 80% of the respondent engaged in sedentary lifestyles for more than five hours. Males are likely to be more physically active and engaged in less sedentary behaviour compared to females, which was statistically significant Table 2. It was observed that sex has significant association with both physical activity and showing sedentary behaviour.

Obesity/Overweight. The overall prevalence of overweight/obesity was 36.7% of the study participants Table 2. The mean and standard deviation of the BMI of the participants was 24.02 ±4.26.

Prevalence of selected non-communicable diseases.

The overall prevalence of selected NCDs among the respondents was 26.7% (CI = 0.23–0.31). Out of the 128 (26.7%) who reported having been diagnosed with the selected NCDs, 99 (77.3%) reported one NCD, 25 (19.5%) reported two, while 2 (1.6%) each reported three and four NCDs. The prevalence of the selected NCDs are: hypertension, 109 (22.7% (CI = 0.19–0.27)); diabetes, 19 (4.0% (CI = 0.0.03–0.06)); dyslipidemia, 15(3.1% (CI = 0.02–0.06)); stroke 10 (2.1%); heart diseases, 7 (1.5%); COPDs, 2 (0.4%). No report of previously diagnosed cancer was found as shown in Table 3. But for COPD, There were statistically significant differences in the participants’ hypertension, diabetes, stroke and dyslipidemia status by age groups. The prevalence of hypertension, diabetes, and dyslipidemia increases with advanced age Table 3. Nearly two-thirds of the participants with history of hypertension and diabetes were females Table 2. There was an observed statistically significant difference between sex and having hypertension but not diabetes Table 2.

Download:

Table 3. Prevalence of selected NCDs.

https://doi.org/10.1371/journal.pone.0281310.t003

Determinants of NCD status.

All the significant variables from the Chi-square analysis (Table 4) were selected for multivariable logistic regression analysis to estimate the AOR. The results indicate that the odds of females getting NCDs is 2.32 times that of males (AOR = 2.32, CI = 1.32–4.1, P<0.004). People aged 35 to 49 years are 3.03 times more likely to suffer NCDs than those aged 18 to 34 years (AOR = 3.03, CI = 1.61–5.69, P<0.001) and those aged between 50–64 years are 9.22 times more likely to suffer from NCDs compared to those aged 18 to 34 years (AOR = 9.22, CI = 4.11–20.68, P<0.001). People without family history of NCDs were 30% less likely to suffer from NCDs than those with family history of the diseases (AOR = 0.30, CI = 0.15–0.46, P<0.001). Obese or overweight people are 2.78 times more likely of developing NCDs than those with healthy weight (AOR = 2.78, CI = 1.65–4.70, P<0.001). People who have never consumed alcohol in their life time are 22% less likely of developing NCDs than their counterparts who have ever consumed alcohol (AOR = 0.22, CI = 0.12–0.40, P<0.001) Table 5.

Download:

Table 4. Association of NCD risk factors by NCD status.

https://doi.org/10.1371/journal.pone.0281310.t004

Download:

Table 5. Multivariate logistic regression to determine predictors of NCD risk factors (n = 480).

https://doi.org/10.1371/journal.pone.0281310.t005

Discussion

The overall prevalence of NCDs in this study was 26.7%. In the last decade, the burden of NCDs in Ghanaian society has increased significantly. The brevity of the present study is owed to the number of diseases investigated and the highlights of the burden of NCDs in a typical Ghanaian health care facility. Hypertension prevalence alone accounts for 22.7%. This rate falls within the interval of hypertension prevalence rate reported by several cross-sectional studies and systematic reviews conducted in Africa and Ghana [18–20]. A systematic review and meta-analysis that included 13 articles in sub-Africa found the prevalence of hypertension between 15% and 70% [18]. Specifically in Ghana, a systematic review and meta-analysis found a pooled prevalence of 30.1% with a range of 4.5% to 54.3% among populations living in both urban and rural settings [19]. Similarly, our study found the prevalence of stroke to be 2.1%. A previous study that assessed the prevalence and correlates of stroke among older adult Ghanaians reported the prevalence of stroke to be 2.6% [20]. Given the similarity between the ages of our participants and previous studies, it is quite apparent that the rate of stroke among young adults in Ghana is rising steadily. Therefore, pragmatic measures to curtail the upsurge in the prevalence among adults, especially in the working population is urgently needed.

Prevalence of selected risk factors

Several studies have linked the development of NCDs to several factors. The factors include age, sex, income levels, educational status, alcohol use, smoking, air quality, access to quality healthcare, diet and physical activity [21–24]. Baird & Cooper [25], grouped these factors into genetic, environmental, behavioural, psychosocial, preconception and pregnancy.

The prevalence of lifetime alcohol consumption in this study was 54.2%. The prevalence of alcohol consumption seems to be generally high in Ghana. A study that assessed the prevalence and determinants of alcohol consumption among the youth in the Volta Region of Ghana reported a lifetime prevalence of 43.4% [26].

The high prevalence of alcohol consumption among Ghanaians can be ascribed to advertisement, peer influence and curiosity due to its supposed benefits such as sexual enhancement, appetiser, and relaxation [26]. In a contemporary Ghanaian society, males are believed to consume more alcohol than females, which could be attributed to societal norms where male drinking is considered normal and vice versa for the female counterpart [27, 28]. Moreover, some studies conducted in South Africa, India and Nepal corroborate this assertion [27]. Interestingly, unlike the findings in the above previous studies, 53% of people with a history of alcohol consumption were females in our study. With the rising spate of physical inactivity among women and postmenopausal hormonal changes, the risk of developing NCDs among women could increase. Putatively, the physiology of alcohol metabolism are different between men and women [28]. Women are known to have less total body water than their conuterparts who are men with the same body weight. Thus, consumption of the same amount of alcohol, would lead to higher blood alcohol concentration in women, thereby potentially putting women at high risk from alcohol-related NCDs [29]. In other words, women are easily intoxicated with small volumes of alcohol. Conversely, women eliminate alcohol faster than men which also confer an advantage of less risk of alcohol-related NCDs such as stroke, cirrhosis or some cancer among women. Thus, while there was high risk of harm from alcohol use, its remote effects regarding other NCDs were less likely to be observed among women as much as it would in men [30].

In the same vein, the prevalence of physical activity recorded in this study was 46.3%. There is a global decline in physical activity owing to urbanisation and technological advancements. Recently, this has been compounded by the COVID-19 pandemic, where measures to curtail its spread favours physical inactivity [31]. Previous studies by Oyeyemi et al., [32] and Afrifa-Anane et al., [33] recorded a higher prevalence of physical inactivity than the present study. The decline in physical activity in our study could be related to the impact of the COVID-19 pandemic, as reported in another similar study by Castañeda-Babarro et al., [31]. In our study, it is worth noting that sex plays a key role in physical activity participation with males being more physically active (57.2%) compared to (42.8%) females. This trend is consistent with the findings of the previous studies [32, 33].

In another dimension, the prevalence of overweight/obesity among the respondents was 36.7%. According to a WHO global report on obesity, the prevalence of overweight/obesity has doubled since 1980 [34]. It is estimated that 2.5 billion of the world’s adult population are overweight or obese [34]. A systematic review on obesity in Africa showed a higher prevalence of overweight/obesity among females than males [35]. Specifically in Ghana, Ofori-Asenso and colleagues in a systematic review and meta-analysis, demonstrated a rising prevalence of overweight/obesity among Ghanaians [36]. The prevalence rate of 43% reported among females in this previous study is lower than the 65.3% documented in our study.

Determinants of NCDs

This study reveals significant associations between NCDs and sex, age, BMI, marital status, educational status, occupation, alcohol, family history, sedentary behaviour and physical activity.

Regarding sex, males are generally more involved in unhealthy lifestyles such as smoking and drinking alcohol than their female counterparts, while more females are physically inactive than males [37]. A comparative study conducted in China found women at a higher risk of developing hypertension, diabetes and heart diseases than their male counterparts. Conversely, men were at higher risk of developing stroke and chronic heart diseases than women [37]. The observation in this study agrees with that of Opoku et al., [38], whose findings also showed the life risk of hypertension for men at early stages as opposed to women due to the physiological protection women experience during the pre-menopausal stages. In this study, women have 2.5 times the risk of developing an NCD compared to men.

As reported by other studies, age emerged as a significant determinant of NCDs studied. The risk of developing an NCD increases steadily as one ages which is consistent with what other studies have reported recently in Ghana [39, 40]. Moreover, being overweight/obese increases the chances of developing NCDs by 2.78. Ofori-Asenso et al., [35], also found a strong tie between overweight/obesity and diabetes. Overweight/obesity is likely to rise in Ghana in the next decade due to the rising spate of urbanisation and the digital world where engagement in physical activities is drastically reducing. Furthermore, not having a family history of NCDs reduced the risk of developing an NCD to almost 27%. Similarly, the odds of developing NCDs in adults who have never consumed alcohol before is 0.22 times that of adults who have ever consumed alcohol. These findings align with the previous studies on this subject [10, 25]. According to the WHO reports on NCDs, effective control of NCDs demands focus on modifying the risk factors associated with the diseases. Moderate solutions are available for all stakeholders including the Governments, to reduce the common modifiable risk factors. Adequate monitoring of progress and trends of NCDs and their risk is important for formulating policy and priorities. To ameliorate the burden of NCDs on individuals and society, a holistic approach is demanded of all sectors. Thus, the interplay of various indicators such as health, finance, transport, education, agriculture, planning, and other factors are important to reduce the risks associated with NCDs, and to promote interventions to prevent and control them.

Strengths and limitations

This study has significant strengths which are worth mentioning. It is one of the few studies to examine the burden of key NCDs at secondary healthcare levels in Ghana. This is important to inform the arrangement of health services for this special group of patients, given the rising burden of NCDs and associated complications. Again, the participants included in this study were from the various cultural, socioeconomic, urban and rural divides. This has positive implications for the diversity of the data collected and the generalizability of study findings.

Nonetheless, the study has limitations. We relied on previously diagnosed self-reported NCDs which might introduce a recall bias.

Conclusion

Our study provided evidence of high prevalence of NCDs and their determinants among participants who access healthcare at LEKMA hospital at the time of this survey. Age, sex, BMI, alcohol consumption and family history, which are key determinants of the selected NCDs, heighten the need to strengthen health systems and health promotion activities to improve surveillance, treatment and control activities. This is particularly essential for primary healthcare facilities, which are generally accessible to many Ghanaian populations. Moreover, given the rising risk factors for NCDs, further research is required to investigate how to improve behavioural adherence to lessen the burden of NCDs in Ghana.

Supporting information

S1 Data.

https://doi.org/10.1371/journal.pone.0281310.s001

(XLSX)

Acknowledgments

We acknowledge the support of the management of LEKMA Hospital and the staff of the physiotherapy and public health department of LEKMA Hospital.

References

1. Lloyd-Sherlock P, Minicuci N, Corso B, Beard J, Chatterji S, Ebrahim S. Diseases of the Rich? the Social Patterning of Hypertension in Six Low- and Middle-Income Countries. Eur J Dev Res. 2017 Aug;29(4):827–42.
- View Article
- Google Scholar
2. World Health Organization. Global status report on noncommunicable diseases. Geneva: World Health Organization; 2010. 176 p.
3. World Health Organization. Noncommunicable diseases; factsheet. 2021.
- View Article
- Google Scholar
4. Coleman R, Gill G, Wilkinson D. Noncommunicable disease management in resource-poor settings: A primary care model from rural South Africa. Bull World Health Organ. 1998;76(6):633–40. pmid:10191559
- View Article
- PubMed/NCBI
- Google Scholar
5. World Health Organisation. Global NCD Action Plan 2013–2020. WHO. 2015.
6. Bigna JJ, Noubiap JJ. The rising burden of non-communicable diseases in sub-Saharan Africa. Lancet Glob Heal. 2019 Oct;7(10):e1295–6. pmid:31537347
- View Article
- PubMed/NCBI
- Google Scholar
7. Gouda HN, Charlson F, Sorsdahl K, Ahmadzada S, Ferrari AJ, Erskine H, et al. Burden of non-communicable diseases in sub-Saharan Africa, 1990–2017: results from the Global Burden of Disease Study 2017. Lancet Glob Heal [Internet]. 2019;7(10):e1375–87. Available from: pmid:31537368
- View Article
- PubMed/NCBI
- Google Scholar
8. Ofori-Asenso R, Garcia D. Cardiovascular diseases in Ghana within the context of globalization. Cardiovasc Diagn Ther. 2016;6(1):67. pmid:26885494
- View Article
- PubMed/NCBI
- Google Scholar
9. Ministry Of Health. REPUBLIC OF GHANA National Policy for the Prevention and Control of Chronic Non-Communicable Diseases in Ghana. 2012.
- View Article
- Google Scholar
10. Aikins A, Kushitor M, Koram K, Gyamfi S, Ogedegbe G. Chronic non-communicable diseases and the challenge of universal health coverage: insights from community-based cardiovascular disease research in urban poor communities in Accra, Ghana. BMC Public Health. 2014;14(Suppl 2):1–9.
- View Article
- Google Scholar
11. World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks. Institutional Repository for infromation sharing. 2009.
- View Article
- Google Scholar
12. Tenkorang EY, Kuuire V, Luginaah I, Banchani E. Examining risk factors for hypertension in ghana: Evidence from the study on global ageing and adult health. Glob Health Promot. 2017 Mar;24(1):14–26. pmid:26205104
- View Article
- PubMed/NCBI
- Google Scholar
13. Laar AK, Adler AJ, Kotoh AM, Legido-Quigley H, Lange IL, Perel P, et al. Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders. BMC Heal Serv Res 2019 191. 2019 Oct;19(1):1–13. pmid:31615529
- View Article
- PubMed/NCBI
- Google Scholar
14. Nelson F, Nyarko KM, Binka FN. Prevalence of Risk Factors for Non-Communicable Diseases for New Patients Reporting to Korle-Bu Teaching Hospital. Ghana Med J. 2015 Mar;49(1):12–8. pmid:26339079
- View Article
- PubMed/NCBI
- Google Scholar
15. Riley L, Guthold R, Cowan M, Savin S, Bhatti L, Armstrong T, et al. The world health organization STEPwise approach to noncommunicable disease risk-factor surveillance: Methods, challenges, and opportunities. Am J Public Health. 2016;106(1):74–8. pmid:26696288
- View Article
- PubMed/NCBI
- Google Scholar
16. Osei E, Amu H, Appiah-Kubi P, Konlan KD, Mumuni H, Orish VN, et al. Prevalence and predictors of selected risk factors of non-communicable diseases in Ghana: evidence from a sub-national survey. J Glob Heal Sci. 2021;3(2):1–14.
- View Article
- Google Scholar
17. Tatah L, Pearce M, Goel R, Brage S, Woodcock J, Dake FAA. Physical Activity Behaviour and Comparison of GPAQ and Travel Diary Transport-Related Physical Activity in Accra, Ghana. Int J Environ Res Public Health. 2022;19(12):7346. pmid:35742612
- View Article
- PubMed/NCBI
- Google Scholar
18. Ataklte F, Erqou S, Kaptoge S, Taye B, Echouffo-Tcheugui JB, Kengne AP. Burden of undiagnosed hypertension in sub-saharan africa: A systematic review and meta-analysis. Hypertension. 2015;65(2):291–8. pmid:25385758
- View Article
- PubMed/NCBI
- Google Scholar
19. Atibila F, Hoor G ten, Donkoh ET, Wahab AI, Kok G. Prevalence of hypertension in Ghanaian society: a systematic review, meta-analysis, and GRADE assessment. Syst Rev [Internet]. 2021;10(1):1–15. Available from: pmid:34364395
- View Article
- PubMed/NCBI
- Google Scholar
20. Sanuade OA, Dodoo FNA, Koram K, De-Graft Aikins A. Prevalence and correlates of stroke among older adults in Ghana: Evidence from the Study on Global AGEing and adult health (SAGE). PLoS One. 2019;14(3):1–17.
- View Article
- Google Scholar
21. Bosu W. ACCELERATING THE CONTROL AND PREVENTION OF NON-COMMUNICABLE DISEASES IN GHANA: THE KEY ISSUES * NCDs are now a developmental issue The burden of NCDs in Ghana is higher than is often appreciated. 2013;2(1):32–40.
- View Article
- Google Scholar
22. Dalal S, Beunza JJ, Volmink J, Adebamowo C, Bajunirwe F, Njelekela M, et al. Non-communicable diseases in sub-Saharan Africa: What we know now. Int J Epidemiol. 2011;40(4):885–901. pmid:21527446
- View Article
- PubMed/NCBI
- Google Scholar
23. Williams J, Allen L, Wickramasinghe K, Mikkelsen B, Roberts N, Townsend N. A systematic review of associations between non-communicable diseases and socioeconomic status within low- and lower-middle-income countries. J Glob Health. 2018;8(2). pmid:30140435
- View Article
- PubMed/NCBI
- Google Scholar
24. Tenkorang EY, Kuuire VZ. Noncommunicable Diseases in Ghana: Does the Theory of Social Gradient in Health Hold? Heal Educ Behav. 2015;43:25S–36S.
- View Article
- Google Scholar
25. Baird J, Cooper C. Noncommunicable (Ncds) Diseases and Sexual and Reproductive Health (Srh): Linkages and Opportunities Through a Life-Course Approach. 2015;(5):16–9. Available from: %0ANONCOMMUNICABLE(NCDS)DISEASESANDSEXUAL…www.euro.who.int›__data›assets›pdf_file%0A
- View Article
- Google Scholar
26. Osei-Bonsu E. Prevalence of Alcohol Consumption and Factors Influencing Alcohol Use Among the Youth in Tokorni-Hohoe, Volta Region of Ghana. Sci J Public Heal. 2017;5(3):205.
- View Article
- Google Scholar
27. Dahal S, Sah RB, Niraula SR, Karkee R, Chakravartty A. Prevalence and determinants of noncommunicable disease risk factors among adult population of Kathmandu. PLoS One [Internet]. 2021;16(9 September):1–16. Available from: pmid:34495984
- View Article
- PubMed/NCBI
- Google Scholar
28. SAMHSA. Substance Abuse Treatment: Addressing the Specific Needs of Women: TIP 51. Treat Cent Subst Abus [Internet]. 2009; Available from: http://store.samhsa.gov.
- View Article
- Google Scholar
29. Erol A, Karpyak VM. Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations. Drug Alcohol Depend [Internet]. 2015;156:1–13. Available from: pmid:26371405
- View Article
- PubMed/NCBI
- Google Scholar
30. Jakkaew N, Pinyopornpanish K, Jiraporncharoen W, Wisetborisut A, Jiraniramai S, Hashmi A, et al. Risk of harm from alcohol use and heavy alcohol consumption: Its association with other NCD risk factors in Thailand. Sci Rep [Internet]. 2019;9(1):1–8. Available from: http://dx.doi.org/10.1038/s41598-019-52754-w
- View Article
- Google Scholar
31. Castañeda-Babarro A, Coca A, Arbillaga-Etxarri A, Gutiérrez-Santamaría B. Physical activity change during COVID-19 confinement. Int J Environ Res Public Health. 2020;17(18):1–10. pmid:32967091
- View Article
- PubMed/NCBI
- Google Scholar
32. Oyeyemi AL, Oyeyemi AY, Jidda ZA, Babagana F. Prevalence of physical activity among adults in a metropolitan nigerian city: A cross-sectional study. J Epidemiol. 2013;23(3):169–77. pmid:23604060
- View Article
- PubMed/NCBI
- Google Scholar
33. Afrifa-Anane E, De-Graft Aikins AMA, Meeks KAC, Beune E, Addo J, Smeeth L, et al. Physical Inactivity among Ghanaians in Ghana and Ghanaian Migrants in Europe. Med Sci Sports Exerc. 2020;52(10):2152–61. pmid:32301855
- View Article
- PubMed/NCBI
- Google Scholar
34. WHO. No Title. 2022; Available from: https://www.afro.who.int/health-topics/obesity
35. Adeboye B, Bermano G, Rolland C. Obesity and its health impact in Africa: A systematic review. Cardiovasc J Afr. 2012;23(9):512–21. pmid:23108519
- View Article
- PubMed/NCBI
- Google Scholar
36. Ofori-Asenso R, Agyeman AA, Laar A, Boateng D. Overweight and obesity epidemic in Ghana—A systematic review and meta-analysis. BMC Public Health [Internet]. 2016;16(1). Available from: pmid:27938360
- View Article
- PubMed/NCBI
- Google Scholar
37. Liu Y, Liu G, Wu H, Jian W, Wild SH, Gasevic D. Sex differences in non-communicable disease prevalence in China: A cross-sectional analysis of the China Health and Retirement Longitudinal Study in 2011. BMJ Open. 2017;7(12):1–7.
- View Article
- Google Scholar
38. Opoku S, Addo-Yobo E, Trofimovitch D, Opoku RB, Lasong J, Gan Y, et al. Increased prevalence of hypertension in Ghana: New 2017 American College of Cardiology/American Hypertension Association hypertension guidelines application. J Glob Health. 2020;10(2).
- View Article
- Google Scholar
39. Syed MA, Alnuaimi AS, Zainel AJ, Qotba HA. Prevalence of non-communicable diseases by age, gender and nationality in publicly funded primary care settings in Qatar. BMJ Nutr Prev Heal. 2019;2(1):20–9. pmid:33235953
- View Article
- PubMed/NCBI
- Google Scholar
40. Gyasi RM, Phillips DR, Meeks S. Aging and the Rising Burden of Noncommunicable Diseases in Sub-Saharan Africa and other Low- A nd Middle-Income Countries: A Call for Holistic Action. Gerontologist. 2020;60(5):806–11. pmid:31322656
- View Article
- PubMed/NCBI
- Google Scholar

[ref1] 1. Lloyd-Sherlock P, Minicuci N, Corso B, Beard J, Chatterji S, Ebrahim S. Diseases of the Rich? the Social Patterning of Hypertension in Six Low- and Middle-Income Countries. Eur J Dev Res. 2017 Aug;29(4):827–42.
View Article
Google Scholar

[2] View Article

[3] Google Scholar

[ref2] 2. World Health Organization. Global status report on noncommunicable diseases. Geneva: World Health Organization; 2010. 176 p.

[ref3] 3. World Health Organization. Noncommunicable diseases; factsheet. 2021.
View Article
Google Scholar

[6] View Article

[7] Google Scholar

[ref4] 4. Coleman R, Gill G, Wilkinson D. Noncommunicable disease management in resource-poor settings: A primary care model from rural South Africa. Bull World Health Organ. 1998;76(6):633–40. pmid:10191559
View Article
PubMed/NCBI
Google Scholar

[9] View Article

[10] PubMed/NCBI

[11] Google Scholar

[ref5] 5. World Health Organisation. Global NCD Action Plan 2013–2020. WHO. 2015.

[ref6] 6. Bigna JJ, Noubiap JJ. The rising burden of non-communicable diseases in sub-Saharan Africa. Lancet Glob Heal. 2019 Oct;7(10):e1295–6. pmid:31537347
View Article
PubMed/NCBI
Google Scholar

[14] View Article

[15] PubMed/NCBI

[16] Google Scholar

[ref7] 7. Gouda HN, Charlson F, Sorsdahl K, Ahmadzada S, Ferrari AJ, Erskine H, et al. Burden of non-communicable diseases in sub-Saharan Africa, 1990–2017: results from the Global Burden of Disease Study 2017. Lancet Glob Heal [Internet]. 2019;7(10):e1375–87. Available from: pmid:31537368
View Article
PubMed/NCBI
Google Scholar

[18] View Article

[19] PubMed/NCBI

[20] Google Scholar

[ref8] 8. Ofori-Asenso R, Garcia D. Cardiovascular diseases in Ghana within the context of globalization. Cardiovasc Diagn Ther. 2016;6(1):67. pmid:26885494
View Article
PubMed/NCBI
Google Scholar

[22] View Article

[23] PubMed/NCBI

[24] Google Scholar

[ref9] 9. Ministry Of Health. REPUBLIC OF GHANA National Policy for the Prevention and Control of Chronic Non-Communicable Diseases in Ghana. 2012.
View Article
Google Scholar

[26] View Article

[27] Google Scholar

[ref10] 10. Aikins A, Kushitor M, Koram K, Gyamfi S, Ogedegbe G. Chronic non-communicable diseases and the challenge of universal health coverage: insights from community-based cardiovascular disease research in urban poor communities in Accra, Ghana. BMC Public Health. 2014;14(Suppl 2):1–9.
View Article
Google Scholar

[29] View Article

[30] Google Scholar

[ref11] 11. World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks. Institutional Repository for infromation sharing. 2009.
View Article
Google Scholar

[32] View Article

[33] Google Scholar

[ref12] 12. Tenkorang EY, Kuuire V, Luginaah I, Banchani E. Examining risk factors for hypertension in ghana: Evidence from the study on global ageing and adult health. Glob Health Promot. 2017 Mar;24(1):14–26. pmid:26205104
View Article
PubMed/NCBI
Google Scholar

[35] View Article

[36] PubMed/NCBI

[37] Google Scholar

[ref13] 13. Laar AK, Adler AJ, Kotoh AM, Legido-Quigley H, Lange IL, Perel P, et al. Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders. BMC Heal Serv Res 2019 191. 2019 Oct;19(1):1–13. pmid:31615529
View Article
PubMed/NCBI
Google Scholar

[39] View Article

[40] PubMed/NCBI

[41] Google Scholar

[ref14] 14. Nelson F, Nyarko KM, Binka FN. Prevalence of Risk Factors for Non-Communicable Diseases for New Patients Reporting to Korle-Bu Teaching Hospital. Ghana Med J. 2015 Mar;49(1):12–8. pmid:26339079
View Article
PubMed/NCBI
Google Scholar

[43] View Article

[44] PubMed/NCBI

[45] Google Scholar

[ref15] 15. Riley L, Guthold R, Cowan M, Savin S, Bhatti L, Armstrong T, et al. The world health organization STEPwise approach to noncommunicable disease risk-factor surveillance: Methods, challenges, and opportunities. Am J Public Health. 2016;106(1):74–8. pmid:26696288
View Article
PubMed/NCBI
Google Scholar

[47] View Article

[48] PubMed/NCBI

[49] Google Scholar

[ref16] 16. Osei E, Amu H, Appiah-Kubi P, Konlan KD, Mumuni H, Orish VN, et al. Prevalence and predictors of selected risk factors of non-communicable diseases in Ghana: evidence from a sub-national survey. J Glob Heal Sci. 2021;3(2):1–14.
View Article
Google Scholar

[51] View Article

[52] Google Scholar

[ref17] 17. Tatah L, Pearce M, Goel R, Brage S, Woodcock J, Dake FAA. Physical Activity Behaviour and Comparison of GPAQ and Travel Diary Transport-Related Physical Activity in Accra, Ghana. Int J Environ Res Public Health. 2022;19(12):7346. pmid:35742612
View Article
PubMed/NCBI
Google Scholar

[54] View Article

[55] PubMed/NCBI

[56] Google Scholar

[ref18] 18. Ataklte F, Erqou S, Kaptoge S, Taye B, Echouffo-Tcheugui JB, Kengne AP. Burden of undiagnosed hypertension in sub-saharan africa: A systematic review and meta-analysis. Hypertension. 2015;65(2):291–8. pmid:25385758
View Article
PubMed/NCBI
Google Scholar

[58] View Article

[59] PubMed/NCBI

[60] Google Scholar

[ref19] 19. Atibila F, Hoor G ten, Donkoh ET, Wahab AI, Kok G. Prevalence of hypertension in Ghanaian society: a systematic review, meta-analysis, and GRADE assessment. Syst Rev [Internet]. 2021;10(1):1–15. Available from: pmid:34364395
View Article
PubMed/NCBI
Google Scholar

[62] View Article

[63] PubMed/NCBI

[64] Google Scholar

[ref20] 20. Sanuade OA, Dodoo FNA, Koram K, De-Graft Aikins A. Prevalence and correlates of stroke among older adults in Ghana: Evidence from the Study on Global AGEing and adult health (SAGE). PLoS One. 2019;14(3):1–17.
View Article
Google Scholar

[66] View Article

[67] Google Scholar

[ref21] 21. Bosu W. ACCELERATING THE CONTROL AND PREVENTION OF NON-COMMUNICABLE DISEASES IN GHANA: THE KEY ISSUES * NCDs are now a developmental issue The burden of NCDs in Ghana is higher than is often appreciated. 2013;2(1):32–40.
View Article
Google Scholar

[69] View Article

[70] Google Scholar

[ref22] 22. Dalal S, Beunza JJ, Volmink J, Adebamowo C, Bajunirwe F, Njelekela M, et al. Non-communicable diseases in sub-Saharan Africa: What we know now. Int J Epidemiol. 2011;40(4):885–901. pmid:21527446
View Article
PubMed/NCBI
Google Scholar

[72] View Article

[73] PubMed/NCBI

[74] Google Scholar

[ref23] 23. Williams J, Allen L, Wickramasinghe K, Mikkelsen B, Roberts N, Townsend N. A systematic review of associations between non-communicable diseases and socioeconomic status within low- and lower-middle-income countries. J Glob Health. 2018;8(2). pmid:30140435
View Article
PubMed/NCBI
Google Scholar

[76] View Article

[77] PubMed/NCBI

[78] Google Scholar

[ref24] 24. Tenkorang EY, Kuuire VZ. Noncommunicable Diseases in Ghana: Does the Theory of Social Gradient in Health Hold? Heal Educ Behav. 2015;43:25S–36S.
View Article
Google Scholar

[80] View Article

[81] Google Scholar

[ref25] 25. Baird J, Cooper C. Noncommunicable (Ncds) Diseases and Sexual and Reproductive Health (Srh): Linkages and Opportunities Through a Life-Course Approach. 2015;(5):16–9. Available from: %0ANONCOMMUNICABLE(NCDS)DISEASESANDSEXUAL…www.euro.who.int›__data›assets›pdf_file%0A
View Article
Google Scholar

[83] View Article

[84] Google Scholar

[ref26] 26. Osei-Bonsu E. Prevalence of Alcohol Consumption and Factors Influencing Alcohol Use Among the Youth in Tokorni-Hohoe, Volta Region of Ghana. Sci J Public Heal. 2017;5(3):205.
View Article
Google Scholar

[86] View Article

[87] Google Scholar

[ref27] 27. Dahal S, Sah RB, Niraula SR, Karkee R, Chakravartty A. Prevalence and determinants of noncommunicable disease risk factors among adult population of Kathmandu. PLoS One [Internet]. 2021;16(9 September):1–16. Available from: pmid:34495984
View Article
PubMed/NCBI
Google Scholar

[89] View Article

[90] PubMed/NCBI

[91] Google Scholar

[ref28] 28. SAMHSA. Substance Abuse Treatment: Addressing the Specific Needs of Women: TIP 51. Treat Cent Subst Abus [Internet]. 2009; Available from: http://store.samhsa.gov.
View Article
Google Scholar

[93] View Article

[94] Google Scholar

[ref29] 29. Erol A, Karpyak VM. Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations. Drug Alcohol Depend [Internet]. 2015;156:1–13. Available from: pmid:26371405
View Article
PubMed/NCBI
Google Scholar

[96] View Article

[97] PubMed/NCBI

[98] Google Scholar

[ref30] 30. Jakkaew N, Pinyopornpanish K, Jiraporncharoen W, Wisetborisut A, Jiraniramai S, Hashmi A, et al. Risk of harm from alcohol use and heavy alcohol consumption: Its association with other NCD risk factors in Thailand. Sci Rep [Internet]. 2019;9(1):1–8. Available from: http://dx.doi.org/10.1038/s41598-019-52754-w
View Article
Google Scholar

[100] View Article

[101] Google Scholar

[ref31] 31. Castañeda-Babarro A, Coca A, Arbillaga-Etxarri A, Gutiérrez-Santamaría B. Physical activity change during COVID-19 confinement. Int J Environ Res Public Health. 2020;17(18):1–10. pmid:32967091
View Article
PubMed/NCBI
Google Scholar

[103] View Article

[104] PubMed/NCBI

[105] Google Scholar

[ref32] 32. Oyeyemi AL, Oyeyemi AY, Jidda ZA, Babagana F. Prevalence of physical activity among adults in a metropolitan nigerian city: A cross-sectional study. J Epidemiol. 2013;23(3):169–77. pmid:23604060
View Article
PubMed/NCBI
Google Scholar

[107] View Article

[108] PubMed/NCBI

[109] Google Scholar

[ref33] 33. Afrifa-Anane E, De-Graft Aikins AMA, Meeks KAC, Beune E, Addo J, Smeeth L, et al. Physical Inactivity among Ghanaians in Ghana and Ghanaian Migrants in Europe. Med Sci Sports Exerc. 2020;52(10):2152–61. pmid:32301855
View Article
PubMed/NCBI
Google Scholar

[111] View Article

[112] PubMed/NCBI

[113] Google Scholar

[ref34] 34. WHO. No Title. 2022; Available from: https://www.afro.who.int/health-topics/obesity

[ref35] 35. Adeboye B, Bermano G, Rolland C. Obesity and its health impact in Africa: A systematic review. Cardiovasc J Afr. 2012;23(9):512–21. pmid:23108519
View Article
PubMed/NCBI
Google Scholar

[116] View Article

[117] PubMed/NCBI

[118] Google Scholar

[ref36] 36. Ofori-Asenso R, Agyeman AA, Laar A, Boateng D. Overweight and obesity epidemic in Ghana—A systematic review and meta-analysis. BMC Public Health [Internet]. 2016;16(1). Available from: pmid:27938360
View Article
PubMed/NCBI
Google Scholar

[120] View Article

[121] PubMed/NCBI

[122] Google Scholar

[ref37] 37. Liu Y, Liu G, Wu H, Jian W, Wild SH, Gasevic D. Sex differences in non-communicable disease prevalence in China: A cross-sectional analysis of the China Health and Retirement Longitudinal Study in 2011. BMJ Open. 2017;7(12):1–7.
View Article
Google Scholar

[124] View Article

[125] Google Scholar

[ref38] 38. Opoku S, Addo-Yobo E, Trofimovitch D, Opoku RB, Lasong J, Gan Y, et al. Increased prevalence of hypertension in Ghana: New 2017 American College of Cardiology/American Hypertension Association hypertension guidelines application. J Glob Health. 2020;10(2).
View Article
Google Scholar

[127] View Article

[128] Google Scholar

[ref39] 39. Syed MA, Alnuaimi AS, Zainel AJ, Qotba HA. Prevalence of non-communicable diseases by age, gender and nationality in publicly funded primary care settings in Qatar. BMJ Nutr Prev Heal. 2019;2(1):20–9. pmid:33235953
View Article
PubMed/NCBI
Google Scholar

[130] View Article

[131] PubMed/NCBI

[132] Google Scholar

[ref40] 40. Gyasi RM, Phillips DR, Meeks S. Aging and the Rising Burden of Noncommunicable Diseases in Sub-Saharan Africa and other Low- A nd Middle-Income Countries: A Call for Holistic Action. Gerontologist. 2020;60(5):806–11. pmid:31322656
View Article
PubMed/NCBI
Google Scholar

[134] View Article

[135] PubMed/NCBI

[136] Google Scholar

Figures

Abstract

Introduction

Method

Study design/setting

Participants’ recruitment and sampling strategies

Sample size estimation

Study measures

Outcome variable.

Exposure variables.

Data collection

Questionnaire.

Procedure.

Statistical analysis

Results and discussion

Demographics

Prevalence of NCD Risk factor.

Prevalence of selected non-communicable diseases.

Determinants of NCD status.

Discussion

Prevalence of selected risk factors

Determinants of NCDs

Strengths and limitations

Conclusion

Supporting information

S1 Data.

Acknowledgments

References