Diabetes in Ghana: a community based prevalence study in Greater Accra

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Abstract

Data on the prevalence of diabetes in Ghana is scanty and unreliable. In the present study we have ascertained the prevalence of diabetes, impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT) in a random cluster sample of Ghanaians aged 25 years and above from the Greater Accra area of Ghana. Diabetes, IFG and IGT were defined by criteria of the American Diabetes Association and World Health Organization. The mean age of the 4733 subjects involved in the study was 44.3±14.7 years, and participation rate was 75%. The crude prevalence of diabetes was 6.3%. Out of 300 subjects with diabetes, 209 (69.7%) had no prior history of the disease. Diabetes, IGT and combined IFG and IGT increased with age. The oldest age group (64+ years) had the highest diabetes prevalence (13.6%). The age-adjusted prevalence of diabetes, IFG and IGT, were 6.4, 6.0 and 10.7%, respectively. Diabetes was more common in males than females (7.7 vs. 5.5%) [P<0.05]. Worsening glycaemic status tended to be associated with increase in age, body mass index, systolic and diastolic blood pressures. Ascertainment of predictors for diabetes in Ghanaians and the significance of the relatively high rates of and IFG and IGT however, remain to be determined.

Introduction

The prevalence of diabetes in sub-Saharan Africa had been estimated between 0.0 and 1.9% [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]. Recent studies from urban Cameroon, Nigeria and Tanzania suggest that the disease may now be more common in sub-Saharan Africa than previously thought [12], [13], [14]. In Ghana, information on the prevalence of diabetes is scanty and outdated. In 1958, using urinalysis for diabetes screening, Dodu [1] found a diabetes prevalence of 0.4% among 4000 urban outpatient population in Accra. In a community sample of 5000 subjects from a provincial capital in Ghana, Dodu and de Heer [15] reported a diabetes prevalence of 0.2%. Based on these figures, the impression was created among policy makers that diabetes is rare in Ghanaians.

The diagnostic criteria for diabetes have recently been revised by an Expert Committee of the American Diabetes Association (ADA) [16] and by a World Health Organization (WHO) consultation [17]. The threshold of fasting plasma glucose for diabetes has been lowered to 7.0 mmol/l and an additional category, impaired fasting glycaemia (IFG) has been proposed as a new group with increased risk of developing diabetes [16], [17]. Additionally, the WHO retained the 2-h glucose criteria for diagnosis of diabetes [17]. The new diagnostic criteria have recently been employed to review previously published studies in Africans [18].

Ghana is a tropical country in West Africa with a surface area of 238,533 km2. The population in 2000 was 19.7 million with a gross domestic product (GDP) of US$ 7.4 bn and per capita GDP of US$ 412. The Accra metropolitan area is the largest urban population (1.6 million) [19]. In 1998, a non-communicable diseases survey (NCDS 98) was initiated to determine the prevalence of diabetes, hypertension, obesity, ischaemic heart disease and cardiovascular risk factors in selected communities in this area. In this communication, we report the prevalence of diabetes, IFG and IGT in the Greater Accra area, using the new diagnostic criteria [16], [17].

Section snippets

Target population and sampling

For ease of survey, two urban communities in the Accra metropolis (Labadi/Cantoments and Teshie), together with one area of rural Accra (Danfa/Abokobi, 20 villages) were selected as representative. A stratified two-stage cluster sampling technique was used.

A sample size of 752 was determined based on an estimate of diabetes prevalence of 2%, an absolute precision of 1% and a confidence interval of 95%, in accordance with the Statcalc function of Epi Info, Version 6 (Center for Diseases Control,

Results

Out of a total of 6300 subjects selected, 4733 subjects participated in the study, giving a response rate of 75%. The response rates in the first, second and third communities were 70, 77 and 77%, respectively. Table 1 shows the mean±SD of selected variables for males and females and for the total study population. The mean age of subjects was 44.3±14.7 years. Males were older and had lower BMI than females. The crude prevalence of diabetes in all subjects was 6.3%. The corresponding prevalence

Discussion

The health care policy in Ghana places little emphasis on diabetes control and prevention, due to the belief that the disease is rare among Ghanaians [1], [24]. We provide for the first time, diabetes prevalence data in adult Ghanaians, using current recommended diagnostic criteria [16], [17]. Adjusting the crude prevalence rate to the adult Ghanaian population or to the ‘new’ world standard population [23] did not result in great differences in the rates of diabetes. Adjustment to the new

Acknowledgments

We wish to thank Twumasi-Ankrah, Tweneboa-Kodua (Ghana Statistical Service, Accra), Thomas Ndanu, Nana Esi Nkumah Amoah (Field Coordinators, Ghana Non-communicable Diseases Survey, NCDS 98), Mercy Abbey (Health Research Unit, Ministry of Health, Accra) and our survey personnel for their assistance. We are also thankful to Charles Oppong and Henry Edu (Diabetes Research Laboratory, Department of Medicine, University of Ghana Medical School) for their assistance with laboratory analyses. We are

References (30)

  • J.C. Davidson et al.

    The prevalence of diabetes in the Kalene Hill area of Zambia

    Med. Proc.

    (1969)
  • B. Ahren et al.

    Prevalence of diabetes mellitus in North-Western Tanzania

    Diabetologia

    (1984)
  • A. Fisch et al.

    Prevalence and risk factors for diabetes mellitus in the rural region of Mali (West Africa): a practical approach

    Diabetologia

    (1987)
  • J.-C.N. Mbanya et al.

    Standardized comparison of glucose intolerance in West Africa—origin populations of rural and urban Cameroon, Jamaica, and Caribbean Migrants to Britain

    Diabetes Care

    (1999)
  • R.S. Cooper et al.

    Prevalence of NIDDM among populations of the African diaspora

    Diabetes Care

    (1997)
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