Diabetes in Ghana: a community based prevalence study in Greater Accra
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 In Ghana, information on the prevalence of diabetes is scanty and outdated.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
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