Descriptive epidemiology of obesity, diabetes, and hypertension in the Wa Municipal Area of Ghana

INTRODUCTION

Chronic, non-communicable diseases (NCDs) such as obesity, diabetes, and hypertension pose a significant global public health threat, with approximately three-quarters of all deaths outside of pandemics attributed to these diseases globally in 2021.^[1] Although NCDs were previously thought to predominantly affect individuals in high-income countries, the prevalence of these NCDs has unexpectedly risen in low- and middle-income countries (LMICs), including those in sub-Saharan Africa.^[2] In fact, it is now known that over 70% of fatalities from NCDs occur in LMICs. These countries are also disproportionately burdened by higher rates of NCD-related complications and poor overall quality of life due to lack of or inadequate opportunities for proper management of these conditions.^[1,2]

Ghana has experienced a notable epidemiological transition, with NCDs accounting for a growing share of morbidity and mortality.^[3,4] A recent systematic review and meta-analysis yielded a mean body mass index (BMI) of adults in Ghana of 24.7 kg/m², with overweight and obesity prevalence of 23.1% and 13.3%, respectively. The results further showed that women and urban dwellers had significantly higher rates of obesity and were more likely to be overweight compared to men and rural dwellers.^[5] Similar trends are observed for diabetes, with a national prevalence between 2.80% and 3.95%, revealing that women are again disproportionately affected compared to men.^[6] Hypertension, a major cardiovascular risk factor, continues to be prevalent, affecting an estimated 30% of adults in Ghana, with males and urban dwellers being relatively more affected than females and rural dwellers.^[7] The rising burden of diabetes, hypertension, and obesity globally has been attributed to the synergistic effects of multiple factors, including rapid urbanization, sedentary behavior, unhealthy dietary patterns, population aging, limited preventive health care, and widening social inequalities.^[1]

With over 200,000 residents, the Wa Municipal area serves as the regional capital of the Upper West Region of Ghana.^[8] However, the area has faced severe shortages of essential healthcare workers, including doctors and nurses, for many years.^[9] This chronic shortage of essential healthcare workers in the area has ultimately led to a complete lack of or limited access to critical specialist medical needs such as cardiology and nephrology services in the area. As urbanization accelerates and lifestyle patterns change, understanding the prevalence of NCDs in the local area is a crucial first step toward targeted public health initiatives, policy development, and intervention programs to mitigate the burden of NCDs in this area. Leveraging data from a community-based health screening program, this study sought to estimate the prevalence of obesity, diabetes, and hypertension among adults in the Wa Municipal area of Ghana and to evaluate gender-based differences in disease burden.

MATERIALS AND METHODS

RESULTS

A total of 459 residents participated in the screening exercise with a mean age of 52.3 years (standard deviation = 15.4). There were 166 males (35.3%) and 291 (61.9%) females. Most of the participants reported active coverage under the National Health Insurance Scheme (NHIS), accounting for 85.19% (n = 391) of the sample. Interestingly, most participants have never undergone a voluntary annual health exam. Table 1 provides a summary of the demographic health information and results of annual health screening exposure based on categorical data, whereas Table 2 summarizes the mean and associated standard deviations for age, BMI, blood pressure, blood glucose, and total cholesterol levels for the analytical sample based on continuous data.

The analysis of metabolic and cardiovascular risk factors highlights notable gender-based disparities, particularly in obesity, cholesterol levels, and hypertension or elevated blood pressure readings. Table 3 provides a comprehensive summary of the distribution of key cardio-metabolic risk factors among males and females.

DISCUSSION

This study highlights a significant burden of metabolic and cardiovascular risk factors within the screened population in the Wa Municipal area of the Upper West Region of Ghana, with notable gender disparities and a substantial gap between clinical measurements, formal diagnosis, and treatment rates. A comprehensive discussion of the specific findings of the study in the context of available national, regional, and global trends is provided below. The overall prevalence of obesity (BMI ≥30 kg/m²) among study participants was 22.0%, while 29.2% were classified as overweight (BMI 25.0–29.9), yielding a combined prevalence of 51.2%. Females exhibited a significantly higher burden of excess weight compared to males, with 30.58% categorized as obese and 29.9% as overweight, versus 7.19% and 27.5% among males, respectively, as shown in Table 2. This marked gender disparity underscores a disproportionate impact of obesity and overweight status among women. These findings are consistent with national data, where Ghanaian women demonstrate higher rates of obesity and overweight compared to men. The combined prevalence in this study also exceeds the national average of approximately 43% (25.4% overweight and 17.1% obese),^[10] indicating a concerning trend that warrants targeted public health interventions. Similar trends have been reported across West Africa, where female obesity rates among women are higher compared to men.^[11,12] The higher prevalence of obesity in women may be influenced by biological factors, socio-cultural norms, and disparities in physical activity levels, requiring gender-sensitive health policies and intervention programs.^[11,13] On the global scale, about a third of all people are estimated to be overweight or obese,^[14] with rates higher among women compared to men. This underscores the urgent need for targeted interventions to address obesity-related complications such as hypertension, diabetes, and dyslipidemia.^[15] A striking finding of this study is the high prevalence of elevated blood pressure based on clinical measurements versus the low rate of formal hypertension diagnosis and treatment. 34.85% of participants had systolic blood pressure (SBP) ≥140 mmHg, and 31.58% had diastolic blood pressure (DBP) ≥90 mmHg suggestive of stage 2 hypertension,^[16] yet only 18.52% reported a formal diagnosis of hypertension, and just 14.16% reported being on antihypertensive medication as depicted in Table 3. Based on the relatively higher number of participants with elevated blood pressures (SBP ≥140 mmHg and/or DBP ≥90 mmHg), it is conceivable that nearly half of hypertensive individuals remain undiagnosed based on the results. Even among those diagnosed, many reported not being on treatment. Future research is needed to investigate why such a gap exists.

Hypertension was also more prevalent among females, with 22.34% having a formal diagnosis compared to 11.98% of males. More females than males also met diagnostic criteria for stage 2 hypertension with SBP ≥140 mmHg at 36.08% compared to 32.93% of males and DBP ≥90 mmHg at 33.10% compared to 29.34% of males [Table 3]. However, more females (16.49%) were on antihypertensive medication than males (10.18%).

This gap between elevated blood pressure as measured during the screening program and diagnosis/treatment reflects findings from national surveys, where hypertension prevalence in Ghana was 13.0%, yet awareness, treatment, and control rates remain low, with women slightly more affected compared to men,^[17] similar to the findings of this study. The regional prevalence of hypertension across West Africa is estimated at 30–45%, with fewer than 25% of hypertensive individuals receiving treatment.^[18] Globally, more than 1.2 million adults have hypertension, with over 46% of adults with hypertension unaware of their condition, a situation that is worse in LMICs, which face the greatest challenges in detection and management.^[19] The study found an overall diabetes prevalence of 11.55% based on formal diagnosis, with comparable rates among females (11.68%) and males (10.78%). Interestingly, the proportion of individuals with hyperglycemia consistent with diabetes - defined as FBG ≥7 mmol/L or random blood glucose (RBG) ≥11.1 mmol/L^[20] was 10.68%. A higher percentage of males (8.38%) than females (7.22%) had elevated FBG levels, while the prevalence of elevated RBG was slightly higher in females (3.09%) than in males (2.99%). Despite these variations, the rate of formal diabetes diagnosis remained slightly higher among females (11.68%) compared to males (10.78%), while only 8.06% of all respondents reported being on diabetes medication [Table 3]. This diagnosis-treatment gap suggests that many individuals with diabetes potentially remain undiagnosed and untreated or are not currently on treatment despite a formal diagnosis of diabetes, significantly increasing their risk of complications from uncontrolled diabetes. Nationally, the prevalence of diabetes in Ghana is estimated at 6.46%,^[21] with a similar prevalence across neighboring regions of West Africa at 6.2%.^[22] At a global level, diabetes now affects more than 800 million adults, with more than half of the affected people unaware of their diagnosis and/or not on treatment, a situation worse in LMICs.^[23] The potentially undiagnosed and untreated burden of diabetes observed in this study is particularly alarming, as uncontrolled diabetes significantly increases the risk of cardiovascular disease, kidney failure, blindness, and amputations.^[24-27] In addition to diabetes, our study highlights a concerning prevalence of hyperglycemia concerning prediabetes, which is often underdiagnosed but represents a major risk factor for progression to full-blown diabetes. 14.16% of participants had FBG between 5.6 and 6.9 mmol/L, while 10.24% had RBG between 7.8 and 11.0 mmol/L, both suggestive of prediabetes^[20,26] [Table 3]. There were minimal gender differences for FBG, with hyperglycemia rates being nearly equal between males (14.37%) and females (14.10%). However, hyperglycemia in the prediabetes range for RBG was higher among males at 13.77% compared to 8.25% among females. Prediabetes prevalence in Ghana is rising steadily, mirroring trends across West Africa, where about 6.6% of adults exhibit impaired glucose tolerance (IGT) in urban areas compared to 35% in rural areas.^[22] Globally, two markers of prediabetes - IGT and impaired fasting glucose (IFG) were estimated at 9.1% and 5.8% in 2021, respectively, with about 50% of all cases of IGT and IFG progressing to full-blown diabetes within 5 years.^[26,27] Given that lifestyle modifications, such as diet and exercise, can prevent or delay the onset of diabetes, early identification and intensive lifestyle interventions are essential. The high prevalence of prediabetes in this study underscores the urgent need for targeted intervention prevention programs to mitigate the growing diabetes epidemic with support from local data and research such as this study. Similarly, a formal diagnosis of high cholesterol was more common in females (11.00%) than males (5.39%), and medication use for high cholesterol was also higher in females (7.90%) compared to males (2.99%).

Our results show that while a total of 41 participants, representing 8.93% of all participants, reported having a formal diagnosis of hypercholesterolemia, a combined 66 (47.75%) of 157 considered participants (who reported fasting at least 8 hours before tests) had total cholesterol levels of 5.2 (borderline high) or higher with 33 (21.02%) of these participants having fasting total cholesterol ≥6.21 mmol/L (suggestive of hypercholesterolemia),^[26,28,29] yet only 28 (6.10%) of total participants reported being on lipid-lowering medication. Women again reported a higher formal diagnosis of high cholesterol (11% compared to 5.39% of men) as well as recorded higher rates of elevated total cholesterol (19.75%, compared to 1.27% in males), as shown in Table 3. Medication use for the treatment of high cholesterol was again higher among women at 7.90% compared to 2.99% among males. The disparity between measured cholesterol levels and treatment suggests a substantial proportion of individuals with untreated dyslipidemia, which significantly increases the risk of atherosclerosis, heart disease, and stroke. In Ghana, 30–40% of adults exhibit cholesterol abnormalities, yet awareness and treatment remain critically low.^[3] Across West Africa, dietary shifts toward high-fat, processed foods are contributing to rising cholesterol levels, with a significant impact on cardiovascular morbidity and mortality.^[17] At a global level, elevated cholesterol is responsible for about a third of ischemic heart disease cases, emphasizing the need for routine lipid screening and cholesterol management strategies.^[29,30] The findings of this study provide baseline descriptive data and highlight major gaps in disease detection, diagnosis, and treatment concerning diabetes, hypertension, obesity, and hypercholesterolemia in the Wa Municipal area of Ghana. Undiagnosed and untreated diabetes, hypertension, and dyslipidemia pose serious threats to population health and are known to be associated with life-threatening complications and fatalities globally.^[1,24,31,32] The self-reported lack of routine medical check-ups, with as high as 68.41% of all participants suggesting they have never voluntarily undergone a medical exam, is particularly concerning in a region where access to life-saving treatments for complications including heart attacks, strokes, and end-stage renal disease are completely lacking or severely limited at best. We find it plausible that the relatively higher rates of formal diagnosis of hypertension and diabetes among women compared to men in this study may reflect increased opportunities for screening among women due to clinical visits for women’s health needs (such as pregnancy and childbirth) compared to men. Intervention programs targeted at improving screening for men may, therefore, be needed for the purposes of secondary prevention. Community-based health screenings, such as this program, offer desirable opportunities for secondary prevention of these chronic conditions while helping estimate the local burden of chronic diseases such as diabetes and hypertension as a baseline for developing further targeted intervention programs to mitigate them. Beyond creating awareness and educating the local population about the dangers of obesity, hypercholesterolemia, hypertension, and diabetes during the screening program, all participants identified to have abnormal indices related to obesity, hypercholesterolemia, hypertension, and diabetes received individual counseling for dietary improvements and physical activity as well as medication adherence from a dedicated team of volunteer doctors, nutritionists/dieticians and nurses, and were referred to the Municipal hospital for further evaluation and management. Efforts to reduce the burden of obesity, hypertension, diabetes, and dyslipidemia in the Wa Municipal area should prioritize expanding community-based screening initiatives and incorporating early detection activities into existing public health programs. We recommend targeted health promotion strategies to address the higher burden of these chronic, NCDs among women and encourage greater healthcare engagement among men. Strengthening access to lifestyle modification programs, improving NHIS coverage for chronic disease management, and investing in ongoing training for healthcare workers are also essential to mitigating the burden of these diseases in the underserved Wa area. Collaborating with local nonprofits and community-based organizations can enhance outreach, education, and patient support. In addition, further inferential and longitudinal studies are recommended to better understand the local drivers of disease and guide the development of effective, context-specific interventions. This study provides important epidemiological insights into obesity, diabetes, hypertension, and dyslipidemia in a historically understudied population in Ghana. The study broadened access by utilizing an open, community-based screening model and likely captured a diverse cross-section of the adult population. Using standardized clinical measures, validated equipment, and trained healthcare personnel ensured the reliability of the data collected and added to the study’s strengths. Ethical standards were upheld through IRB approval and the securing of informed consent from all participants. The gender-specific analysis further highlighted critical disparities that can inform the design of more targeted public health strategies. Notwithstanding the above strengths, the study’s cross-sectional design limits causal inference. Voluntary participation may have introduced selection bias, and the short screening window may have excluded some groups. Reliance on self-reported data may also have introduced potential recall and social desirability biases, while the variability in fasting status could affect glucose and cholesterol measurements. Finally, the absence of broader sociodemographic data limits the depth of risk factor analysis.

CONCLUSION

This study reveals a significant prevalence of obesity, hypertension, diabetes, and dyslipidemia in the Wa Municipal area, with many cases potentially going undiagnosed or untreated. Notably, there are gender differences, with females showing higher rates of obesity, hypertension, and dyslipidemia, highlighting the need for targeted interventions. The alarming prevalence of prediabetes points to an emerging rise in diabetes and cardiovascular disease if effective preventive measures are not prioritized. Expanding access to early detection services, community-based screening programs, and preventive health initiatives will be critical to reducing the burden of these chronic NCDs in settings such as the Wa Municipal area of Ghana, where specialist care remains scarce. Finally, while this study provides important descriptive data, additional inferential and longitudinal research is needed to better understand the local drivers of disease and support the development of tailored intervention strategies.