The Prevalence and Correlates of Non-Communicable Diseases among Rural Ghanaians

Recent studies have suggested that both hypertension and hypertension-related factors (e.g. diabetes mellitus, dyslipidemia, hypercholesterolemia) are common in some regions of the African sub-Sahara. Until recently, hypertension and related diseases were considered rare and were not the main focus of medical intervention in this region. Recent studies among rural Ghanaians have shown widespread levels of hypertension, yet there have been no surveys on lipid disorders and diabetes mellitus among the same population. A previous study has suggested that among urban West Africans and African-Americans with the metabolic syndrome, fasting hyperglycemia has a low prevalence. The object of this study is to explore the prevalence of lipid disorders and rates of diabetes mellitus in this population.

THE PREVALENCE AND CORRELATES OF NON-COMMUNICABLE DISEASES AMONG RURAL GHANAIANS B Espiritu1, OA Owusu2, S Imanbekova1, E Cryer1, R Heyrend1 , S Connor1, B Pearson1, R Gilfillan1, C Jensen1, E Amuzu3, JM Boaheng2, R Buxton1, LS Benson1, D Ansong2,3, TT Dickerson1 1University of Utah School of Medicine, Salt Lake City, Utah, U.S.A. 2School of Medical Sciences-Kwame Nkrumah University of Science and Technology, Kumasi, Ghana 3Research and Development Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana Background • Recent studies have suggested that both hypertension and hypertension-related factors (e.g. diabetes mellitus, dyslipidemia, hypercholesterolemia) are common in some regions of the African sub-Sahara (1,2). • Until recently, hypertension and related diseases were considered rare and were not the main focus of medical intervention in this region (3). • Recent studies among rural Ghanaians have shown widespread levels of hypertension (4,5), yet there have been no surveys on lipid disorders and diabetes mellitus among the same population. • A previous study has suggested that among urban West Africans and African-Americans with the metabolic syndrome, fasting hyperglycemia has a low prevalence (6). • The object of this study is to explore the prevalence of lipid disorders and rates of diabetes mellitus in this population. Methods • This cross-sectional study focused on rural-living adults (≥18 years old) in the Barekese sub-district of the Ashanti Region of Ghana. • In the weeks and days prior to the day of the study, villages were notified of the upcoming study. • Eligible participants were each assigned a unique number, which was used to track their study values. • Anthropometric data (height, body weight, and waist circumference), total cholesterol levels, and HDL levels were measured. • Two resting blood pressure measurements were taken using calibrated aneroid sphygmomanometers while using American Heart Association guidelines. • Participants, with the help of research assistants and translators, completed a structured questionnaire in their native language. The questionnaire included data such as: • Alcohol Use • Tobacco Use • History of diabetes or hypercholesterolemia • Hypertensive status and cholesterol status were classified according to categories as defined by the American Heart Association and the National Institutes of Health, respectively. Discussion Results • HYPERTENSION • 39% were pre-hypertensive and 39% hypertensive. Male: 31% • Only 33% were overweight or obese. Female: 69% • This discrepancy, together with the low prevalence TOBACCO USE of alcohol and tobacco use, suggests that obesity, Average Age: 47 + Past, - Current: 5% alcohol, and tobacco are not the only causes of Age Range: 18-100 + Past, + Current: 2% Most Frequent Age: 20 No: 93% hypertension in this population. • LIPID DISORDERS • 55% had desirable levels of total cholesterol; only 15% had desirable levels of HDL cholesterol. • Both males and females had high total cholesterol and HDL cholesterol ratios. • This indicates a high risk of heart disease for both males and females. • HISTORY OF DIABETES MELLITUS • 5% reported a previous diagnosis of diabetes Figure 1 - Prevalence of the different stages Figure 2 - Prevalence of the different stages mellitus. of hypertension (in mmHg; values are of body mass index (in kg/m2) • Low surveillance by health care professionals in this systolic and diastolic respectively) rural population may mask the true prevalence of diabetes mellitus. Total participants: 460 ALCOHOL USE Yes: 18% No: 82% Conclusion Figure 3 - Prevalence of total cholesterol levels (mg/dL) Figure 4 - Prevalence of HDL cholesterol levels (mg/dL) Total Cholesterol : HDL Cholesterol Ratio Males: Mean: 5.3 Standard Error: 0.1 Females: Mean: 5.6 Standard Error: 0.3 Figure 5 - Prevalence of prior diabetes mellitus diagnosis (DM Dx) References 1. Asiki G, Murphy GAV, Baisley K, Nsubuga RN, Karabarinde A, et al. (2014) Prevalence of Dyslipidaemia and Associated Risk Factors in a Rural Population in South-Western Uganda: A Community Based Survey. PLoS ONE 10(5). 2. Oguoma VM, Nwose EU, Skinner TC, Digban KA, Onyia IC, et al. (2015) Prevalence of cardiovascular disease risk factors among a Nigerian adult population: relationship with income level and accessibility to CVD risks screening. MBC Public Health 15:397. 3. Peck RN, Green E, Mtabaji J, Majinge C, Smart LR, et al. (2013) Hypertension-Related Diseases as a Common Cause of Hospital Mortality in Tanzania: A 3-Year Prospective Study. J Hypertens 13(9): 1806-1811. 4. Williams EA, Keenan KE, Ansong D, Simpson LM, Boakye I, et al. (2013) The burden and correlates of hypertension in rural Ghana: A cross-sectional study. Diab & MetSyn: Clinic Res & Rev 7:123-128. 5. Williams EA, Ansong D, Alder S, Benson LS, Campbell SJ, et al. (2014) Silent Crisis: Epidemic Hypertension in Rural West Africa. J Hypertens 3:3. 6. Sumner AE, Zhou J, Doumatey A, Imoisili Oe, Amoah A, et al. (2010) Low HDL-cholesterol with normal triglyceride levels is the most common lipid pattern in West Africans and African Americans with Metabolic Syndrome: Implications for cardiovascular disease prevention. CVD Prevention and Control 5,75-80. • Hypertension is widespread among rural-living Ghanaian adults. • High total cholesterol : HDL cholesterol ratios in both males and females suggest increased risk of heart disease in both groups. • Nearly all participants reported no previous history of a diabetes mellitus diagnosis. Greater surveillance among this population may be needed. • The high prevalence of hypertension, low HDL-C levels, and high total cholesterol : HDL cholesterol ratios suggest the importance of detecting and educating this population of the dangers of cardiovascular disease. Acknowledgements • Barekuma Collaborative Community Development Project • Kwame Nkrumah University of Science and Technology • Komfo Anokye Teaching Hospital Contact Information [e-mail]