Social networks, perceived social support, and HbA1c in individuals with type 2 diabetes mellitus in urban Ghana.

OBJECTIVES: Although links between social relationships and health are well established, few studies have concurrently examined the effects of compositional, structural, and functional dimensions of social networks on glycemic (HbA1c) control in low- and middle-income countries such as Ghana. In these settings where informal social relationships are critical for access to resources, evaluating the links between social network characteristics, social support, and glycemic control may provide clarity about important relationships that facilitate the well-being of individuals with type 2 diabetes mellitus (T2DM). DESIGN: In 2018, we conducted a hospital-based, cross-sectional survey of noninstitutionalized adults with T2DM in Ghana. Using data from 247 study participants, multivariable linear regression models were used to estimate associations between: 1) HbA1c and three social network characteristics (kin composition, household composition, and network density); 2) social support and the three social network characteristics; and 3) HbA1c and social support. We also examined gender differences in these associations and applied mediation techniques to determine if network characteristics operated through social support to affect HbA1c. RESULTS: Findings indicated that higher kin composition and higher household composition were each significantly associated with increased social support. Neither social support nor social network characteristics were significantly related to HbA1c, and there were no gender differences in any of these associations. CONCLUSION: Although family and household members were identified as important sources of social support for diabetes management, the ways in which they influence HbA1c control among Ghanaians require further investigation. Future studies can examine whether changes in social support over time, social support satisfaction, or other dimensions of social relationships improve T2DM outcomes in countries like Ghana.

Incidence and determinants of diabetes-related lower limb amputations in Ghana, 2010-2015- a retrospective cohort study.

BACKGROUND: Diabetes-related lower limb amputations (LLA) are associated with significant morbidity and mortality. Although the incidence has decreased over the past two decades in most High-Income Countries, the situation in Low-Middle Income Countries (LMIC), especially those in sub-Saharan Africa (SSA) is not clear. We have determined the incidence and determinants of diabetes-related LLA in Ghana. METHODS: This was a tertiary-care-based retrospective cohort study involving patients enrolled in the diabetes clinic of Komfo Anokye Teaching Hospital, Ghana from 1st January 2010 to 31st December 2015 after a median follow-up of 4.2 years. Demographic characteristics and clinical variables at baseline were recorded. The primary outcome was new diabetes-related LLA in each year under study. Cox proportional hazard regression models were used to describe the associations of diabetes-related LLA. RESULTS: The mean age at enrolment for the cohort was 55.9 ± 14.6 years, with a female preponderance (62.1%). The average incidence rate of diabetes-related LLA was 2.4 (95% CI:1.84-5.61) per 1000 follow-up years: increasing from 0.6% (95% CI:0.21-2.21) per 1000 follow up years in 2010 to 10.9% (95% CI:6.22-12.44) per 1000 follow-up years in 2015. Diabetes-related LLA was associated with increased age at enrollment (for every 10 year increase in age: HR: 1.11, CI: 1.06-1.22, p < 0.001), male gender (HR: 3.50, CI:2.88-5.23, p < 0.01), type 2 diabetes (HR 3.21, CI: 2.58-10.6, p < 0.001), high Body Mass Index (HR: 3.2, CI: 2.51-7.25 p < 0.001), poor glycemic control (for a percent increase in HbA1c, HR:1.11, CI:1.05-1.25, p = 0.03), hypertension (HR:1.14, CI:1.12-3.21 p < 0.001), peripheral sensory neuropathy (HR:6.56 CI:6.21-8.52 p < 0.001) and peripheral vascular disease (HR: 7.73 CI: 4.39-9.53, p < 0.001). CONCLUSION: The study confirms a high incidence of diabetes related-LLA in Ghana. Interventions aimed at addressing systemic and patient-level barriers to good vascular risk factor control and proper foot care for diabetics should be introduced in LMICs to stem the tide of the increasing incidence of LLA.

Frequency and determinants of thyroid autoimmunity in Ghanaian type 2 diabetes patients: a case-control study.

BACKGROUND: The link between type 1 diabetes and thyroid autoimmunity is well described. The same cannot be said for type 2 diabetes where results have been mixed so far. We investigated the prevalence and determinants of thyroid autoimmunity among Ghanaian type 2 diabetes patients. METHODS: This was a case-control study involving 302 type 2 diabetes patients and 310 non - diabetic controls aged 40-80 years. Anthropometric and blood pressure measurements were obtained. Fasting samples were analyzed for glucose, thyroid function, and antibodies to thyroglobulin and thyroid peroxidase. RESULTS: The prevalence of thyroid autoimmunity was significantly higher among T2DM subjects (12.2% vs. 3.9%, p = 0.0004). Among T2DM subjects, 44 (14.7%) tested positive for TPOAb, 5 (1.7%) tested positive for TGAb and 15 (5.0%) tested positive for both autoantibodies. Females T2DM subjects showed a 3-fold increased risk of thyroid autoimmunity compared to males (OR:3.16, p =0.004), T2DM subjects with hyperthyroidism had a 41% increased risk of thyroid autoimmunity (OR: 1.41, p < 0.001), sub-clinical hyperthyroidism increased the risk of thyroid autoimmunity by 2 fold, (OR:2.19, p < 0.001), subclinical hypothyroidism increased the risk of autoimmunity by 4-fold, (OR:3.57 95% p < 0.0001), and hypothyroidism was associated with a 61% increased risk of thyroid autoimmunity (OR: 1.61,1.35-2.23). Dyslipidaemia was associated with a 44% increased risk of thyroid autoimmunity (OR: 1.44, p = 0.01) and a percentage increase in HbA1c was associated with 46% increased risk of thyroid autoimmunity (OR:1.46, p < 0.0001). CONCLUSION: We observed a high prevalence of thyroid autoimmunity in Ghanaian T2DM subjects compared to the general population. Thyroid autoimmunity in T2DM subjects was significantly associated with female gender, thyroid dysfunction, dyslipidaemia and poor glycemic control.

One-Year Rates and Determinants of Poststroke Systolic Blood Pressure Control among Ghanaians.

BACKGROUND AND OBJECTIVE: Elevated systolic blood pressure (SBP) is potently associated with risk of recurrent strokes. In resource-limited settings, there is a dearth of data on the rates and determinants of uncontrolled SBP among stroke survivors at high risk of recurrent events. The objective of this study is to assess the rates and determinants of uncontrolled SBP over the first year post stroke. METHODS: This is a retrospective observational study involving stroke survivors who enrolled into an outpatient neurology clinic in Kumasi, Ghana, between January 2012 and June 2014. Baseline demographic features, clinical characteristics, antihypertensive medications prescribed at each clinic visit, treatment modifications, and clinic blood pressure measurements were recorded. Predictors of uncontrolled SBP during follow-up were assessed using a multivariable logistic regression model. RESULTS: A total of 602 stroke survivors enrolled for follow-up within the study period of which 89.8% had hypertension. Up to 35% of subjects had an SBP above 140 mmHg during follow-up clinic visits. Among those with uncontrolled SBP, 17% had antihypertensive treatment modifications during follow-up. Predictors of uncontrolled SBP were SBP at enrollment into clinic, with an adjusted odds ratio (OR [95% confidence interval {CI}]) of 1.31 (1.17-1.47)/10 mmHg increase, and average number of antihypertensive medications prescribed, with an adjusted OR (95% CI) of 1.30 (1.06-1.60) for an increase in the number of antihypertensives prescribed. CONCLUSION: A third of stroke survivors had SBP not on target during follow-up possibly due to a combination of therapeutic inertia, apparent treatment resistance, and poor adherence to therapy. Longer-term prospective interventional studies on hypertension control among stroke survivors are warranted in sub-Saharan Africa.

Prevalence and Predictors of Sleep Apnea Risk among Ghanaian Stroke Survivors.

BACKGROUND AND PURPOSE: Sleep apnea (SA) has emerged as a potent risk factor for stroke recurrence and mortality. The burden of SA among stroke survivors in sub-Saharan Africa where stroke incidence and mortality are escalating is unknown. We sought to assess the prevalence of SA risk and its clinical correlates and predictors among Ghanaian stroke survivors. METHODS: This cross-sectional study involved 200 consecutive stroke survivors attending a neurology clinic in a tertiary medical center in Kumasi, Ghana. The validated Berlin, STOP-BANG, and Epworth Sleepiness Scale questionnaires were administered to all eligible subjects to assess SA risk and daytime somnolence, and their demographic and clinical information, health-related quality of life, and symptoms of depression were collected using the questionnaires. RESULTS: The median (interquartile range) age of stroke survivors was 62 (52-72) years and 52.5% were male. Ninety-nine (49.5%) subjects were identified as high risk for SA using the Berlin questionnaire, whereas 26 (13%), 137 (68.5%), and 37 (18.5%) subjects were classified as low, intermediate, and high risk for SA, respectively, using the STOP-BANG questionnaire. Patients at high risk of SA were significantly older, used excess alcohol, and were less able to perform activities of daily living, although their mean National Institutes of Health Stroke Scale scores were significantly lower than those with low risk for SA. None of the stroke survivors had ever been screened for SA. CONCLUSIONS: One out of every 2 stroke survivors attending a neurology clinic in Ghana is at high risk for undiagnosed SA. Greater regional awareness about SA presence and outcomes among patients and providers is warranted.

Assessment of prison life of persons with disability in Ghana.

BACKGROUND: Persons with Disabilities (PWDs) are a unique group that are often overlooked in many developing countries due to systemic weaknesses, lack of political commitment and inadequate support from government and non-governmental agencies. The population of these individuals is however steadily on the increase and currently corresponds to 15 % of the world population. Although much data exist on lifestyle and conditions of prisoners with disabilities in the western world, scanty information is available in Africa. In Ghana, there is insufficient data on the occurrence and social characteristics of prisoners with disabilities. The purpose of this current study was therefore to identify the occurrence, types and causes of disabilities among prisoners serving sentences in Ghanaian prisons. METHODS: This study was a descriptive cross-sectional survey conducted in the Male and Female Regional Prisons in Kumasi, Sunyani and the Nsawam Medium Security Prison, from November to December 2011. PWDs were selected by prisons officers and interviewed using structured questionnaires on variables such as socio-demographic characteristics, causes of disabilities and accessibility to recreational facilities. Ethical approval was obtained from the security services and the Committee of Human Research Publications and Ethics (CHRPE) of the School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST). RESULTS: We screened 6114 records of prisoners of which 1852 (30.3 %) were from the Kumasi Central Prisons, 3483 (57 %) from the Nsawam Medium Security and 779 (12.8 %) from the Sunyani Central Prisons. A total of 99 PWDs were identified with the commonest disability being physical, followed by visual, hearing, speech, mental and albinism. Most of the disabilities were caused by trauma (68.8 %) followed by infection (16.7 %), and drug related mental disabilities (6.3 %). Fifty (50.5 %) out of the 99 PWDs were not provided with assistive devices although they admitted the need for such. CONCLUSION: The present study has demonstrated the occurrence and conditions of PWDs in Ghanaian prisons. Major stakeholders including government agencies and other organisations could develop policies that would improve the conditions and livelihood of prisoners with disabilities in Ghana.

Frequency & factors associated with elevated lipoprotein-a among Ghanaian stroke survivors.

BACKGROUND: Indigenous Africans are genetically predisposed to elevated lipoprotein-a (Lp(a)), a veritable risk factor for ischemic stroke. Recent studies have demonstrated the promising efficacy of therapeutic interventions for addressing elevated Lp(a) among patients at high risk of atherosclerotic cardiovascular events. It is important to assess the burden of elevated Lp(a) among stroke survivors of African ancestry aimed at addressing potential unmet therapeutic gaps for optimal secondary prevention. PURPOSE: To assess the frequency of elevated lipoprotein-a among Ghanaian stroke survivors and factors associated with it. METHODS: A prospective study conducted at the Neurology clinic of the Komfo Anokye Teaching Hospital among ischemic stroke survivors aged ≥18 years. Serum lipoprotein-a concentrations were measured using ELISA kits. A multivariate regression analysis was fitted to identify factors independently associated with elevated lipoprotein-a concentration > 30 mg/dl. RESULTS: Among 116 stroke survivors, 35 (30.2%) had elevated Lp(a). The adjusted odds ratio (95% CI) of factors associated with elevated Lp(a) were female sex 3.09 (1.05-9.12), p = 0.04, diabetes mellitus 3.52 (1.32-9.40), p = 0.01, urban dwelling 4.64 (1.61-13.39), p = 0.005 and total cholesterol 1.85 (1.28-2.67), p = 0.001. Whereas the LDL cholesterol significantly decreased from baseline to month 12 among a subset of participants, the Lp(a) levels significantly increased from a baseline value of 29.38 ± 15.32 mg/dl to 40.97 ± 29.72 mg/dl, p = 0.032. CONCLUSION: Approximately 1 in 3 Ghanaian ischemic stroke survivors harbor an elevated Lp(a) associated with female sex, urban residence, diabetes mellitus and raised cholesterol. This burden highlights an unmet therapeutic gap in secondary risk reduction in this resource-limited setting.

BCG Vaccination-Associated Lower HbA1c and Increased CD25 Expression on CD8+ T Cells in Patients with Type 1 Diabetes in Ghana.

BCG vaccination affects other diseases beyond tuberculosis by unknown-potentially immunomodulatory-mechanisms. Recent studies have shown that BCG vaccination administered during overt type 1 diabetes (T1D) improved glycemic control and affected immune and metabolic parameters. Here, we comprehensively characterized Ghanaian T1D patients with or without routine neonatal BCG vaccination to identify vaccine-associated alterations. Ghanaian long-term T1D patients (n = 108) and matched healthy controls (n = 214) were evaluated for disease-related clinical, metabolic, and immunophenotypic parameters and compared based on their neonatal BCG vaccination status. The majority of study participants were BCG-vaccinated at birth and no differences in vaccination rates were detected between the study groups. Notably, glycemic control metrics, i.e., HbA1c and IDAA1c, showed significantly lower levels in BCG-vaccinated as compared to unvaccinated patients. Immunophenotype comparisons identified higher expression of the T cell activation marker CD25 on CD8+ T cells from BCG-vaccinated T1D patients. Correlation analysis identified a negative correlation between HbA1c levels and CD25 expression on CD8+ T cells. In addition, we observed fractional increases in glycolysis metabolites (phosphoenolpyruvate and 2/3-phosphoglycerate) in BCG-vaccinated T1D patients. These results suggest that neonatal BCG vaccination is associated with better glycemic control and increased activation of CD8+ T cells in T1D patients.

Determinants of visit-to-visit systolic blood pressure variability among Ghanaians with hypertension and diabetes mellitus.

Objective: To identify the determinants of systolic blood pressure variability (SBPV) among Ghanaians. Design: We undertook a secondary analysis of data collected in a prospective study. Setting: The study involved patients with hypertension and or diabetes receiving care in five hospitals in Ghana. Main outcome measures: We assessed determinants of SBPV among 2,785 Ghanaian patients. We calculated the standard deviation (SD) of systolic BP recordings of 3 to 10 visits per patient over 18 months as a measure of SBPV. A multivariate linear regression analysis was fitted to identify factors independently associated with risk visit-to-visit SBP standard deviation. Results: The mean SD of individual patient visit-to-visit SBP overall was 14.8± 6.3 mm Hg. Those with hypertension and diabetes had the highest SD of 15.4 ±6.2 mm Hg followed by 15.2 ±6.5 mm Hg among those with hypertension only and then 12.0 ± 5.2 mm Hg among those with diabetes only, p<0.0001. Factors independently associated with SBPV with adjusted ß coefficients (95% CI) included age: 0.06 (0.03 - 0.08) for each year rise in age, eGFR -0.03 (-0.05 - -0.02) for each ml/min rise, low monthly income of <210 Ghana cedis 1.45 (0.43-2.46), and secondary level of education -1.10 (-1.69, -0.50). Antihypertensive classes were associated with SBPV, the strongest associations being hydralazine 2.35 (0.03 - 4.68) and Methyldopa 3.08 (2.39 - 3.77). Conclusion: Several socio-demographic and clinical factors are associated with SBPV. Future studies should assess the contribution of SBPV to CVD outcomes among indigenous Africans and identify actionable targets. Funding: Funding for this study was provided by MSD, Novartis, Pfizer, Sanofi (each a Participant Company) and the Bill and Melinda Gates Foundation (collectively, the Funders) through the New Venture Fund (NVF). FSS and BO are also supported by funding from the National Heart, Lung, and Blood Institute (R01HL152188).

Trends in type 1 diabetes diagnosis in Ghana.

BACKGROUND: Despite the fact that the rate of type 1 diabetes (T1D) is increasing worldwide, there exists a dearth of information on the disease in most sub-Saharan African countries. The goal of this study was to determine the enrolment trend of T1D using data compiled over 28 y from a teaching hospital in Kumasi, Ghana. METHODS: Information collected included sex, age at diagnosis and date of T1D diagnosis. We identified trends from 1992 to 2018, divided into 3 y intervals. RESULTS: From 1992 to 2018, 1717 individuals with T1D were enrolled in the diabetes clinic at the Komfo Anokye Teaching Hospital. The male:female ratio was 1:1.2. The number of individuals diagnosed with T1D decreased among the 10-19 y age group during the 1992-1994 period, followed by a progressive increase within the same age group during the subsequent period (from 35.4% in 1995-1997 to 63.2% in 2016-2018). There was a decline in the proportion of children 0-9 y of age diagnosed during the study period (from 5.1% in 1992-1994 to 3.6% in 2016-2018). CONCLUSIONS: In our study population, a decreasing trend of T1D enrolments was observed in general while among adolescents an increasing trend was observed.

International collaboration for the development of clinical guidelines in low and middle-income countries: case study on the development of a national framework and clinical guidelines for diabetic retinopathy in Ghana.

BACKGROUND: Diabetic retinopathy is a leading cause of blindness in many countries across the world. Ghana has seen a rise in diabetic retinopathy and is working on various strategies to prevent blindness. Clinical guidelines are seen as a promising strategy for improving quality and reducing cost of care. Little is known about the processes of collaborative guideline development in the African context. METHODS: This case study discusses the process of developing clinical guidelines for diabetic retinopathy in Ghana via a collaboration with the Kenya team that had previously developed guidelines for Kenya. RESULTS: The main lesson learnt was the ability to overcome challenges. The main output achieved was the draft national framework, guidelines and training slides on the guidelines. CONCLUSION: Horizontal international collaboration can aid development of clinical guidelines.

Causes and predictors of mortality among Ghanaians hospitalised with endocrine disorders.

BACKGROUND: Endocrine disorders have been noted to be on the increase in the developing world, but little is known about their outcomes on the African continent. METHODS: We conducted a retrospective longitudinal study to evaluate the demographic characteristics and determinants of endocrine-related mortality among adult patients over 9 y in a leading tertiary hospital in Ghana. We determined the predictors of inpatient mortality using Kaplan-Meier survival curves and Cox proportional hazard regression analysis. RESULTS: Overall, 6265 patients (9.7% of all medical admissions) were admitted with various endocrine disorders during the period. The most common endocrine cause of hospitalisation was diabetes mellitus (86.0%), followed in order of decreasing frequency by thyroid disorders (7.7%) and miscellaneous disorders (1.4%). The overall crude mortality rate of endocrine admissions was 16.7%. Death was predicted by increasing age with an adjusted hazard ratio of 1.25 (95% confidence interval 1.15 to 1.65) for every 10-y increase in age. CONCLUSIONS: Almost one in six adults admitted with an endocrine disorder to a tertiary care centre in Ghana died in hospital, and many of the deaths were due to non-communicable disease complications. Enhanced public health disease prevention strategies and endocrine inpatient care processes are warranted.

Pilot Mobile Phone Intervention in Promoting Type 2 Diabetes Management in an Urban Area in Ghana: A Randomized Controlled Trial.

PURPOSE: The purpose of the study was to evaluate the feasibility and effectiveness of a nurse-led mobile phone call intervention on glycemic management and adherence to self-management practices among patients with type 2 diabetes mellitus (T2DM) in Ghana. METHODS: This was a pilot randomized controlled trial to compare diabetes care as usual to a mobile phone call intervention delivered by nurses in addition to care as usual over a 12-week period in a tertiary referral hospital in Ghana. Sixty patients with T2DM were randomized to either the intervention or the control arm. The intervention group received up to 16 mobile phone calls (mean duration = 12 minutes) from a diabetes specialist nurse in addition to their care as usual. The control group received only care as usual. The primary outcome was the change in A1C over the 12-week period. The secondary outcomes were changes in self-reported adherence to medication and diabetes self-management measures over the 12-week period. RESULTS: Mean baseline A1C was comparable between the intervention and control groups (9.54%, SD = 2.00% vs 9.07%, SD = 1.72%, P = .334). After 12 weeks, A1C was significantly lower in the intervention group compared to the control group. The difference in mean A1C in the control group rose by +0.26 ± 1.30% (P = .282; 95% CI, -0.23 to 0.75), whereas that of the intervention group reduced by -1.51 ± 2.67% (P = .004; 95% CI, -2.51 to -0.51). No improvements in self-management were recorded in the control group. In the intervention group, however, the only significant improvement was recorded in the area of foot care practices. Participant recruitment and retention were 100% without any attrition. About 87% (n = 26) of the intervention group completed at least 70% (≥11) of the calls. At the end of the trial, participants who received the intervention rated their satisfaction as 89.3% on average. CONCLUSION: A mobile phone follow-up call by nurses emphasizing adherence to self-management practices is feasible and can improve short- to medium-term glycemic management among patients with T2DM.

Longitudinal control of blood pressure among a cohort of Ghanaians with hypertension: A multicenter, hospital-based study.

There are limited data on factors associated with longitudinal control of blood pressure (BP) among Ghanaians on antihypertensive treatment. We sought to evaluate associations between prospective BP control and 24 putative factors within socio-demographic, biological, and organizational domains. This is a cohort study involving 1867 (65%) adults with hypertension and 1006 (35%) with both hypertension and diabetes mellitus at five public hospitals. Clinic BP was measured every 2 months for 18 months of follow-up. A multivariate logistic regression analysis was fitted via generalized linear mixed models to identify factors associated with clinic BP ≥ 140/90 mm Hg at each clinic visit during follow-up. Mean age of study participants was 58.9 ± 16.6 years and 76.8% were females. Proportions with controlled BP increased from 46.3% at baseline to 59.8% at month 18, P < .0001. Eight factors with adjusted OR (95% CI) associated prospectively with uncontrolled BP were male gender: 1.37 (1.09-1.72), secondary education: 1.32 (1.00-1.74), non-adherence to antihypertensive treatment: 1.03 (1.00-1.06), fruit intake: 0.94 (0.89-1.00), duration of hypertension diagnosis: 1.01 (1.00-1.02), hypertension with diabetes mellitus: 2.05 (1.72-2.46), number of antihypertensive medications: 1.63 (1.49-1.79), and estimated glomerular filtration rate (mL/min rise): 0.82 (0.76-0.89). Interventions aimed at addressing modifiable factors associated with poorly controlled BP would be critical in prevention of cardiovascular diseases among Ghanaians.

Time to onset of type 2 diabetes mellitus in Ghana.

BACKGROUND: Type 2 diabetes affects an increasing number of Ghanaians. The timing of the onset of diabetes is linked to several other co-morbid conditions, yet no study has examined the timing of the onset of type 2 diabetes in Ghana. METHODS: To fill this gap in the literature, this study applied logit models to data extracted from the medical records at the Diabetes Clinic of the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Gender-specific models were also estimated. RESULTS: The results show that obesity was a significant predictor of the timing of the first onset of diabetes among both males and females. Women with high school education compared with no formal education, and female employees compared with the unemployed were more likely to experience an early onset of type 2 diabetes. CONCLUSION: Policymakers must educate Ghanaians about behaviors that will reduce their risk of obesity and diabetes.

Type-1 diabetes onset age and sex differences between Ghanaian and German urban populations.

Highlights Type 1 diabetes onset age in Kumasi/Ghana has a peak at around 17 to 20 years, whereas the peak is at 11 to 12 years in North Rhine-Westphalia, Germany. Higher proportions of females were found in the type 1 diabetes cohort from Ghana, and males were more frequent in the German cohort.

Prevalence and risk factors for diabetes mellitus among adults in Ghana: a systematic review and meta-analysis.

BACKGROUND: The prevalence and risk factors for diabetes in Ghana vary from location to location, yet no study has been conducted to quantitatively synthesize the available studies. METHODS: The authors conducted a comprehensive literature search in Medline (PubMed), Embase, Cinahl, Web of Science, Scopus, African journals and grey literature. Two reviewers screened the articles for relevance, identified and selected studies based on inclusion and exclusion criteria. Methodological quality was independently assessed, using two validated assessment-of-bias tools. We explored study heterogeneity and performed a publication bias check. RESULTS: This search yielded a total of 624 articles, of which 17 studies were finally selected for the qualitative review and 12 studies included in the meta-analysis. The overall prevalence of diabetes mellitus among adult Ghanaians was high at 6.46% (95% CI: 4.66-8.26%) based on the inverse-variance random-effects model. Significant risk factors associated with diabetes were a family history of diabetes (OR: 3.46, 95% CI: 2.50-4.78), physical inactivity (OR: 3.06, 95% CI: 1.66-5.64) and age ≥40 years (OR: 2.36, 95% CI: 1.77-3.16). CONCLUSION: Studies with high methodological quality provided sufficient evidence about diabetes prevalence among adults and the associated significant risk factors in Ghana.

Prevalence and predictors of chronic kidney disease among Ghanaian patients with hypertension and diabetes mellitus: A multicenter cross-sectional study.

The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astronomical increases in key risk factors including hypertension and diabetes. We sought to assess the burden and predictors of CKD among Ghanaians with hypertension and/or diabetes mellitus in a multicenter hospital-based study. We conducted a cross-sectional study in the Ghana Access and Affordability Program (GAAP) involving adults with hypertension only (HPT), hypertension with diabetes mellitus (HPT + DM), and diabetes mellitus only (DM) in 5 health facilities in Ghana. A structured questionnaire was administered to collect data on demographic variables, medical history, and clinical examination. Serum creatinine and proteinuria were measured, and estimated glomerular filtration rate derived using the CKD-EPI formula. A multivariable logistic regression model was used to identify factors associated with CKD. A total of 2781 (84.4%) of 3294 participants had serum creatinine and proteinuria data available for analysis. The prevalence of CKD was 242 (28.5%) among participants with both DM and HPT, 417 (26.3%) among participants with HPT, and 56 (16.1%) among those with DM alone. Predictors of CKD were increasing age aOR 1.26 (1.17-1.36), low educational level aOR 1.7 (1.23-2.35), duration of HPT OR, 1.02 (1.01-1.04), and use of herbal medications aOR 1.39 (1.10-1.75). Female gender was protective of CKD aOR 0.75 (0.62-0.92). Among patients with DM, increasing age and systolic blood pressure were associated with CKD. There is high prevalence of CKD among DM and hypertension patients in Ghana. Optimizing blood pressure control and limiting the use of herbal preparations may mitigate CKD occurrence in high cardiovascular risk populations in developing countries.

Estimated glomerular filtration rate predicts incident stroke among Ghanaians with diabetes and hypertension.

BACKGROUND: Sub-Saharan Africa is currently experiencing a high burden of both chronic kidney disease (CKD) and stroke as a result of a rapid rise in shared common vascular risk factors such as hypertension and diabetes mellitus. However, no previous study has prospectively explored independent associations between CKD and incident stroke occurrence among indigenous Africans. This study sought to fill this knowledge gap. METHODS: A prospective cohort study involving Ghanaians adults with hypertension or type II diabetes mellitus from 5 public hospitals. Patients were followed every 2 months in clinic for 18 months and assessed clinically for first ever stroke by physicians. Serum creatinine derived estimated glomerular filtration rates (eGFR) were determined at baseline for 2631 (81.7%) out of 3296 participants. We assessed associations between eGFR and incident stroke using a multivariate Cox Proportional Hazards regression model. RESULTS: Stroke incidence rates (95% CI) increased with decreasing eGFR categories of 89, 60-88, 30-59 and <29 ml/min corresponding to incidence rates of 7.58 (3.58-13.51), 14.45 (9.07-21.92), 29.43 (15.95-50.04) and 66.23 (16.85-180.20)/1000 person-years respectively. Adjusted hazard ratios (95%CI) for stroke occurrence according to eGFR were 1.42 (0.63-3.21) for eGFR of 60-89 ml/min, 1.88 (1.17-3.02) for 30-59 ml/min and 1.52 (0.93-2.43) for <30 ml/min compared with eGFR of >89 ml/min. Adjusted HR for stroke occurrence among patients with hypertension with eGFR<60 ml/min was 3.69 (1.49-9.13), p = .0047 and among those with diabetes was 1.50 (0.56-3.98), p = .42. CONCLUSION: CKD is dose-dependently associated with occurrence of incident strokes among Ghanaians with hypertension and diabetes mellitus. Further studies are warranted to explore interventions that could attenuate the risk of stroke attributable to renal disease among patients with hypertension in SSA.

Phone-based intervention for blood pressure control among Ghanaian stroke survivors: A pilot randomized controlled trial.

BACKGROUND: The potential of mobile-health (mHealth) technology for the management of hypertension among stroke survivors in Africa remains unexplored. We assessed whether an mHealth technology-enabled, nurse-guided intervention initiated among stroke patients within one month of symptom onset is effective in improving their blood pressure (BP) control. METHODS: A two-arm pilot cluster randomized controlled trial involving 60 stroke survivors, ≥18 years, with BP ≥140/90 mmHg at screening/enrollment visit at a medical center in Ghana. Participants in the intervention arm (n = 30) received a Blue-toothed BP device and smartphone with an App for monitoring BP measurements and medication intake under nurse guidance for three months after which intervention was withdrawn. Control arm (n = 30) received usual care. Primary outcome measure was proportion with clinic BP < 140/90 mmHg at month 9; secondary outcomes included medication adherence. FINDINGS: Mean ± SD age was 55 ± 13 years, 65% males. Two participants on intervention and three in control group were lost to follow-up. At month 9, proportion on the intervention versus controls with BP < 140/90 mmHg was 14/30 (46.7%) versus 12/30 (40.0%), p = 0.79 by intention-to-treat; systolic BP < 140 mmHg was 22/30 (73.3%) versus 13/30 (43.3%), p = 0.035. Mean ± SD medication possession ratio was 0.95 ± 0.16 on intervention versus 0.98 ± 0.24 in the control arm, p = 0.56. INTERPRETATION: We demonstrate feasibility and signal of improvement in BP control among stroke survivors in a resource-limited setting via an mHealth intervention. Larger scale studies are warranted. TRIAL REGISTRATION: NCT02568137. Registered on 13 July 2015 at ClinicalTrials.gov.