Prevalence of diabetes and associated risk factors in Ga Mashie, Accra, Ghana – the CARE Diabetes community-based survey

ABSTRACT Background Globally, diabetes affects 537 million individuals aged 20-79, significantly undermining their quality of life and economic stability, with the greatest impact in low- and middle-income countries. This study aims to deepen understanding of the diabetes burden in Ga Mashie, an urban-poor area in Accra, Ghana. Methods We conducted a cluster survey of adults over 25 years in 80 enumeration areas within Ga Mashie, targeting 959 eligible households based on the 2021 census. Household-level data included household membership and structure, water and sanitation, cooking infrastructure, and asset ownership. Individual-level data encompassed demographics, lifestyle behaviours, and biometric measurements. Diabetes was identified through random blood glucose levels ≥11.1 mmol/L or a prior diagnosis, with obesity defined as a body mass index >30 kg/m2 and central obesity as a waist circumference-to-height ratio >0.5. We derived weighted prevalence estimates and compared these estimates by age, sex, and wealth, using unadjusted odds-ratios (OR). Results The survey, achieving a 67% response rate, covered 854 individuals from 644 households. It unveiled a notable prevalence of non-communicable disease risk factors: 47.2% for alcohol consumption (95% CI: 43.7-50.8), 50.7% for insufficient physical activity (95% CI: 46.0-55.3), 28.9% for unhealthy snack consumption (95% CI: 24.5-33.7), 35.1% for obesity (95% CI: 31.3-39.1), and 74.5% for central obesity (95% CI: 70.8-77.9). Diabetes affected 8.2% of the population aged ≥25 (95% CI: 6.4-10.5), with disparities evident across age, wealth, and sex (2.66 greater odds in females for diabetes 95% CI: 1.38-5.12). Conclusion Diabetes and its risk factors are highly prevalent in Ga Mashie, with significant demographic disparities underscoring the need for targeted interventions. The study highlights the critical challenge diabetes poses in urban-poor contexts, emphasizing the necessity for tailored health initiatives to mitigate this burden. KEY QUESTIONS What is already known on this topic? Diabetes and non-communicable diseases (NCDs) present a significant global health challenge, especially in low- and middle-income countries, where there is a notable lack of data on the prevalence and distribution of these conditions and their associated risk factors. The variation in diabetes epidemiology and its risk factors between urban and rural settings highlights the need for context-specific intervention strategies. What this study adds? In Ga Mashie, the prevalence of diabetes is approximately 8%, with over 25% of individuals with diabetes being unaware of their condition and more than a third of those diagnosed not achieving control over the disease. There is also a high prevalence of NCD risk factors, such as insufficient physical activity (73%) and central obesity (75%). The distribution of diabetes and NCD risk factors is uneven across different demographic groups, with women and older adults bearing a higher burden of physical inactivity, adiposity, and diagnosed but uncontrolled diabetes, whereas men are more prone to engage in smoking and alcohol consumption. How might this study affect research, practice, or policy? Given the substantial health threat posed by diabetes and NCDs in Ga Mashie, there is a pressing need for interventions at the individual, community, and health system levels. These interventions should be designed with consideration of the unequal disease and risk factor distribution and should aim to address the specific contextual factors driving these disparities.