Abstract Fish health significantly influences aquaculture productivity, sustainability, food security, and public health. Despite Ghana's rapid aquaculture expansion, the sector remains constrained by widespread disease outbreaks and environmental threats. This systematic review synthesizes existing literature (2010–2024) to comprehensively assess fish health issues, management practices, diagnostic capabilities, environmental threats, and policy implications in Ghana. Following PRISMA guidelines, 65 eligible studies were selected from an initial 386 records and critically appraised using the Mixed Methods Appraisal Tool (MMAT). Findings indicate that bacterial pathogens (notably Streptococcus and Aeromonas spp.), viral infections such as Infectious Spleen and Kidney Necrosis Virus (ISKNV), parasitic infestations, and emerging fungal pathogens constitute major disease threats. Environmental stressors such as heavy metals, pesticides, and microplastics were frequently detected in aquaculture‐associated water bodies, raising ecological and food safety concerns. Although molecular diagnostic tools are increasingly being adopted, national diagnostic coverage remains uneven. Widespread antibiotic misuse, weak biosecurity implementation, and regulatory gaps further exacerbate fish health risks. This review provides the first integrated synthesis linking disease epidemiology, environmental contamination, diagnostic capacity, farmer practices, and governance challenges within Ghana's aquaculture sector. Strengthening surveillance systems, improving diagnostic infrastructure, enhancing farmer training, and enforcing regulatory frameworks are essential to improving resilience and sustainability. The findings offer policy‐relevant insights applicable to emerging aquaculture systems across sub‐Saharan Africa and other developing regions.
Samuel et al. (Sat,) studied this question.