Browsing by Author "Danquah, I."

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Association between socioeconomic position and the prevalence of type 2 diabetes in Ghanaians in different geographic locations: the RODAM study.
(2017) Addo, J.; Agyemang, C.; de-Graft Aikins, A.; Beune, E.; Schulze, M.B.; Danquah, I.; Galbete, C.; Nicolaou, M.; Meeks, K.; Klipstein-Grobusch, K.; Bahendeka, S.; Mockenhaupt, F.P.; Owusu-Dabo, E.; Kunst, A.; Stronks, K.; Smeeth, L.
ACKGROUND: The prevalence of diabetes has been shown to be socially patterned but the direction of the association in low-income countries and among migrant populations in Europe has varied in the literature. This study examined the association between socioeconomic position (SEP) and diabetes in Ghanaians in Europe and in Ghana. METHODS: Data were derived from the multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study of Ghanaian adults aged 25-70 years residing in Europe (Amsterdam, Berlin and London) and in urban and rural Ghana. Educational attainment (elementary, secondary or higher) and occupational class (low or high) were used as indicators of SEP. Age-standardised prevalence of diabetes and prevalence ratios were evaluated separately for men and women of different SEP in Ghana and Europe. RESULTS: A total of 5290 participants were included in the analyses. The prevalence of diabetes decreased with increasing level of education in Ghanaian men and women in Europe and in men in urban Ghana, whereas diabetes prevalence increased with increasing level of education in men and women in rural Ghana. The association between occupational class and the prevalence of diabetes followed a less consistent pattern in men and women in the different locations. CONCLUSIONS: The association of diabetes and SEP differed in rural Ghana compared with urban settings in Ghana and Europe and comparing men and women, highlighting the complex interaction of SEP and the development of diabetes. These findings have important implications for diabetes prevention strategies in Ghanaians in different locations.
Cardiovascular disease risk prediction in sub-Saharan African populations — Comparative analysis of risk algorithms in the RODAM study
(International Journal of Cardiology, 2018-03) Boateng, D.; Agyemang, C.; Beune, E.; Meeks, K.; Smeeth, L.; Schulze, M.B.; Addo, J.; de-Graft Aikins, A.; Galbete, C.; Bahendeka, S.; Danquah, I.; Agyei-Baffour, P.; Owusu-Dabo, E.; Mockenhaupt, F.P.; Spranger, J.; Kengne, A.P.; Grobbee, D.E.; Klipstein-Grobusch, K.
Background: Validated absolute risk equations are currently recommended as the basis of cardiovascular disease (CVD) risk stratification in prevention and control strategies. However, there is no consensus on appropriate equations for sub-Saharan African populations. We assessed agreement between different cardiovascular risk equations among Ghanaian migrant and home populations with no overt CVD. Methods: The 10-year CVD risks were calculated for 3586 participants aged 40–70 years in the multi-centre RODAM study among Ghanaians residing in Ghana and Europe using the Framingham laboratory and non-laboratory and Pooled Cohort Equations (PCE) algorithms. Participants were classified as low, moderate or high risk, corresponding to < 10%, 10–20% and > 20% respectively. Agreement between the risk algorithms was assessed using kappa and correlation coefficients. Results: 19.4%, 12.3% and 5.8% were ranked as high 10-year CVD risk by Framingham non-laboratory, Framingham laboratory and PCE, respectively. The median (25th–75th percentiles) estimated 10-year CVD risk was 9.5% (5.4–15.7), 7.3% (3.9–13.2) and 5.0% (2.3–9.7) for Framingham non-laboratory, Framingham laboratory and PCE, respectively. The concordance between PCE and Framingham non-laboratory was better in the home Ghanaian population (kappa = 0.42, r = 0.738) than the migrant population (kappa = 0.24, r = 0.732) whereas concordance between PCE and Framingham laboratory was better in migrant Ghanaians (kappa = 0.54, r = 0.769) than the home population (kappa = 0.51, r = 0.758). Conclusion: CVD prediction with the same algorithm differs for the migrant and home populations and the interchangeability of Framingham laboratory and non-laboratory algorithms is limited. Validation against CVD outcomes is needed to inform appropriate selection of risk algorithms for use in African ancestry populations. © 2017 The Authors
Cross-sectional study of association between psychosocial stressors with chronic kidney disease among migrant and non-migrant Ghanaians living in Europe and Ghana: the RODAM study
(BMJ Open, 2019-06-17) Adjei, D.N.; Stronks, K.; Adu, D.; Beune, E.; Meeks, K.; Smeeth, L.; Addo, J.; Owusu-Dabo, E.; Klipstein-Grobusch, K.; Mockenhaupt, F.; Schulze, M.; Danquah, I.; Spranger, J.; Bahendeka, S.K.; Agyemang, C.
Objectives The association between psychosocial stressors (PS) and chronic kidney disease (CKD) among sub-Saharan African (SSA) populations is unknown. We examined the association between PS and CKD prevalence among rural and urban Ghanaians and Ghanaian migrants living in three European cities. We also assessed if the influence of PS on CKD is partially mediated by primary risk factors (hypertension and diabetes) of CKD. Design A multi-centred cross sectional data from the Research on Obesity and Diabetes among African Migrants study. Setting Rural and urban Ghana and three European cities (Amsterdam, Berlin and London). Participants A random sample of 5659 adults (Europe 3167, rural Ghana 1043 and urban Ghana 1449) aged 25–70 years. Explanatory measures PS defined by negative life events, perceived discrimination, perceived stress at work/ home and depressive symptoms. Three CKD outcomes were considered using the 2012 Kidney Disease: Improving Global Outcomes severity of CKD classification. Comparisons between PS and CKD outcomes were made using logistic regression analyses across all sites. Results We observed higher proportion of negative life events (68.7%) and perceived permanent stress (15.9%) among Ghanaians living in Ghana than Ghanaians living in Europe. Depressive symptoms (7.5%) and perceived discrimination (29.7%) were more common among Ghanaians living in Europe than Ghanaians living in Ghana. No significant association was observed between any of the PS constructs and CKD outcomes across sites except for positive association between stress at work/home and albuminuria (2.81, 95% CI 1.46 to 5.40) and CKD risk (2.78, 95% CI 1.43 to 5.43) among Ghanaians living in Berlin. Conclusion Our study found a positive association between stress at work/home and albuminuria and CKD risk. There was no convincing evidence of associations between the other PS constructs and the prevalence of CKD risk. Further studies are needed to identify potential factors driving the high prevalence of CKD among these populations.
Cross-sectional study of association between socioeconomic indicators and chronic kidney disease in rural-urban Ghana: The RODAM study
(BMJ Open, 2019-04-04) Adjei, D.N.; Stronks, K.; Adu, D.; Beune, E.; Meeks, K.; Smeeth, L.; Addo, J.; Owusu-Dabo, E.; Klipstein-Grobusch, K.; Mockenhaupt, F.P.; Danquah, I.; Spranger, J.; Bahendeka, S.; Aikins, A.D.; Agyemang, C.
Objectives Studies from high-income countries suggest higher prevalence of chronic kidney disease (CKD) among individuals in low socioeconomic groups. However, some studies from low/middle-income countries show the reverse pattern among those in high socioeconomic groups. It is unknown which pattern applies to individuals living in rural and urban Ghana. We assessed the association between socioeconomic status (SES) indicators and CKD in rural and urban Ghana and to what extent the higher SES of people in urban areas of Ghana could account for differences in CKD between rural and urban populations. Setting The study was conducted in Ghana (Ashanti region). We used baseline data from a multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study. Participants The sample consisted of 2492 adults (Rural Ghana, 1043, Urban Ghana, 1449) aged 25–70 years living in Ghana. Exposure Educational level, occupational level and wealth index. Outcome Three CKD outcomes were considered using the 2012 Kidney Disease: Improving Global Outcomes severity of CKD classification: albuminuria, reduced glomerular filtration rate and high to very high CKD risk based on the combination of these two. Results All three SES indicators were not associated with CKD in both rural and urban Ghana after age and sex adjustment except for rural Ghana where high wealth index was significantly associated with higher odds of reduced estimated glomerular filtration rate (eGFR) (adjusted OR, 2.38; 95% CI 1.03 to 5.47). The higher rate of CKD observed in urban Ghana was not explained by the higher SES of that population. Conclusion SES indicators were not associated with prevalence of CKD except for wealth index and reduced eGFR in rural Ghana. Consequently, the higher SES of urban Ghana did not account for the increased rate of CKD among urban dwellers suggesting the need to identify other factors that may be driving this.
Dietary patterns and type 2 diabetes among Ghanaian migrants in Europe and their compatriots in Ghana: The RODAM study
(Nature Publishing Group, 2018) Galbete, C.; Nicolaou, M.; Meeks, K.; Klipstein-Grobusch, K.; De-Graft Aikins, A.; Addo, J.; Amoah, S.K.; Smeeth, L.; Owusu-Dabo, E.; Spranger, J.; Agyemang, C.; Mockenhaupt, F.P.; Beune, E.; Stronks, K.; Schulze, M.B.; Danquah, I.
Background/objectives: We aimed to study the associations of dietary patterns (DPs) with type 2 diabetes (T2D) among Ghanaian adults. Subjects/methods: In the multi-centre, cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study (n = 4543), three overall DPs ("mixed", "rice, pasta, meat and fish," and "roots, tubers and plantain") and two site-specific DPs per study site (rural Ghana, urban Ghana and Europe) were identified by principal component analysis. The DPs-T2D associations were calculated by logistic regression models. Results: Higher adherence to the "rice, pasta, meat and fish" DP (characterized by legumes, rice/pasta, meat, fish, cakes/sweets, condiments) was associated with decreased odds of T2D, adjusted for socio-demographic factors, total energy intake and adiposity measures (odds ratio (OR)per 1 SD = 0.80; 95% confidence interval (CI) = 0.70-0.92). Similar DPs and T2D associations were discernible in urban Ghana and Europe. In the total study population, neither the "mixed" DP (whole grain cereals, sweet spreads, dairy products, potatoes, vegetables, poultry, coffee/tea, sodas/juices, olive oil) nor the "roots, tubers and plantain" DP (refined cereals, fruits, nuts/seeds, roots/tubers/plantain, fermented maize products, legumes, palm oil, condiments) was associated with T2D. Yet, after the exclusion of individuals with self-reported T2D, the "roots, tubers and plantain" DP was inversely associated with T2D (ORper 1 SD = 0.88; 95% CI = 0.69-1.12). Conclusion: In this Ghanaian population, DPs characterized by the intake of legumes, fish, meat and confectionery were inversely associated with T2D. The effect of a traditional-oriented diet (typical staples, vegetables and legumes) remains unclear. © 2018 The Author(s).
Differences in Alcohol Consumption and Drinking Patterns in Ghanaians in Europe and Africa: The RODAM Study
(PloS one, 2018-11) Addo, J.; Cook, S.; Galbete, C.; Agyemang, C.; Klipstein-Grobusch, K.; Nicolaou, M.; Danquah, I.; Schulze, M.B.; Brathwaite, R.; Mockenhaupt, F.P.; Beune, E.; Meeks, K.; de-Graft Aikins, A.; Bahendaka, S.; Owusu-Dabo, E.; Smeeth, L.
BACKGROUND: Little is known about alcohol consumption among Africans living in rural and urban Africa compared to African migrants in Europe. We compared the patterns of alcohol consumption in a group of Ghanaians living in different locations in Ghana and in Europe and examined the factors associated with drinking alcohol. METHODS: Data were from a cross-sectional study (RODAM) of Ghanaians aged 25-70 years living in rural and urban Ghana and in Amsterdam, Berlin and London. Information on how often participants consumed at least one standard alcoholic drink in the preceding 12 months, the type of alcoholic beverage and the average serving size was obtained using a food propensity questionnaire. The associations between drinking alcohol and socio-demographic variables, and frequency of attending religious services were investigated using logistic regression models stratified by site and sex. For Ghanaians living in Europe, the number of years since migration and acculturation were also included in the model as covariates. RESULTS: 4280 participants (62.2% women) were included in the analyses. In both men and women, the prevalence of drinking and amount of alcohol consumed per day was highest in Berlin (prevalence of drinking 71.0% and 61.7%) and lowest in urban Ghana (41.4% and 26.8%). After adjustment for age and education in both men and women in Europe, those attending religious services less frequently reported higher levels of drinking alcohol than non-attendants (never attend/no religion compared to attending service at least once a week men OR 4.60 95% CI 2.85, 7.44; women OR 1.80 95% CI 1.12, 2.90) p-trend with frequency <0.001 in men; 0.002 in women); this association was seen also in men in rural Ghana (p-trend = 0.001) and women in urban Ghana (p-trend = 0.02). The prevalence of drinking was positively associated with years since migration in both men and women in Europe ((OR per years increase in time lived in Europe 1.25 (95% CI 1.02,1.53) test for trend p = 0.03 in women; OR 1.29 (95% CI 1.03, 1.62 p = 0.03 in men) but no association was found with self-reported measures of acculturation (ethnic identity, cultural orientation or social networks). CONCLUSION: There are marked differences in alcohol consumption between Ghanaians living in Europe and in Ghana suggesting migration has an important influence of drinking patterns and also suggesting the possibility of requiring different strategies in alcohol reduction campaigns among Ghanaians in different locations.
Differential associations between psychosocial stress and obesity among Ghanaians in Europe and in Ghana: findings from the RODAM study
(Social Psychiatry and Psychiatric Epidemiology, 2019-03-11) de‑Graft Aikins, A.; Baratin, C.; Beune, E.; van Schalkwijk, D.; Meeks, K.; Smeeth, L.; Addo, J.; Owusu‑Dabo, E.; Bahendeka, S.; Mockenhaupt, F.P.; Danquah, I.; Schulze, M.B.; Spranger, J.; Boateng, D.; Klipstein‑Grobusch, K.; Stronks, K.; Agyemang, C.
Purpose Psychosocial stress is associated with obesity in some populations, but it is unclear whether the association is related to migration. This study explored associations between psychosocial stress and obesity among Ghanaian migrants in Europe and non-migrant Ghanaians in Ghana. Methods Cross-sectional data from the RODAM study were used, including 5898 Ghanaians residing in Germany, the UK, the Netherlands, rural Ghana, and urban Ghana. Perceived discrimination, negative life events and stress at work or at home were examined in relation to body mass index (BMI) and waist circumference (WC). Linear regression analyses were performed separately for migrants and non-migrants stratified by sex. Results Perceived discrimination was not associated with BMI and WC in both migrants and non-migrants. However, negative life events were positively associated with BMI (β = 0.78, 95% CI 0.34–1.22) and WC (β = 1.96, 95% CI 0.79–3.12) among male Ghanaian migrants. Similarly, stress at work or at home was positively associated with BMI (β = 0.28, 95% CI 0.00–0.56) and WC (β = 0.84, 95% CI 0.05–1.63) among male Ghanaian migrants. Among non-migrant Ghanaians, in contrast, stress at work or at home was inversely associated with BMI and WC in both males (β = − 0.66, 95% CI − 1.03 to − 0.28; β = − 1.71 95% CI − 2.69 to − 0.73, respectively) and females (β = − 0.81, 95% CI − 1.20 to − 0.42; β = − 1.46, 95% CI − 2.30 to − 0.61, respectively). Conclusions Negative life events and stress at work or at home are associated with increased body weight among male Ghanaians in European settings, whereas stress at work or at home is associated with reduced body weight among Ghanaians in Ghana. More work is needed to understand the underlying factors driving these differential associations to assist prevention efforts.
Efficacy and safety of intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in African infants: a pooled analysis of six randomised, placebo-controlled trials
(The Lancet, 2009-10) Aponte, J.J.; Schellenberg, D.; Egan, A.; Breckenridge, A.; Carneiro, I.; Critchley, J.; Danquah, I.; Dodoo, A.; Kobbe, R.; Lell, B.; May, J.et.al.
Background: Intermittent preventive treatment (IPT) is a promising strategy for malaria control in infants. We undertook a pooled analysis of the safety and efficacy of IPT in infants (IPTi) with sulfadoxine-pyrimethamine in Africa. Methods: We pooled data from six double-blind, randomised, placebo-controlled trials (undertaken one each in Tanzania, Mozambique, and Gabon, and three in Ghana) that assessed the efficacy of IPTi with sulfadoxine-pyrimethamine. In all trials, IPTi or placebo was given to infants at the time of routine vaccinations delivered by WHO's Expanded Program on Immunization. Data from the trials for incidence of clinical malaria, risk of anaemia (packed-cell volume <25% or haemoglobin <80 g/L), and incidence of hospital admissions and adverse events in infants up to 12 months of age were reanalysed by use of standard outcome definitions and time periods. Analysis was by modified intention to treat, including all infants who received at least one dose of IPTi or placebo. Findings: The six trials provided data for 7930 infants (IPTi, n=3958; placebo, n=3972). IPTi had a protective efficacy of 30·3% (95% CI 19·8-39·4, p<0·0001) against clinical malaria, 21·3% (8·2-32·5, p=0·002) against the risk of anaemia, 38·1% (12·5-56·2, p=0·007) against hospital admissions associated with malaria parasitaemia, and 22·9% (10·0-34·0, p=0·001) against all-cause hospital admissions. There were 56 deaths in the IPTi group compared with 53 in the placebo group (rate ratio 1·05, 95% CI 0·72-1·54, p=0·79). One death, judged as possibly related to IPTi because it occurred 19 days after a treatment dose, was subsequently attributed to probable sepsis. Four of 676 non-fatal hospital admissions in the IPTi group were deemed related to study treatment compared with five of 860 in the placebo group. None of three serious dermatological adverse events in the IPTi group were judged related to study treatment compared with one of 13 in the placebo group. Interpretation: IPTi with sulfadoxine-pyrimethamine was safe and efficacious across a range of malaria transmission settings, suggesting that this intervention is a useful contribution to malaria control. Funding: Bill & Melinda Gates Foundation. © 2009 Elsevier Ltd. All rights reserved.
Food variety, dietary diversity, and type 2 diabetes in a multi-center cross-sectional study among Ghanaian migrants in Europe and their compatriots in Ghana: the RODAM study
(European Journal of Nutrition, 2017-09) Danquah, I.; Galbete, C.; Meeks, K.; Nicolaou, M.; Klipstein-Grobusch, K.; Addo, J.; Aikins, A.D.-G.; Amoah, S.K.; Agyei-Baffour, P.; Boateng, D.; Bedu-Addo, G.; Spranger, J.; Smeeth, L.; Owusu-Dabo, E.; Agyemang, C.; Mockenhaupt, F.P.; Beune, E.; Schulze, M.B.
Purpose: The importance of dietary diversification for type 2 diabetes (T2D) risk remains controversial. We investigated associations of between- and within-food group variety with T2D, and the role of dietary diversification for the relationships between previously identified dietary patterns (DPs) and T2D among Ghanaian adults. Methods: In the multi-center cross-sectional Research on Obesity and Diabetes among African Migrants (RODAM) Study (n = 3810; Ghanaian residence, 56%; mean age, 46.2 years; women, 63%), we constructed the Food Variety Score (FVS; 0–20 points), the Dietary Diversity Score (DDS; 0–7 points), and the Diet Quality Index-International (DQI-I) variety component (0–20 points). The associations of these scores, of a “rice, pasta, meat and fish” DP, of a “mixed” DP, and of a “roots, tubers and plantain” DP with T2D were calculated by logistic regression. Results: The FVS was inversely associated with T2D, adjusted for socio-demographic, lifestyle, and anthropometric factors [odds ratio (OR) for T2D per 1 standard deviation (SD) increase: 0.81; 95% confidence interval (CI) 0.71–0.93]. The DDS and the DQI-I variety component were not associated with T2D. There was no association of the “mixed” DP and the “roots, tubers and plantain” DP with T2D. Yet, the “rice, pasta, meat and fish” DP is inversely associated with T2D (OR for T2D per 1 SD increase: 0.82; 95% CI 0.71–0.95); this effect was slightly attenuated by the FVS. Conclusions: In this Ghanaian population, between-food group variety may exert beneficial effects on glucose metabolism and partially explains the inverse association of the “rice, pasta, meat and fish” DP with T2D. © 2017 The Author(s)
Higher prevalence of peripheral arterial disease in Ghana compared to Ghanaian migrants in Europe: The RODAM study
(International Journal of Cardiology, 2019-12-14) Amoah, A.G.B.; Hayfron-Benjamin, C.F.; Van den Born, B.J.; Maitland-van der Zee, A.H.; Van der Linden, E.L.; Stronks, K.; Klipstein-Grobusch, K.; Bahendeka, S.; Danquah, I.; Beune, E.; Smeeth, L.; Agyemang, C.
Background: Evidence suggests that the burden of peripheral artery disease (PAD) is rising more rapidly than other forms of cardiovascular diseases in sub-Saharan Africa, but the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the burden of PAD among Ghanaians living in rural- and urban-Ghana and Ghanaian migrants living in three European countries. Methods: Cross-sectional analyses of baseline data fromthemulticenter Research on Obesity and Diabetesamong African Migrants (RODAM) study were done. Data from 5516 participants living in Europe (1487 Amsterdam, 546 Berlin, 1047 London) and Ghana [1419 urban and 1017 rural] aged 25–70years were included. PAD was defined as ankle brachial index≤0.90. Comparisons among sites were made using logistic regression analysis. Results: The age-standardized prevalence of PAD was higher in Ghanaians living in rural [7.52%, 95% CI = 5.87–9.51] and urban [8.93%, 7.44–10.64] Ghana than for their compatriots living in Europe [5.70%, 4.35–7.35 for London; 3.94%, 2.96–5.14 for Amsterdam; and 0.44%, 0.05–1.58 for Berlin]. The differences persisted even after adjustment for age, sex, education and the conventional cardiovascular risk factors [adjusted odds ratio= 3.16, 95% CI=2.16–4.61, p b .001 for rural-Ghana; and 2.93, 1.87–4.58, p b .00 for urban-Ghana, compared with Ghanaian migrants in Europe]. Conclusions: Our study shows that Ghanaians living in Ghana have higher prevalence of PAD than their migrant compatriots. Further work is needed to identify potential factors driving the high prevalence of PAD among nonmigrant Ghanaians to assist interventions aimed at reducing PAD burden.
Innovative ways of studying the effect of migration on obesity and diabetes beyond the common designs: lessons from the RODAM study.
(2016) Agyemang, C.; Beune, E.; Meeks, K.; Addo, J.; de-Graft Aikins, A.; Bahendeka, S.; Danquah, I.; Mockenhaupt, F.P.; Schulze, M.B.; Klipstein-Grobusch, K.; Smeeth, L.; Stronks, K.
ype 2 diabetes and obesity are major global public health problems, with migrant populations in high-income countries being particularly affected. Type 2 diabetes and obesity are also major threats in low- and middle-income countries, from which most migrant populations originate. Transitioning of societies and the resulting changes in lifestyles are thought to be major driving forces, but the key specific factors within this broad category still need to be determined. Migrant studies provide a unique opportunity to understand the potential underlying causes of these conditions, but current research is mainly geared toward analyzing the differences between migrants and the host populations in the countries of settlement. For better understanding, there is a need to extend migrant health research across national boundaries. This review discusses innovative ways of studying the effect of migration on type 2 diabetes and obesity beyond the common designs and the relevance of extending migrant health studies across national boundaries in the current era of increasing global migration. Specifically, we describe the burden and different methods for conducting migrant studies. We use the Research on Obesity and Diabetes among African Migrants (RODAM) study as a case study, discussing the methods, some results, and lessons learned, including challenges and an essential recipe for success that may guide future migrant health research.
Knowledge and perceptions of type 2 diabetes among Ghanaian migrants in three European countries and Ghanaians in rural and urban Ghana: The RODAM qualitative study
(PLoS ONE, 2019-04) de-Graft Aikins, A.; Dodoo, F.; Awuah, R.B.; Owusu-Dabo, E.; Addo, J.; Nicolaou, M.; Beune, E.; Mockenhaupt, F.P.; Danquah, I.; Bahendeka, S.et.al
African migrants in Europe and continental Africans are disproportionately affected by type 2 diabetes (T2D). Both groups develop T2D at a younger age, and have higher morbidity and mortality from T2D and complications, compared to European populations. To reduce risk, and avoidable disability and premature deaths, culturally congruent and context specific interventions are required. This study aimed to: (a) assess perceptions and knowledge of T2D among Ghanaian migrants in Europe and their compatriots in Ghana and (b) identify specific perceptions and knowledge gaps that might predispose migrants to higher risk of diabetes. Data was gathered through 26 focus groups with 180 individuals, aged 21 to 70, from Amsterdam, Berlin and London and rural and urban Ashanti Region, Ghana. Thematic analysis of the data was informed by Social Representations Theory, which focuses on the sources, content and functions of social knowledge. Three key insights emerged from analysis. First, there was general awareness, across migrant and non-migrant groups, of T2D as a serious chronic condition with life threatening complications, and some knowledge of biomedical strategies to prevent diabetes (e.g healthy eating) and diabetes complications (e.g medication adherence). However, knowledge of T2D prevention and reduction of diabetes complications was not comprehensive. Secondly, knowledge of biomedical diabetes theories and interventions co-existed with theories about psychosocial and supernatural causes of diabetes and the efficacy of herbal and faith-based treatment of diabetes. Finally, migrants’ knowledge was informed by both Ghanaian and European systems of T2D knowledge suggesting enculturation dynamics. We discuss the development of culturally congruent and context-specific T2D interventions for the research communities.
Microvascular and macrovascular complications in type 2 diabetes Ghanaian residents in Ghana and Europe: The RODAM study
(Journal of Diabetes and Its Complications, 2019-04-30) Amoah, A.G.B.; Hayfron-Benjamin, C.; Hayfron-Benjamin, B.V.D.; Maitland - van der Zee, A.H.; Meeks, K.A.C.; Klipstein-Grobusch, K.; Bahendeka, S.; Spranger, J.; Danquah, I.; Mockenhaupt, F.; Beune, E.; Smeeth, L.; Agyemang, C.
Aims: To compare microvascular and macrovascular complication rates among Ghanaians with type 2 diabetes (T2D) living in Ghana and in three European cities (Amsterdam, London and Berlin). Methods: Data from the multicenter Research on Obesity and Diabetes among African Migrants (RODAM) study were analyzed. 650 Ghanaian participants with T2D (206 non-migrant and 444 migrants) were included. Logistic regression analyses were used to determine the association between migrant status and microvascular (nephropathy and retinopathy) and macrovascular (coronary artery disease (CAD), peripheral artery disease (PAD) and stroke) complications with adjustment for age, gender, socioeconomic status, alcohol, smoking, physical activity, hypertension, BMI, total-cholesterol, and HbA1c. Results: Microvascular and macrovascular complications rates were higher in non-migrant Ghanaians than in migrant Ghanaians (nephropathy 32.0% vs. 19.8%; PAD 11.2% vs. 3.4%; CAD 18.4% vs. 8.3%; and stroke 14.5% vs. 5.6%), except for self-reported retinopathy (11.0% vs. 21.6%). Except nephropathy and stroke, the differences persisted after adjustment for the above-mentioned covariates: PAD (OR 7.48; 95% CI, 2.16–25.90); CAD (2.32; 1.09–4.93); and retinopathy (0.23; 0.07–0.75). Conclusions: Except retinopathy, the rates of microvascular and macrovascular complications were higher in nonmigrant than in migrant Ghanaians with T2D. Conventional cardiovascular risk factors did not explain the differences except for nephropathy and stroke.
Obesity and type 2 diabetes in sub-Saharan Africans - Is the burden in today's Africa similar to African migrants in Europe? The RODAM study.
(2016) Agyemang, C.; Meeks, K.; Beune, E.; Owusu-Dabo, E.; Mockenhaupt, F.P.; Addo, J.; de-Graft Aikins, A.; Bahendeka, S.; Danquah, I.; Schulze, M.B.; Spranger, J.; Burr, T.; Agyei-Baafour, P.; Amoah, S.K.; Galbete, C.; Henneman, P.; Klipstein-Grobusch, K.; Nicolaou, M.; Adeyemo, A.; van Straalen, J.; Smeeth, L.; Stronks, K.
BACKGROUND: Rising rates of obesity and type 2 diabetes (T2D) are impending major threats to the health of African populations, but the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the burden of obesity and T2D among Ghanaians living in rural and urban Ghana and Ghanaian migrants living in different European countries. METHODS: A multi-centre cross-sectional study was conducted among Ghanaian adults (n = 5659) aged 25-70 years residing in rural and urban Ghana and three European cities (Amsterdam, London and Berlin). Comparisons between groups were made using prevalence ratios (PRs) with adjustments for age and education. RESULTS: In rural Ghana, the prevalence of obesity was 1.3 % in men and 8.3 % in women. The prevalence was considerably higher in urban Ghana (men, 6.9 %; PR: 5.26, 95 % CI, 2.04-13.57; women, 33.9 %; PR: 4.11, 3.13-5.40) and even more so in Europe, especially in London (men, 21.4 %; PR: 15.04, 5.98-37.84; women, 54.2 %; PR: 6.63, 5.04-8.72). The prevalence of T2D was low at 3.6 % and 5.5 % in rural Ghanaian men and women, and increased in urban Ghanaians (men, 10.3 %; PR: 3.06; 1.73-5.40; women, 9.2 %; PR: 1.81, 1.25-2.64) and highest in Berlin (men, 15.3 %; PR: 4.47; 2.50-7.98; women, 10.2 %; PR: 2.21, 1.30-3.75). Impaired fasting glycaemia prevalence was comparatively higher only in Amsterdam, and in London, men compared with rural Ghana. CONCLUSION: Our study shows high risks of obesity and T2D among sub-Saharan African populations living in Europe. In Ghana, similarly high prevalence rates were seen in an urban environment, whereas in rural areas, the prevalence of obesity among women is already remarkable. Similar processes underlying the high burden of obesity and T2D following migration may also be at play in sub-Saharan Africa as a consequence of urbanisation.
The prevalence of metabolic syndrome among Ghanaian migrants and their homeland counterparts: the Research on Obesity and type 2 Diabetes among African Migrants (RODAM) study
(European Journal of Public Health, 2019-04-09) Aikins, A.D.; van der Linden, E.L.; Meeks, K.; Beune, E.; Addo, J.; Owusu-Dabo, E.; Mockenhaupt, F.P.; Bahendeka, S.; Danquah, I.; Schulze, M.B.; Spranger, J.; Klipstein-Grobusch, K.; Appiah, L.T.; Smeeth, L.; Stronks, K.; Agyemang, C.
Background Metabolic syndrome (MetSyn) is an important risk factor for cardiovascular diseases and type 2 diabetes. It is unknown whether the MetSyn prevalence differs within a homogenous population residing in different settings in Africa and Europe. We therefore assessed the prevalence of MetSyn among Ghanaians living in rural- and urban-Ghana and Ghanaian migrants living in Europe. Methods We used data from the cross-sectional multi-centre RODAM study that was conducted among Ghanaian adults aged 25–70 years residing in rural- and urban-Ghana and in London, Amsterdam and Berlin (n = 5659). MetSyn was defined according to the 2009 harmonized definition. Geographical locations were compared using age-standardized prevalence rates, and prevalence ratios (PRs), adjusted for age, education, physical activity, and smoking and stratified for sex. Results In men, the age-standardized prevalence of MetSyn was 8.3% in rural Ghana and showed a positive gradient through urban Ghana (23.6%, adjusted PR = 1.85, 95% confidence interval 1.17–2.92) to Europe, with the highest prevalence in Amsterdam (31.4%; PR = 4.45, 2.94–6.75). In women, there was a rural-to-urban gradient in age-standardized MetSyn prevalence (rural Ghana 25%, urban Ghana 34.4%, PR = 1.38, 1.13–1.68), but small differences in MetSyn prevalence between urban-Ghanaian and European-Ghanaian women (Amsterdam 38.4%; London 38.2%). Conclusion MetSyn is highly prevalent in Ghana as well as in Ghanaian migrants in Europe. To assist prevention efforts, further research is needed to understand the mechanisms driving the geographical differences in MetSyn prevalence between migrant and non-migrant Ghanaians.
Rationale and cross-sectional study design of the research on obesity and type 2 diabetes among African migrants: The RODAM study
(BMJ Open, 2014-03) Agyemang, C.; Beune, E.; Meeks, K.; Owusu-Dabo, E.; Agyei-Baffour, P.; De-Graft Aikins, A.; Dodoo, F.; Smeeth, L.; Addo, J.; Mockenhaupt, F.P.; Amoah, S.K.; Schulze, M.B.; Danquah, I.; Spranger, J.; Nicolaou, M.; Klipstein-Grobusch, K.; Burr, T.; Henneman, P.; Mannens, M.M.; Van Straalen, J.P.; Bahendeka, S.; Zwinderman, A.H.; Kunst, A.E.; Stronks, K.
Introduction: Obesity and type 2 diabetes (T2D) are highly prevalent among African migrants compared with European descent populations. The underlying reasons still remain a puzzle. Gene-environmental interaction is now seen as a potential plausible factor contributing to the high prevalence of obesity and T2D, but has not yet been investigated. The overall aim of the Research on Obesity and Diabetes among African Migrants (RODAM) project is to understand the reasons for the high prevalence of obesity and T2D among sub-Saharan Africans in diaspora by (1) studying the complex interplay between environment (eg, lifestyle), healthcare, biochemical and (epi)genetic factors, and their relative contributions to the high prevalence of obesity and T2D; (2) to identify specific risk factors within these broad categories to guide intervention programmes and (3) to provide a basic knowledge for improving diagnosis and treatment. Methods and analysis: RODAM is a multicentre cross-sectional study among homogenous sub-Saharan African participants (ie, Ghanaians) aged >25 years living in rural and urban Ghana, the Netherlands, Germany and the UK (http://rod-am.eu/). Standardised data on the main outcomes, genetic and non-genetic factors are collected in all locations. The aim is to recruit 6250 individuals comprising five subgroups of 1250 individuals from each site. In Ghana, Kumasi and Obuasi (urban stratum) and villages in the Ashanti region (rural stratum) are served as recruitment sites. In Europe, Ghanaian migrants are selected through the municipality or Ghanaian organisations registers. Ethics and dissemination: Ethical approval has been obtained in all sites. This paper gives an overview of the rationale, conceptual framework and methods of the study. The differences across locations will allow us to gain insight into genetic and non-genetic factors contributing to the occurrence of obesity and T2D and will inform targeted intervention and prevention programmes, and provide the basis for improving diagnosis and treatment in these populations and beyond.
Smoking prevalence differs by location of residence among Ghanaians in Africa and Europe: The RODAM study
(Public Library of Science, 2017) Brathwaite, R.; Addo, J.; Kunst, A.E.; Agyemang, C.; Owusu-Dabo, E.; De-Graft Aikins, A.; Beune, E.; Meeks, K.; Bahendeka, S.; Mockenhaupt, F.P.; Amoah, S.; Galbete, C.; Schulze, M.B.; Danquah, I.; Smeeth, L.
Background Although the prevalence of smoking is low in Ghana, little is known about the effect of migration on smoking. Comparing Ghanaians living in their country of origin to those living in Europe offers an opportunity to investigate smoking by location of residence and the associations between smoking behaviours and migration-related factors. Methods Data on a relatively homogenous group of Ghanaians living in London (n = 949), Amsterdam (n = 1400), Berlin (n = 543), rural Ghana (n = 973) and urban Ghana (n = 1400) from the cross-sectional RODAM (Research on Obesity & Diabetes in African Migrants) study were used. Age-standardized prevalence rates of smoking by location of residence and factors associated with smoking among Ghanaian men were estimated using prevalence ratios (PR: 95% CIs). Results Current smoking was non-existent among women in rural and urban Ghana and London but was 3.2% and 3.3% in women in Amsterdam and Berlin, respectively. Smoking prevalence was higher in men in Europe (7.8%) than in both rural and urban Ghana (4.8%): PR 1.91: 95% CI 1.27, 2.88, adjusted for age, marital status, education and employment. Factors associated with a higher prevalence of smoking among Ghanaian men included European residence, being divorced or widowed, living alone, Islam religion, infrequent attendance at religious services, assimilation (cultural orientation), and low education. Conclusion Ghanaians living in Europe are more likely to smoke than their counterparts in Ghana, suggesting convergence to European populations, although prevalence rates are still far below those in the host populations. © 2017 Brathwaite et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Type 2 diabetes mellitus management among Ghanaian migrants resident in three European countries and their compatriots in rural and urban Ghana – The RODAM study
(Diabetes Research and Clinical Practice, 2018-02) Bijlholt, M.; Meeks, K.A.C.; Beune, E.; Addo, J.; Smeeth, L.; Schulze, M.B.; Danquah, I.; Galbete, C.; De-Graft Aikins, A.; Klipstein-Grobusch, K.et.al.
Aims To compare Type 2 Diabetes Mellitus (T2DM) awareness, treatment and control between Ghanaians resident in Ghana and Europe. Methods Comparisons were made for the 530 participants of the Research on Obesity and Diabetes among African Migrants (RODAM) study with T2DM (25–70 years) living in Amsterdam, Berlin, London, urban Ghana and rural Ghana. We used logistic regression to assess disparities with adjustment for age, sex and education. Results T2DM awareness was 51% in rural Ghana. This was lower than levels in Europe ranging from 73% in London (age-sex adjusted odds ratio (OR) = 2.7; 95%CI = 1.2–6.0) to 79% in Amsterdam (OR = 4.7; 95%CI = 2.3–9.6). T2DM treatment was also lower in rural Ghana (37%) than in urban Ghana (56%; OR = 2.6; 95%CI = 1.3–5.3) and European sites ranging from 67% in London (OR = 3.4; 95%CI = 1.5–7.5) to 73% in Berlin (OR = 6.9; 95%CI = 2.9–16.4). In contrast, T2DM control in rural Ghana (63%) was comparable to Amsterdam and Berlin, but higher than in London (40%; OR = 0.4; 95%CI = 0.2–0.9) and urban Ghana (28%; OR = 0.3; 95%CI = 0.1–0.6). Conclusions Our findings suggest that improved detection and treatment of T2DM in rural Ghana, and improved control for people with diagnosed T2DM in London and urban Ghana warrant prioritization. Further work is needed to understand the factors driving the differences.
Variations in hypertension awareness, treatment, and control among Ghanaian migrants living in Amsterdam, Berlin, London, and nonmigrant Ghanaians living in rural and urban Ghana-the RODAM study
(Journal of Hypertension, 2018-01) Agyemang, C.; Nyaaba, G.; Beune, E.; Meeks, K.; Owusu-Dabo, E.; Addo, J.; Aikins, A.D.-G.; Mockenhaupt, F.P.; Bahendeka, S.; Danquah, I.; Schulze, M.B.; Galbete, C.; Spranger, J.; Agyei-Baffour, P.; Henneman, P.; Klipstein-Grobusch, K.; Adeyemo, A. .; Van Straalen, J.; Commodore-Mensah, Y.; Appiah, L.T.; Smeeth, L.; Stronks, K.
Objectives: Hypertension is a major burden among African migrants, but the extent of the differences in prevalence, treatment, and control among similar African migrants and nonmigrants living in different contexts in high-income countries and rural and urban Africa has not yet been assessed. We assessed differences in hypertension prevalence and its management among relatively homogenous African migrants (Ghanaians) living in three European cities (Amsterdam, London, and Berlin) and nonmigrants living in rural and urban Ghana. Methods: A multicenter cross-sectional study was conducted among Ghanaian adults (n=5659) aged 25-70 years. Comparisons between sites were made using prevalence ratios with adjustment for age, education, and BMI. Results: The age-standardised prevalence of hypertension was 22 and 28% in rural Ghanaian men and women. The prevalence was higher in urban Ghana [men, 34%; adjusted prevalence ratio=1.37, 95% confidence interval (CI), 1.10-1.70]; and much higher in migrants in Europe, especially in Berlin (men, 57%; prevalence ratio=2.21, 1.78-2.73; women, 51%; prevalence ratio=1.74, 1.45-2.09) than in rural Ghana. Hypertension awareness and treatment levels were higher in Ghanaian migrants than in nonmigrant Ghanaians. However, adequate hypertension control was lower in Ghanaian migrant men in Berlin (20%; prevalence ratio=0.43 95%, 0.23-0.82), Amsterdam (29%; prevalence ratio=0.59, 0.35-0.99), and London (36%; prevalence ratio=0.86, 0.49-1.51) than rural Ghanaians (59%). Among women, no differences in hypertension control were observed. About 50% of migrants to 85% of rural Ghanaians with severe hypertension (Blood pressure>180/110) were untreated. Antihypertensive medication prescription patterns varied considerably by site. Conclusion: Hypertension prevalence, awareness, and treatment levels were generally higher in African migrants, but blood pressure control level was lower in Ghanaian migrant men compared with their nonmigrant peers. Further work is needed to identify key underlying factors to support prevention and management efforts.