Socio-Demographics and Behavioural Risk Factors of Non-Communicable Diseases in Ghana

Abstract

Introduction: Studies on non-communicable diseases have explored their prevalence and management. Whilst they provided valuable insights on NCDs globally, within sub-Saharan Africa and in Ghana, very few studies have delved into gender differences, using an intersectional approach to ascertain barriers to adherence and community-based perceptions of risks and interventions associated with hypertension, diabetes, and mental health disorders. This thesis explored these research areas among the adult population of Ghana. Methodology: The study was done using both qualitative and quantitative research methods. The quantitative data helped in exploring gender-specific socio-demographic predictors of hypertension, diabetes and mental health disorders as well as adherence to recommended lifestyle choices associated with hypertension. The dataset used was the nationally representative World Health Organization’s Study on Global Ageing and Adult Health (SAGE) Ghana survey Wave 2. Of the 4735 participants, 59% were females. Persons aged 50 years and above were 76%, since this age category was oversampled. The key non-communicable diseases that affected majority of the participants in this study were hypertension, diabetes and mental health disorders. For the quantitative, bivariate analysis was first conducted using t-tests to ascertain relationships between variables and subsequently, logit regressions employed for the multivariate analysis to help in predicting likely associations between the independent variables and the binary outcome variables. The multinomial regression was done to identify socio-demographic characteristics likely to predict adherence to recommended lifestyle choices. The qualitative data explored community perceptions on risks and interventions associated with hypertension, diabetes, and mental health disorders. This was done using 6 Focus Group Discussions (FGDs) in the Adentan Municipal Assembly. The transcripts were analyzed using thematic network analysis. Participants from the FGDs were categorized into three age categories, 18-34 years, 35-49 years and 50 years and above for both males and females. Results: The study outlined the socio-demographic characteristics predicting the NCDs under study for males and females. For males, these were educational status (C=0.88** SE 0.38), place of residence (C=0.86*** SE=0.25) and age (C=-0.95 SE=0.45) for hypertension, educational status (C=1.39** SE=0.66) and employment status (C=-0.86*** SE=0.18) for diabetes and ethnicity (C=1.41*** SE=0.32) and religion (C=1.29*** SE=0.38) for mental health disorders. For females, age (C=-1.70*** (SE=0.45), place of residence (C=0.66*** SE=0.17), wealth status (C=0.63*** SE=0.23) and ethnicity (C=0.45**, SE 0.21) were significant predictors of hypertension. Age (C=-2.39** SE=1.03) and place of residence (C=0.84** 0.3) for diabetes and employment status (C=-0.86*** SE=0.18) and religion (SE=1.29*** SE=0.38) for mental health disorders. The findings also show a high prevalence rate of hypertension with approximately 12% being aware they had hypertension and about 13% unaware of their hypertension status. Checked hypertension status revealed 3.4% in hypertension (uncontrolled), 8.4% in hypertension (controlled), 11.4% in hypertension (unaware) and 76.8% in no hypertension (true) groups. There was a significant relationship between diet and persons in the hypertension (uncontrolled) and hypertension (unaware) groups where consuming five or more fruit and/or vegetable servings per day had the likelihood of decreasing systolic blood pressure readings holding all other variables constant. Wealth status was a significant factor of adherence to recommended lifestyle practices for poor males in the hypertension (uncontrolled) and hypertension (controlled) groups where they were less likely to comply. Rich females in the hypertension (controlled) group were more likely to comply with the recommended lifestyle choices per the data. Under perceived risks and interventions as an organizing theme, participants highlighted in alignment with the biopsychosocial model how psychological factors, lifestyle choices, family history, lifelong ‘chronic’ diseases and spiritual factors were risk factors for developing and managing NCDs. In line with the perceived associated risks, the perceived interventions recommended by the respondents included orthodox treatment, herbal treatment, wellness strategies and prayers. Conclusions: The study identified gender differences on the predictors of NCDs. These are very informative when designing appropriate gender-specific interventions in the prevention and management of NCDs. The findings on the risk factors of NCDs for males and females, adherence to recommended lifestyle choices and perceived risks and interventions for NCDs were multifaceted. A comprehensive approach is needed to contribute to the prevention and management of NCDs.