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Background: Genetic factors play an important role in prostate cancer (PCa) susceptibility.Objective: To discover common genetic variants contributing to the risk of PCa in men of African ancestry.Design, setting, and participants: We conducted a meta-analysis of ten genome-wide association studies consisting of 19378 cases and 61620 controls of African ancestry.Outcome measurements and statistical analysis: Common genotyped and imputed variants were tested for their association with PCa risk. Novel susceptibility loci were identified and incorporated into a multiancestry polygenic risk score (PRS). The PRS was evaluated for associations with PCa risk and disease aggressiveness.Results and limitations: Nine novel susceptibility loci for PCa were identified, of which seven were only found or substantially more common in men of African ancestry, including an African-specific stop-gain variant in the prostate-specific gene anoctamin 7 (ANO7). A multiancestry PRS of 278 risk variants conferred strong associations with PCa risk in African ancestry studies (odds ratios [ORs] >3 and >5 for men in the top PRS decile and percentile, respectively). More importantly, compared with men in the 40-60% PRS category, men in the top PRS decile had a significantly higher risk of aggressive PCa (OR = 1.23, 95% confidence interval = 1.10-1.38, p = 4.4 × 10-4).Conclusions: This study demonstrates the importance of large-scale genetic studies in men of African ancestry for a better understanding of PCa susceptibility in this high-risk population and suggests a potential clinical utility of PRS in differentiating between the risks of developing aggressive and nonaggressive disease in men of African ancestry.Patient summary: In this large genetic study in men of African ancestry, we discovered nine novel prostate cancer (PCa) risk variants. We also showed that a multiancestry polygenic risk score was effective in stratifying PCa risk, and was able to differentiate risk of aggressive and nonaggressive disease.

PURPOSE: African men are disproportionately affected by prostate cancer (PCa). Given the increasing prevalence of obesity in Africa, and its association with aggressive PCa in other populations, we examined the relationship of overall and central obesity with risks of total and aggressive PCa among African men. METHODS: Between 2016 and 2020, we recruited 2,200 PCa cases and 1,985 age-matched controls into a multicenter, hospital-based case-control study in Senegal, Ghana, Nigeria, and South Africa. Participants completed an epidemiologic questionnaire, and anthropometric factors were measured at clinic visit. Multivariable logistic regression was used to examine associations of overall and central obesity with PCa risk, measured by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), respectively. RESULTS: Among controls 16.4% were obese (BMI≥30 kg/m(2)), 26% and 90% had WC>97 cm and WHR>0.9, respectively. Cases with aggressive PCa had lower BMI/obesity in comparison to both controls and cases with less aggressive disease, suggesting weight loss related to cancer. Overall obesity (odds ratio: OR=1.38, 95%CI 0.99–1.93), and central obesity (WC>97cm: OR=1.60, 95%CI 1.10-2.33; and WHtR >0.59: OR=1.68, 95%CI 1.24-2.29) were positively associated with D’Amico intermediate-risk PCa, but not with risks of total or high-risk PCa. Associations were more pronounced in West versus South Africa, but these differences were not statistically significant. DISCUSSION: The high prevalence of overall and central obesity in African men and their association with intermediate-risk PCa represent an emerging public health concern in Africa. Large cohort studies are needed to better clarify the role of obesity and PCa in various African populations.

Background: Although approximately 79% of the world’s suicides occur in low- and middle-income countries (LMICs), the limited research in these regions has primarily focused on the rates of suicide attempts (SA) and ideation among men and younger members of the population. Aim: This study investigated the associations between bodily pain, functional limitation, chronic health conditions, and suicidal ideation among older Ghanaian women with a positive screen for depression. Methods: Data was obtained from the World Health Organization’s Study on global AGEing and adult health (SAGE) Ghana Wave 1, a nationally representative sample. Based on the interpersonal theory of suicide, we used logistic regression analysis to investigate the associations between the variables. Results: Functional limitation, bodily pain, hopelessness, and hypertension were significantly associated with a higher risk of suicidal ideation after accounting for sociodemographic and other confounding factors. Conclusions: Early interventions designed to decrease hopelessness, hypertension, and functional limitations may lead to reduced suicide ideation among older Ghanaian women who screen positive for depression.

Background Depression and hypertension interact through a complex interplay of social, behavioral and biological factors. Despite the huge burden of hypertension in the African sub-region, very little information exists on depression among hypertensive patients. This study assessed the prevalence and factors associated with depression among young and older adult hypertensive patients in Ghana. Method Data from the World Health Organization Study on Global AGEing and Adult Health wave 2 (2014/2015) for Ghana was used. Depression was estimated among participants with blood pressure 140/90mmHg and above. Weighted descriptive statistics and logistic regression with adjusted predictions were carried out. The analysis was performed using Stata 15. Result The overall prevalence of depression was 6.3%. Older hypertensive patients had almost twice the prevalence of depression compared with younger patients (8.4% vs 4.5%). The factors which predicted depression among hypertensive patients were educational level, marital status, religion, region of residence, work status, self-rated health (SRH), and unhealthy lifestyle. Participants with no religion were more than 7 times likely to be depressed compared with Christians [aOR(95%CI)=7.52(2.11-26.8)]. Those in the Volta region were more than 8 times likely to be depressed compared to those in the Greater Accra region [aOR(95%CI)=8.58(2.51-29.3)]. Conclusion Older adult hypertensive patients were more likely to experience depressive symptoms. Multiple factors predicted depression in both young and old hypertensive patients; thus a comprehensive care package including psychological support for patients with hypertension is essential for optimum clinical management.

Aims: The aim of this study is to describe the age-related risk of overweight/obesity among Ghanaians using data from the WHO Study on global AGEing and adult health (SAGE) Wave 2. Study Design: Cross sectional study. Place and Duration of Study: Ghana; 2014-2015. Methodology: Primary study variables were extracted onto Microsoft Excel 14.0 spreadsheet. Secondary variables were generated through grouping, recategorization and combination of primary variables. Descriptive statistics were calculated for age and BMI. Associations between respondents’ characteristics and BMI were evaluated with chi square(χ2) and odds ratio (OR) at 95% confidence level. Results: Data of 1322 respondents were included in data analysis. In all, 520 (39.3%) of the respondents were overweight/obese and nearly half (46.62%) were middle-aged adults. Middle-aged adults were nearly twice as likely to be overweight/obese compared with old adults (AOR=1.62; CI: 1.25-2.10) and the risk was higher for middle-aged females (AOR=2.38; CI: 1.84-3.09). Overall, being middle-aged (OR=1.73; CI: 1.35-2.21); living in an urban community (OR=2.01; CI: 1.61-2.52); being a female (OR=2.69; CI: 2.1-3.44); not engaging in regular physical activity (OR=1.49; CI: 1.18-1.88); and being an occasional drinker of alcoholic beverage (OR=1.58; CI: 1,12-2.22) were significantly associated with overweight/obesity. Conclusion: Obesity/overweight are lifestyle driven phenomenon and can be controlled by risk modification. Public sensitization, imposition of special taxes on sugary beverages, promotion of healthy local staples and creation of enabling community environments to encourage physical activity may be useful approaches in controlling the epidemic.

Background Cervical cancer is the third most common cancer that affects women worldwide. It has been and remains the leading cause of cancer mortality among women in Ghana. Despite the fact that cervical cancer is preventable through early detection and treatment of precancerous lesions, anecdotal evidence from gynaecological clinics in Ghana indicates that most patients present with a late stage of the disease. This study assesses the cervical cancer screening practices among women in Ghana. Methods Data from the World Health Organization’s (WHO) multi-country Study on AGEing and adult health (SAGE) wave 2 conducted between 2014 and 2015 in Ghana was used. We employed binary logistic regression models to analyse data on 2711 women to examine factors associated with having pelvic examination among women aged ≥18 years. Among those who had pelvic examination, we applied binary logistic regression models to analyse factors associated with receiving Pap smear test as a subgroup analysis. Results Of the 2711 women aged 18 years or older surveyed, 225 (8.3%) had ever had a pelvic examination and only 66 (2.4%) of them reported ever having done a Pap smear test. For those who had pelvic examination, only 26.94% had Pap smear test. Ethnic group, marital status, father’s educational level and difficulty with self-care were independently associated with undergoing pelvic examination. Only age and healthcare involvement were independently associated with pelvic examination within the past 5 years to the survey. Marital status, satisfaction with healthcare and healthcare involvement were independently associated with Pap smear test. Conclusion Even though cervical cancer is preventable through early detection of precancerous lesions using Pap smear test, the patronage of this screening test is still very low in Ghana. Factors influencing the low patronage in Ghana include the marital status of women, their level of satisfaction with healthcare as well as their level of involvement with healthcare. These may be the consequences of a weak health system and the lack of a national policy on cervical cancer screening.

Background Body-mass index (BMI) and blood pressure (BP) levels are rising in sub-Saharan African cities, particularly among women. However, there is very limited information on how much they vary within cities, which could inform targeted and equitable health policies. Our study aimed to analyse spatial variations in BMI and BP for adult women at the small area level in the city of Accra, Ghana. Methods and findings We combined a representative survey of adult women’s health in Accra, Ghana (2008 to 2009) with a 10% random sample of the national census (2010). We applied a hierarchical model with a spatial term to estimate the associations of BMI and systolic blood pressure (SBP) and diastolic blood pressure (DBP) with demographic, socioeconomic, behavioural, and environmental factors. We then used the model to estimate BMI and BP for all women in the census in Accra and calculated mean BMI, SBP, and DBP for each enumeration area (EA). BMI and/or BP were positively associated with age, ethnicity (Ga), being currently married, and religion (Muslim) as their 95% credible intervals (95% CrIs) did not include zero, while BP was also negatively associated with literacy and physical activity. BMI and BP had opposite associations with socioeconomic status (SES) and alcohol consumption. In 2010, 26% of women aged 18 and older had obesity (BMI ≥ 30 kg/m2), and 21% had uncontrolled hypertension (SBP ≥ 140 and/or DBP ≥ 90 mm Hg). The differences in mean BMI and BP between EAs at the 10th and 90th percentiles were 2.7 kg/m2 (BMI) and in BP 7.9 mm Hg (SBP) and 4.8 mm Hg (DBP). BMI was generally higher in the more affluent eastern parts of Accra, and BP was higher in the western part of the city. A limitation of our study was that the 2010 census dataset used for predicting small area variations is potentially outdated; the results should be updated when the next census data are available, to the contemporary population, and changes over time should be evaluated. Conclusions We observed that variation of BMI and BP across neighbourhoods within Accra was almost as large as variation across countries among women globally. Localised measures are needed to address this unequal public health challenge in Accra., Sierra N. Clark and colleagues analyze spatial variations of blood pressure and body mass index, and associated factors in Ghanaian women., Author summary Why was this study done? The social, physical, and food environment influence the spatial distribution of noncommunicable diseases and their risk factors such as blood pressure (BP) and body-mass index (BMI) within and across neighbourhoods in cities. In sub-Saharan Africa (SSA), where cities are growing rapidly and BMI and BP have risen, there is limited information on within-city variation in cardiometabolic risk factors. This information could inform targeted and equitable public health programmes. What did the researchers do and find? We combined data from an epidemiological study that had randomly sampled women in Accra and geospatial data on roads and community biomass fuel use to understand how individual and household factors as well as residence predict BMI and BP. Data were analysed in a Bayesian spatial model and then used together with the data from the census to predict BP and BMI levels for all women in Accra. Local area variation in BMI and BP is large within Accra, similar to patterns seen in other cities and regions around the world. Average BMI was higher among women with higher socioeconomic status (SES), as measured by ownership of assets and household infrastructure. What do these findings mean? The spatial variations in BMI and BP across neighbourhoods in Accra were almost as high as variation seen between countries. Localised public health actions can help address these disparities and reduce the resulting overall public health burden.

There is evidence that tumor immunobiology and immunotherapy response may differ between African American and European American prostate cancer patients. Here, we determined if men of African descent harbor a unique systemic immune-oncological signature and measured 82 circulating proteins in almost 3000 Ghanaian, African American, and European American men. Protein signatures for suppression of tumor immunity and chemotaxis were significantly elevated in men of West African ancestry. Importantly, the suppression of tumor immunity protein signature associated with metastatic and lethal prostate cancer, pointing to clinical significance. Moreover, two markers, pleiotrophin and TNFRSF9, predicted poor disease survival specifically among African American men. These findings indicate that immune-oncology marker profiles differ between men of African and European descent. These differences may contribute to the disproportionate burden of lethal prostate cancer in men of African ancestry. The elevated peripheral suppression of tumor immunity may have important implication for guidance of cancer therapy which could particularly benefit African American patients.

We estimated the prevalence of unmet needs of healthcare services (UNHS) and its associated factors among a cohort of older Ghanaian adults. World Health Organization (WHO) Study on Global AGEing and Adult Health for Ghana was used with a total of 4735 participants. Logistics regression analysis was performed using Stata 16 to assess associated factors. The overall UNHS was 3.7% (95% CI = 2.7-4.8) and the prevalence was significantly high amongst older adults aged 60 to 69 years (5.9%). Could not afford the healthcare (56.4%) was the main contender for UNHS. UNHS was influenced by; those aged 60 to 69 years [OR (95% CI) = 1.86 (1.19-2.91)]; no formal educational [aOR (95% CI) = 4.71 (1.27-17.38)], and no NHIS [OR (95% CI) = 1.78 (1.03-3.09)]. Participants needed care for joint pain (25.4%), and communicable diseases (19.1%). The inability to access healthcare was relatively higher for older adults more advanced in age, with low education, and for those without health insurance. Health system strengthening including financial protection by expanding the National Health Insurance Scheme to all Ghanaians in line with Ghana’s Universal Health Coverage Roadmap would reduce the unmet healthcare needs of older adults.

ObjectivesEstablished prostate cancer (PCa) risk factors include age, family history of PCa and African ancestry. Studies, mostly among highly screened, predominantly European ancestral populations, suggest that employment in certain occupations (eg, farming, military) may also have an increased risk for PCa. Here, we evaluated the association between usual adult occupation and PCa risk in Ghanaian men, a population with historically low rates of PCa screening.MethodsThe Ghana Prostate Study is a case-control study of PCa that was conducted from 2004 to 2012 in 749 cases and 964 controls. In-person interviews were conducted to collect information from participants, including longest held job. Industrial hygienists classified job titles into occupational categories. Unconditional logistic regression was used to calculate ORs and 95% CIs for the association between longest held job and PCa risk (overall, aggressive (Gleason≥7)), controlling for potential confounders.ResultsRisk was increased among men in management (overall PCa OR=2.2, 95% CI 1.4 to 3.2; aggressive PCa OR=2.2, 95% CI 1.3 to 3.5) and military occupations (overall PCa OR=3.4, 95% CI 1.7 to 7.0; aggressive PCa OR=3.5, 95% CI 1.5 to 8.3). Risks were also elevated for management and military-specific jobs based on 3-digit level Standard Occupational Classification definitions. Sensitivity analyses accounting for access to medical care did not show significant differences.ConclusionsOur study provides some evidence for increased risk of PCa among men in management and military occupations, which is consistent with the published literature. Additional research is needed to clarify the drivers of the associations between these occupations and PCa.

This paper assessed the transition probabilities between the stages of hypertension severity and the length of time an individual might spend at a particular disease state using the new American College of Cardiology/American Heart Association hypertension blood pressure guidelines. Data for this study were drawn from the Ghana WHO SAGE longitudinal study, with an analytical sample of 1884 across two waves. Using a multistate Markov model, we estimated a seven-year transition probability between normal/elevated blood pressure (systolic ≤ 129 mm Hg & diastolic

Universal salt iodization has been adopted by many countries to address iodine deficiency. More recently, salt-reduction strategies have been widely implemented to meet global salt intake targets of5 g/d. Compatibility of the two policies has yet to be demonstrated. This study compares urinary iodine excretion (UIE) according to 24-h urinary sodium excretion, between South Africa (SA) and Ghana; both countries have implemented universal salt iodization, but in Ghana no salt-reduction legislation has been implemented.Participants from the World Health Organization's Study on Global Ageing and Adult Health Wave 3, with survey and valid 24-h urinary data (Ghana, n = 495; SA, n = 707), comprised the sample. Median 24-h UIE was compared across salt intake categories of5, 5-9 and9 g/d.In Ghana, median sodium excretion indicated a salt intake of 10.7 g/d (interquartile range [IQR] = 7.6), and median UIE was 182.4 µg/L (IQR = 162.5). In SA, both values were lower: median salt = 5.6 g/d (IQR = 5.0), median UIE = 100.2 µg/L (IQR = 129.6). UIE differed significantly across salt intake categories (P0.001) in both countries, with positive correlations observed in both-Ghana: r = 0.1501, P0.0011; South Africa: r = 0.4050, P0.0001. Participants with salt intakes9 g/d in SA did not meet the World Health Organization's recommended iodine intake of 150 µg/d, but this was not the case in Ghana.Monitoring and surveillance of iodine status is recommended in countries that have introduced salt-reduction strategies, in order to prevent reemergence of iodine deficiency.

Background A previous multi-site study involving lower- and middle-income countries demonstrated that asthma in older adults is associated with long-term exposure to particulate matter, male gender and smoking. However, variations may occur within individual countries, which are relevant to inform health promoting policies as populations live longer. The present study estimates asthma prevalence and examines the sociodemographic characteristics and environmental determinants associated with asthma in older adults in Ghana. Methods This study utilised data from the nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2. A final sample of 4621 individuals residing in 3970 households was used in analytical modelling. Factors associated with asthma were investigated using single level and multilevel binary logistic regression models. Results Asthma was reported by 102 (2.2%) respondents. Factors associated with asthma in the univariate model were: those aged 60–69 (OR = 5.22, 95% CI: 1.24, 21.95) and 70 or more (OR = 5.56, 95% CI: 1.33, 23.26) years, Ga-Adangbe dialect group (OR = 1.65, 95% CI: 1.01, 2.71), no religion (OR = 3.59, 95% CI: 1.77, 7.28), having moderate (OR = 1.76, 95% CI: 1.13, 2.75) and bad/very bad (OR = 2.75, 95% CI: 1.58, 4.80) health state, and severe/extreme difficulty with self-care (OR = 3.49, 95% CI: 1.23, 9.88) and non-flush toilet facility (OR = 0.62, 95% CI: 0.39, 0.99). Factors independently associated with asthma in the adjusted models were: those aged 60–69 (OR = 4.49, 95% CI: 1.03, 19.55) years, father with primary education or less (OR = 0.40, 95% CI: 0.17, 0.94), no religion (OR = 2.52, 95% CI: 1.18, 5.41), and households with non-flush toilet facility (OR = 0.58, 95% CI: 0.35, 0.96). Significant residual household-level variation in asthma was observed. Over 40% of variance in asthma episodes could be attributable to residual household-level variations. Conclusion Individual as well as household factors were seen to influence the prevalence of asthma in this national survey. Clinical management of these patients in health facilities should consider household factors in addition to individual level factors.

Men of African descent, including African American (AA) men and Ghanaian (AFR) men, have a disproportionately higher burden of lethal prostate cancer (PCa) when compared to European American (EA) men. This increased mortality burden could be partially attributed to lifestyle factors including the intake of dietary fatty acids and their metabolism, but may also relate to differences in inflammation and immune function. Although the extent to which fatty acids are PCa risk factors remains controversial, the relationship between fatty acids, inflammation and immune function, and PCa in men of African descent remains largely unexplored. Therefore, the goal of our study was to characterize the relationship between circulating fatty acids, immune-oncological mediators, and PCa in the ethnically diverse NCI-Maryland and NCI-Ghana Prostate Cancer Case-Control studies, with an over-representation of men of African descent. A CLIA-certified, mass spectrometry-based assay was applied to measure 24 fatty acids in sera from 1,562 cases and 1,693 controls. Logistic regression analyses were performed on seven types of fatty acids including total, saturated, trans, cis-monounsaturated, omega-6, omega-3 fatty acids, and the omega 6:3 fatty acid ratio to explore disease associations by population group. Additionally, we measured 82 immune-oncological proteins in the same sera and explored their role as potential mediators of the relationship between fatty acids and PCa. Using this approach, we observed a significant association between trans fatty acid levels and the odds of developing PCa in all three racial/ethnic groups. Although AFR men were found to have the lowest level of trans fatty acids compared to AA and EA men, they still experienced significantly increased odds of developing PCa with increasing trans fatty acid levels. Exploratory mediation analyses found a relationship between Palmitelaidic trans fatty acid levels and two circulating proteins, CD27 and CXCL1, with protein levels being higher in men with elevated levels of circulating Palmitelaidic trans fatty acids and an increased risk of PCa. Our findings point to a previously unexplored oncogenic role of fatty acids and immune-oncological mediators in men of African descent with PCa. Citation Format: Brittany D. Lord, Tsion Minas, Tiffany H. Dorsey, Francine Baker, Wei Tang, Edward D. Yeboah, Yao Tettey, Richard B. Biritwum, Andrew A. Adjei, Evelyn Tay, James E. Mensah, Robert N. Hoover, Ann W. Hsing, Michael B. Cook, Stefan Ambs. Determining the association between circulating fatty acids, immune oncological markers, and prostate cancer risk in a diverse cohort [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-199.

Purpose Cancer of the prostate (CaP) is the leading cancer among men in sub-Saharan Africa (SSA). A substantial proportion of these men with CaP are diagnosed at late (usually incurable) stages, yet little is known about the etiology of CaP in SSA. Methods We established the Men of African Descent and Carcinoma of the Prostate Network, which includes seven SSA centers partnering with five US centers to study the genetics and epidemiology of CaP in SSA. We developed common data elements and instruments, regulatory infrastructure, and biosample collection, processing, and shipping protocols. We tested this infrastructure by collecting epidemiologic, medical record, and genomic data from a total of 311 patients with CaP and 218 matched controls recruited at the seven SSA centers. We extracted genomic DNA from whole blood, buffy coat, or buccal swabs from 265 participants and shipped it to the Center for Inherited Disease Research (Baltimore, MD) and the Centre for Proteomics and Genomics Research (Cape Town, South Africa), where genotypes were generated using the UK Biobank Axiom Array. Results We used common instruments for data collection and entered data into the shared database. Double-entered data from pilot participants showed a 95% to 98% concordance rate, suggesting that data can be collected, entered, and stored with a high degree of accuracy. Genotypes were obtained from 95% of tested DNA samples (100% from blood-derived DNA samples) with high concordance across laboratories. Conclusion We provide approaches that can produce high-quality epidemiologic and genomic data in multicenter studies of cancer in SSA.

BackgroundLittle is known about the joint mental health effects of air pollution and tobacco smoking in low- and middle-income countries.AimsTo investigate the effects of exposure to ambient fine particulate matter pollution (PM2.5) and smoking and their combined (interactive) effects on depression.MethodMultilevel logistic regression analysis of baseline data of a prospective cohort study (n=41785). The 3-year average concentrations of PM2.5 were estimated using US National Aeronautics and Space Administration satellite data, and depression was diagnosed using a standardised questionnaire. Three-level logistic regression models were applied to examine the associations with depression.ResultsThe odds ratio (OR) for depression was 1.09 (95% CI 1.01–1.17) per 10 μg/m3 increase in ambient PM2.5, and the association remained after adjusting for potential confounding factors (adjusted OR = 1.10, 95% CI 1.02–1.19). Tobacco smoking (smoking status, frequency, duration and amount) was also significantly associated with depression. There appeared to be a synergistic interaction between ambient PM2.5 and smoking on depression in the additive model, but the interaction was not statistically significant in the multiplicative model.ConclusionsOur study suggests that exposure to ambient PM2.5 may increase the risk of depression, and smoking may enhance this effect.

The prevalence of fusions of the transmembrane protease, serine 2, gene (TMPRSS2) with the erythroblast transformation-specific-related gene (ERG), or TMPRSS2:ERG, in prostate cancer varies by race. However, such somatic aberration and its association with prognostic factors have neither been studied in a West African population nor been systematically reviewed in the context of racial differences. We used immunohistochemistry to assess oncoprotein encoded by the ERG gene as the established surrogate of ERG fusion genes among 262 prostate cancer biopsies from the Ghana Prostate Study (2004-2006). Poisson regression with robust variance estimation provided prevalence ratios and 95% confidence intervals of ERG expression in relation to patient characteristics. We found that 47 of 262 (18%) prostate cancers were ERG-positive, and being negative for ERG staining was associated with higher Gleason score. We further conducted a systematic review and meta-analysis of TMPRSS2:ERG fusions in relation to race, Gleason score, and tumor stage, combining results from Ghana with 40 additional studies. Meta-analysis showed the prevalence of TMPRSS2:ERG fusions in prostate cancer to be highest in men of European descent (49%), followed by men of Asian (27%) and then African (25%) descent. The lower prevalence of TMPRSS2:ERG fusions in men of African descent implies that alternative genomic mechanisms might explain the disproportionately high prostate cancer burden in such populations.

In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007–2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.

Background Functional difficulty assessment has been proven as a key factor in the health evaluation of adults. Previous studies have shown a reduction in health and functional difficulties with increasing age. This analysis was conducted to quantify the effect of poor self-rated health on functional difficulty among older adults in Ghana. Method This analysis was based on the World Health Organization Study on Global AGEing and Adult Health in Ghana for older adults 50 years and above. Fifteen standard functioning difficulty tools were extracted and used for the analysis. Three predictive models with the Coarsened Exact Matching method involving Negative Binomial, Logistics and Ordered logistic regression were performed using Stata 14. Results Overall, the prevalence of poor Self-rated health was 34.9% and that of functional difficulties among older adults in Ghana was 69.4%. Female sex, increasing age, being separated, having no religious affiliation, not currently working and being underweight were associated with and significantly influence poor Self-rated health [AOR(95%CI)p-value = 1.41(1.08–1.83)0.011, 3.85(2.62–5.64)0.000, 1.45(1.08–1.94)0.013, 2.62(1.68–4.07)0.000, 2.4(1.85–3.12)0.000 and 1.39(1.06–1.81)0.017 respectively]. In addition, poor Self-rated health and geographical location (rural vs. urban)significantly influence functioning difficulties among older adults in Ghana as predicted by the three models [Negative Binomial: PR(95%CI) = 1.62(1.43–1.82), Binary logistic: AOR(95%CI) = 3.67(2.79–4.81) and ordered logistic: AOR(95%CI) = 2.53(1.14–2.03)]. Conclusion Poor SRH is more pronounced among older adult females in Ghana. Some determinants of poor SRH include; age, geographical location (urban vs. rural), marital status, religion, and employment status. This provides pointers to important socio-demographic determinants with implications on the social function of older adults in line with the theme of the national aging policy of 2010, ‘ageing with security and dignity’ and ultimately in the national quest to achieve the Sustainable Development Goals by 2030.

Obesity has been associated with an increased risk of advanced prostate cancer. However, most studies have been conducted among North American and European populations. Prostate cancer mortality appears elevated in West Africa, yet risk factors for prostate cancer in this region are unknown. We thus examined the relationship between obesity and prostate cancer using a case-control study conducted in Accra, Ghana in 2004–2012. Cases and controls were drawn from a population-based sample of 1,037 men screened for prostate cancer, yielding 73 cases and 964 controls. An additional 493 incident cases were recruited from the Korle-Bu Teaching Hospital. Anthropometric measurements were taken at enrollment. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR) and prostate cancer, adjusting for potential confounders. The mean BMI was 25.1 kg/m(2) for cases and 24.3 kg/m(2) for controls. After adjustment, men with BMI ≥30 kg/m(2) had an increased risk of prostate cancer relative to men with BMI

Objective To determine the uptake of mammography among Ghanaian women aged 40 years or older and to examine critical risk factors that influence the uptake. Study design A cross-sectional survey. Methods A nationally representative sample of 2787 women and 1948 men aged ≥18 years were surveyed in the Wave 2 (2014-2015) of the World Health Organization's multicountry study on AGEing and adult health in Ghana. Of the 2787 women aged ≥18 years, data on a total of 2301 women aged ≥40 years were included in this study. Univariable and multivariable logistic regression models were applied to examine critical risk factors for mammogram examination. Results Of the 2301 women sampled, only 83 (3.61%) ever had mammogram. The odds of mammogram examination were lower for women aged ≥70 years (odds ratio [OR] 0.42, 95% confidence interval [CI]: 0.19, 0.93), being self-employed (OR = 0.21, 95% CI: 0.11, 0.42) and being informal sector employee (OR = 0.26, 95% CI: 0.12, 0.57) in the multivariable analyses. Belonging to the Ewe ethnic group (OR=3.41, 95% CI:1.88, 6.16) compared to the Akan group was associated with increased odds of mammogram examination in the multivariable analysis. Women aged ≥70 years, being self-employed, being an informal employee and belonging to the Ewe ethnic group were independently associated with mammography examination. Conclusion The prevalence of screening for breast cancer using mammography among Ghanaian women aged 40 years and older was 3.6%. Age, type of employer and ethnicity were associated with an older adult woman's likelihood to access mammography screening. Overall, our study provided critical data to encourage and promote good health-seeking behaviour in terms of breast cancer screening among older adult women. Further qualitative studies are warranted to explore why some of these factors influence mammography.

Injuries are a significant cause of hospitalization in the older population, leading to a decline in physical activity and greater dependence on others. Compared to traffic related injury, relatively fewer studies have been conducted on non-traffic related injury in the older population in Ghana. This analysis provides a nationwide baseline prevalence and associated factors of non-traffic related injuries among older adults in Ghana. Data from the 2014–2015 nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2 was used. A final sample of 3461 older adults living in 2827 households was used in the statistical modelling. Predictors of injury were examined using both single-level and multilevel binary logistic regression models. The prevalence of non-traffic related injury found in this study was 3.74%. The odds of being injured decreased among females (OR = 0.66, 95% CI: 0.46, 0.95) compared to their male counterparts and those who rated their heath state as moderate (OR = 0.59, 95% CI: 0.38, 0.94). Depression was the only risk factor identified in the multivariable model (OR = 2.55, 95%CI: 1.38, 4.71). The study did not observe significant residual household-level variation in injury status. The role of depression as a risk factor suggests that interventions that aim to reduce non-traffic related injury in older adults should consider improving mental health., Highlights • Sex, self-reported health and depression predicted non-traffic related injury • Depression increases the odds of non-traffic related injury in older adults • Interventions that improve mental health might have potential benefits

Overweight/obesity is becoming increasingly prevalent in sub-Saharan Africa including Ghana. However, transition probabilities, an essential component to develop cost-effective measures for weight management is lacking in this population. We estimated annual transition probabilities between three body mass index (BMI) categories: normal weight (BMI ≥18.5 and

The prevalence of hypertension is increasing in low- and middle-income countries, however statistics are generally derived from cross sectional surveys that utilize different methodologies and population samples. We investigated blood pressure (BP) changes over 11–12 years in a large cohort of adults aged 50 years and older (n = 820) included in the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE Ghana) Wave 1 (2007/8) with follow up in Wave 3 (2019). Participants’ BP were measured in triplicate and a survey completed at both time points. Survey instruments collected information on sociodemographic characteristics, lifestyle, health behaviors and chronic conditions. While no significant difference was found in systolic BP between Waves 1 and 3, diastolic BP decreased by 9.7mmHg (mean = 88.6, 15.4 to 78.9, 13.6 respectively) and pulse pressure increased by 9.5mmHg (44.8, 13.7 to 54.3, 14.1). Awareness of hypertension increased by 37%, from (20% to 57%), but no differences were found for the proportion of hypertensives receiving treatment nor those that had controlled BP. Mixed effects modelling showed a decrease in diastolic BP was associated with increasing age, living in rural areas and having health insurance. Factors associated with an increased awareness of hypertension were residing in urban areas, having health insurance and increasing body mass index. While diagnosis of hypertension has improved over time in Ghana, there is an ongoing need to improve its treatment in older adults.

Introduction: Although breast cancer incidence in sub-Saharan African countries, including Ghana, has been historically low, incidence is rising. Evaluating age-specific incidence rates by breast cancer risk factors may provide etiologic insights. Here we present age-specific incidence rates for breast cancer estimated from the Ghana Breast Health Study (GBHS) for key breast cancer risk factors. Methods: GBHS is a population-based case-control study with 1,071 pathologically confirmed incident invasive breast cancer cases (18-74 years old) diagnosed between 2013-2015 in three hospitals in Accra and Kumasi. A total of 2,094 controls were sampled from the population, and frequency matched by site and age to the cases. Sample weights for controls were calculated using data from the 2010 Ghana Census, adjusted for non-response. Data on incident breast cancer cases in Accra (2012-2014) and Kumasi (2013-2015) were obtained from their respective cancer registries and compared to the incidence rates observed in the GBHS. Using data from GBHS adjusted by sampling weights, we estimated 5-year age-specific breast cancer incidence rates and 95% confidence intervals overall and according to breast cancer risk factors. Results: Age-specific breast cancer incidence rates estimated from the GBHS rose quickly until approximately age 50 when the rate plateaued but still rose (Clemmeson's hook), which was consistent with cancer registry data from Kumasi and Accra. The rates from the GBHS are not significantly different from the cancer registry rates under age 50 but are significantly higher after age 50. While the rates from the GBHS and Accra and Kumasi cancer registries were much lower than rates observed in the SEER registries for African American women, the trends were consistent. Analyses of overall rates by breast cancer risk factors showed that age-specific breast cancer risk was elevated among women with a family history of breast cancer across all ages. Data suggested cross-over interactions for other factors, particularly parity, and breastfeeding among parous women. Specifically, incidence rates were higher for parous than nulliparous women aged 20-35 years, while incidence rates were lower for parous and breastfeeding (among parous) women older than 35 years. Conclusions: Age-specific incidence rates of breast cancer that demonstrate cross-over interactions by risk factors may be important in understanding racial disparities in breast cancer incidence, overall as well as for specific breast cancer subtypes. Elevated risk among young parous women may be indicative of the higher risk associated with early-onset (triple-negative) breast cancer. Citation Format: Brittny Davis Lynn, Jonine Figueroa, Richard Biritwum, Beatrice Wiafe Addai, Baffour Awuah, Joe Net Clegg-Lamptey, Robertson Adjei, Lucy Afriyie, Joel Yarney, Naomi Oyoe Ohene Oti, Daniel Ansong, Seth Wiafe, Louise Brinton, Montserrat Garcia-Closas, Barry Graubard. Breast cancer age-specific incidence rates among Ghanaian women by breast cancer risk factors: A study using census and population-based case-control study data [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4636.

AimTo estimate the prevalence of visual impairment (VI) and associated factors and further quantify its association with social isolation, depression and life satisfaction among older adults in Ghana.MethodsWHO Study on Global AGEing and Adult Health Ghana dataset for older adults 50 years and above was used for this study. Social isolation, depression and life satisfaction were our primary outcomes with VI being our secondary outcome. We employed negative binomial, Poisson and generalised negative binomial regression models individually modified with Coarsened Exact Matching method of analysis. All analysis was performed by adopting robust SE estimation using Stata V.15.ResultsThe prevalence of VI was 17.1% (95% CI14.3 to 20.2) and the factors associated include age groups, educational level, religion, region, where the participant was born, and difficulty in work/households activity (pConclusionThe prevalence of VI is associated with increasing age, educational level and self-rated health. VI was identified to be associated with social isolation, depression and diminishing life satisfaction. In order to achieve sustainable development goal #3, a national focus on geriatric care as part of the implementation of the National Ageing Policy will garner improvement in the quality of life of older adults with visual VI in Ghana. Eye health practitioners at all levels of the health systems should consider the psychosocial consequences of VI for the optimum care of the older adult client.

Skin lighteners and hair relaxers, both common among women of African descent, have been suggested as possibly affecting breast cancer risk. In Accra and Kumasi, Ghana, we collected detailed information on usage patterns of both exposures among 1,131 invasive breast cancer cases and 2,106 population-controls. Multivariate analyses estimated odds ratios (OR) and 95% confidence intervals (CIs) after adjustment for breast cancer risk factors. Control usage was 25.8% for ever use of skin lighteners and 90.0% for use of hair relaxers for >1 year. The OR for skin lighteners was 1.10 (95% CI 0.93-1.32), with higher risks for former (1.21, 0.98-1.50) than current (0.96, 0.74-1.24) users. No significant dose-response relations were seen by duration, age at first or frequency of use. In contrast, an OR of 1.58 (95% CI 1.15-2.18) was associated with hair relaxers, with higher risks for former (2.22, 1.56-3.16) than current (1.39, 1.00-1.93) users. Although numbers of burns were inconsistently related to risk, associations increased with duration of use, restricted to women who predominately used non-lye products (p for trend

The World Health Organization (WHO) estimates that 79% suicides occur in low- and middle-income countries (LMICs) in 2016 (WHO, 2018) putting a spotlight on the topic of suicide in these countries. While the rates are highest among individuals ages 15 to 29 years, suicide affects individuals, families, and communities throughout the lifespan. The topic of suicide among older adults, especially those living in LMICs, has unfortunately received limited attention. Using a sample of 228 women with depression from the first wave of the WHO’s Study on global AGEing and adult health (SAGE, Ghana), the present study sought to identify predictors of suicide ideation among aging African women. Binominal logistic regression results revealed that wealth (negatively) and health (negatively) were associated with suicide ideation in the sample; indicating that the women who were poor and unhealthy were more likely to have suicidal thoughts. Implications of the findings for aging Ghanaian women will be addressed.

Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis and logistic regression was used to explore for predictors of antibiotic prescription. Average number of medicines prescribed per encounter was 4.01, and 59.9% of prescriptions had antibiotics whilst 24.2% had injections. In total, 79.2% and 88.1% of prescribed medicines were generics and from the national essential medicine list, respectively. In the multivariate analysis, health facility type (odds ratio [OR] = 2.05; 95% confidence interval [CI]: 1.42, 2.95), patient age (OR = 0.97; 95% CI: 0.97, 0.98), number of medicines on a prescription (OR = 1.85; 95% CI: 1.63, 2.10) and ‘no malaria drug’ on prescription (OR = 5.05; 95% CI: 2.08, 12.25) were associated with an antibiotic prescription. A diagnosis of upper respiratory tract infection was positively associated with antibiotic use. The level of antibiotic use varied depending on the health facility type and was generally high compared with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance Scheme, as the main purchaser of health services in Ghana, offers an opportunity that should be exploited to introduce policies in support of rational drug use.

Prostate cancer incidence is 1.6-fold higher in African Americans than in other populations. The risk factors that drive this disparity are unknown and potentially consist of social, environmental, and genetic influences. To investigate the genetic basis of prostate cancer in men of African ancestry, we performed a genome-wide association meta-analysis using two-sided statistical tests in 10 202 case subjects and 10 810 control subjects. We identified novel signals on chromosomes 13q34 and 22q12, with the risk-associated alleles found only in men of African ancestry (13q34: rs75823044, risk allele frequency = 2.2%, odds ratio [OR] = 1.55, 95% confidence interval [CI] = 1.37 to 1.76, P = 6.10 × 10−12; 22q12.1: rs78554043, risk allele frequency = 1.5%, OR = 1.62, 95% CI = 1.39 to 1.89, P = 7.50 × 10−10). At 13q34, the signal is located 5’ of the gene IRS2 and 3’ of a long noncoding RNA, while at 22q12 the candidate functional allele is a missense variant in the CHEK2 gene. These findings provide further support for the role of ancestry-specific germline variation in contributing to population differences in prostate cancer risk.

Salt consumption is high in Africa and the continent also shares the greatest burden of hypertension. This study examines salt-related knowledge, attitude and self-reported behaviours (KAB) amongst adults from two African countries—Ghana and South Africa—which have distributed different public health messages related to salt. KAB was assessed in the multinational longitudinal World Health Organisation (WHO) study on global AGEing and adult health (WHO-SAGE) Wave 2 (2014–2015). Respondents were randomly selected across both countries—Ghana (n = 6746; mean age 58 years old; SD 17; 41% men; 31% hypertensive) and South Africa (n = 3776, mean age 54 years old; SD 17; 32% men; 45% hypertensive). South Africans were more likely than Ghanaians to add salt to food at the table (OR 4.80, CI 4.071–5.611, p < 0.001) but less likely to add salt to food during cooking (OR 0.16, CI 0.130–0.197, p < 0.001). South Africans were also less likely to take action to control their salt intake (OR 0.436, CI 0.379–0.488, p < 0.001). Considering the various salt reduction initiatives of South Africa that have been largely absent in Ghana, this study supports additional efforts to raise consumer awareness on discretionary salt use and behaviour change in both countries.

Late diagnoses and poor prognoses of breast cancer are common throughout Africa. To identify responsible factors, we utilized data from a population-based case–control study involving 1184 women with breast malignancies conducted in three hospitals in Accra and Kumasi, Ghana. Interviews focused on potential breast cancer risk factors as well as factors that might contribute to presentation delays. We calculated odds ratios (OR) and 95% confidence intervals (CI) comparing malignances with biopsy masses larger than 5 cm. (62.4% of the 1027 cases with measurable lesions) to smaller lesions. In multivariate analyses, strong predictors of larger masses were limited education (OR 1.96, 95% CI 1.32–2.90

Objectives Edentulism has important health implications for aging individuals and is used as an indicator of the oral health of a population. Its distribution is unequal within populations, with the greatest burden on disadvantaged and socially marginalized populations. With an increasing older adult population in Ghana, its burden may increase; however, there is no nationwide information on edentulism in Ghana. Focusing on adults 50 years and older, this study assessed the prevalence of edentulism among older Ghanaians and its distribution across the country. Methods Secondary analysis of WHO's Study on global AGEing and adult health (SAGE) Wave 1 in Ghana was conducted using self-reported edentulism as the dependent variable. Results The overall prevalence was 2.8%, varying by sex (men had lower rates; OR = 0.67, 95% CI = 0.47-0.97); by location, being more prevalent in urban areas (3.6%) and the Western Region (4.7%); by education levels (rates were higher among those with no formal education; OR = 1.626, 95% CI = 1.111-2.380); and by marital status (those living without a partner had higher rates; OR = 1.980, 95% CI =1.366-2.870). On multivariate logistic regression, the variables positively associated with edentulism were older age (OR = 0.945) and urban residence (OR = 0.582). Living in the Brong Ahafo (OR = 3.138), Central (OR = 2.172), Eastern (OR = 2.257), or Volta regions (OR = 3.333) was negatively associated with edentulism. Conclusion Edentulism is unequally distributed across Ghana. Future aged cohorts are likely to follow the same patterns of geographic and social disadvantage if needed interventions are not carried out. This study provides nationwide data to assist service planning.

Ghana's population is ageing. In 2011, the Government of Ghana requested technical support from the World Health Organization (WHO) to help revise national policies on ageing and health.We applied WHO's knowledge translation framework on ageing and health to assist evidence based policy-making in Ghana. First, we defined priority problems and health system responses by performing a country assessment of epidemiologic data, policy review, site visits and interviews of key informants. Second, we gathered evidence on effective health systems interventions in low- middle- and high-income countries. Third, key stakeholders were engaged in a policy dialogue. Fourth, policy briefs were developed and presented to the Ghana Health Services.Ghana has a well-structured health system that can adapt to meet the health care needs of older people.Six problems were selected as priorities, however after the policy dialogue, only five were agreed as priorities by the stakeholders. The key stakeholders drafted evidence-based policy recommendations that were used to develop policy briefs. The briefs were presented to the Ghana Health Service in 2014.The framework can be used to build local capacity on evidence-informed policy-making. However, knowledge translation tools need further development to be used in low-income countries and in the field of ageing. The terms and language of the tools need to be adapted to local contexts. Evidence for health system interventions on ageing populations is very limited, particularly for low- and middle-income settings.La population du Ghana est vieillissante. En 2011, le gouvernement du Ghana a sollicité l'assistance technique de l'Organisation mondiale de la Santé (OMS) pour l'aider à réviser ses politiques nationales relatives au vieillissement et à la santé.Nous avons appliqué le cadre d'application des connaissances de l'OMS sur le vieillissement et la santé pour aider à élaborer des politiques fondées sur les données au Ghana. Premièrement, nous avons défini les problèmes prioritaires et les réponses du système de santé en réalisant une évaluation nationale des données épidémiologiques, une révision des politiques, des visites sur site et des entrevues menées auprès des informateurs clés. Deuxièmement, nous avons recueilli les données sur les interventions efficaces des systèmes de santé dans les pays à revenu faible, intermédiaire et élevé. Troisièmement, les principales parties prenantes ont été engagées dans un dialogue politique. Quatrièmement, des documents politiques ont été élaborés et présentés aux Services de Santé du Ghana.Le Ghana possède un système de santé bien structuré, qui peut s'adapter pour répondre aux besoins des personnes âgées en matière de soins de santé.Six problèmes ont été sélectionnés comme prioritaires. Cependant, après le dialogue politique, seuls cinq d'entre eux ont été acceptés comme prioritaires par les parties prenantes. Les principales parties prenantes ont rédigé des recommandations pour les politiques fondées sur les données qui ont été utilisées pour élaborer les documents politiques. Les documents ont été présentés aux Services de Santé du Ghana en 2014.Le cadre peut être utilisé pour renforcer les capacités locales en matière d'élaboration des politiques fondées sur les données. Cependant, les outils d'application des connaissances ont besoin d'être davantage développés pour être utilisés dans les pays à revenu faible et dans le domaine du vieillissement. Les termes et la langue des outils doivent être adaptés aux contextes locaux. Les données des interventions du système de santé sur les populations vieillissantes sont très limitées, en particulier pour les pays à revenu faible et intermédiaire.La población de Ghana está envejeciendo. En 2011, el Gobierno de Ghana solicitó la asistencia técnica de la Organización Mundial de la Salud (OMS) para ayudar a revisar las políticas nacionales sobre el envejecimiento y la salud.Aplicamos el marco de traducción de conocimientos de la OMS sobre el envejecimiento y la salud para apoyar la formulación de políticas basadas en datos empíricos en Ghana. En primer lugar, definimos los problemas prioritarios y las respuestas del sistema de salud mediante la realización de una evaluación nacional de los datos epidemiológicos, una revisión de la política, visitas de campo y entrevistas a informantes clave. En segundo lugar, recopilamos datos empíricos sobre las intervenciones de los sistemas de salud eficaces en países de ingresos bajos, medios y altos. En tercer lugar, las principales partes interesadas entablaron un diálogo sobre políticas y, en cuarto lugar, se desarrollaron y presentaron informes de políticas a los Servicios de Salud de Ghana.Ghana tiene un sistema de salud bien organizado, capaz de adaptarse para atender las necesidades de asistencia sanitaria de las personas mayores.Se seleccionaron seis problemas como prioridades, sin embargo después del diálogo sobre políticas, las partes interesadas acordaron solo cinco de ellos como prioritarios. Las principales partes interesadas redactaron recomendaciones políticas basadas en datos empíricos que se usaron para desarrollar informes sobre políticas. Los escritos se presentaron al Servicio de Salud de Ghana en 2014.El marco puede utilizarse para potenciar las capacidades locales en la formulación de políticas basadas en datos empíricos. Sin embargo, las herramientas de traducción de conocimientos necesitan un mayor desarrollo para emplearse en los países de ingresos bajos y en el ámbito del envejecimiento. Los términos y el lenguaje de las herramientas deben adaptarse a los contextos locales. Los datos empíricos acerca de las intervenciones del sistema de salud sobre el envejecimiento de la población son muy limitados, sobre todo para los contextos de ingresos bajos y medios.يشيخ سكان غانا. وفي عام 2011، طلبت حكومة غانا الدعم التقني من منظمة الصحة العالمية للمساعدة في تنقيح السياسات الوطنية بشأن الشيخوخة والصحة.قمنا بتطبيق إطار ترجمة معارف منظمة الصحة العالمية بشأن الشيخوخة والصحة للمساعدة في وضع السياسات المسندة إلى البيّنات في غانا. أولاً، قمنا بتحديد المشكلات ذات الأولوية وأوجه استجابة النظام الصحي عن طريق إجراء تقييم قطري للبيانات الوبائية واستعراض السياسة والزيارات الميدانية والمقابلات التي أجريت مع مبلغي المعلومات الرئيسيين. ثانياً، قمنا بتجميع البيّنات بشأن تدخلات النظم الصحية الفعالة في البلدان المنخفضة الدخل والبلدان المتوسطة الدخل والبلدان المرتفعة الدخل. ثالثاً، تم إشراك أصحاب المصلحة الرئيسيين في حوار حول السياسات. رابعاً، تم وضع تقارير موجزة عن السياسات وتقديمها إلى الخدمات الصحية في غانا.يوجد لدى غانا نظام صحي منظم بشكل جيد يمكنه التكيف لتلبية احتياجات الرعاية الصحية للمسنين.تم تحديد ست مشكلات كأولويات، غير أنه بعد الحوار الذي أجري حول السياسات، لم يتم الاتفاق من جانب أصحاب المصلحة سوى على خمس منها كأولويات. وقام أصحاب المصلحة الرئيسيين بوضع مسودة التوصيات السياسية المسندة إلى البيّنات التي استخدمت لوضع التقارير الموجزة عن السياسات. وتم تقديم التقارير الموجزة إلى الخدمة الصحية في غانا في عام 2014.يمكن استخدام الإطار لبناء القدرة المحلية بشأن وضع السياسات المستنيرة بالبيّنات. ومع ذلك، يجب مواصلة تطوير أدوات ترجمة المعارف لاستخدامها في البلدان المنخفضة الدخل وفي مجال الشيخوخة. ويجب تكييف مصطلحات الأدوات ولغتها حسب السياقات المحلية. وتتسم البيّنات الخاصة بتدخلات النظم الصحية بشأن الفئات السكانية المسنة بالمحدودية الشديدة، لا سيما بخصوص البيئات المنخفضة الدخل والبيئات المتوسطة الدخل.加纳人口正在老龄化。2011年，加纳政府请求世界卫生组织（WHO）提供技术支持以帮助修订有关老龄化和卫生的国家政策。我们应用WHO有关老龄化与卫生的知识转化框架来帮助加纳的询证决策。首先，我们通过执行国家流行病学数据评估、政策评估、现场走访和面访关键信息提供者来定义优先级问题和卫生系统的回应。其次，我们收集中低收入和高收入国家有关有效卫生系统干预措施的证据。第三，召集关键利益相关者参与政策对话。第四，编制政策简报并呈递给加纳卫生总局。加纳卫生系统结构完善，通过调适能够满足老年人的卫生保健需求。入选的优先问题有六个，然而在政策对话后，利益相关者只同意其中五个为优先问题。关键的利益相关者起草用于编制政策简报的询证政策建议。简报于 2014年呈递给加纳卫生总局。框架可用于构建知证的地方政策制定能力。然而，知识转化工具需要进一步开发，以便在低收入国家和老龄化的领域中使用。工具的术语和语言需要与当地的环境相适应。卫生系统人口老龄化干预措施的证据非常有限，在中低收入背景中尤其如此。Население Ганы стареет. В 2011 году правительство Ганы запросило техническую поддержку у Всемирной организации здравоохранения (ВОЗ) для помощи в пересмотре национальной политики в области старения и здравоохранения.Была использована модель преобразования знаний ВОЗ по проблемам старения и здоровья для помощи в разработке доказательно-обоснованной политики в Гане. Во‑первых, были определены приоритетные проблемы и реакция системы здравоохранения путем выполнения страновой оценки эпидемиологических данных, обзора политики, посещения мест и опросов ключевых источников информации. Во‑вторых, были собраны свидетельства эффективных мероприятий в системах здравоохранения в странах с низким, средним и высоким уровнями доходов. В-третьих, в диалог по разработке политики были вовлечены основные заинтересованные стороны. В‑четвертых, были разработаны концепции политики, которые затем были представлены Службе здравоохранения Ганы.Гана располагает хорошо структурированной системой здравоохранения, которая может адаптироваться для удовлетворения потребностей пожилых людей в медицинской помощи.В качестве приоритетных были выбраны шесть проблем, однако после диалога по вопросам разработки политики только пять из них были согласованы в качестве приоритетных заинтересованными сторонами. Основные заинтересованные стороны составили рекомендации по доказательно-обоснованной политике, которые были использованы для разработки концепций политики. Эти концепции были представлены Службе здравоохранения Ганы в 2014 году.Эта модель может использоваться для создания местного потенциала для разработки фактологически-обоснованной политики. Однако, необходимо продолжить разработку инструментов преобразования знаний, которые будут использоваться в странах с низким уровнем дохода и в области старения. Термины и язык инструментов должны быть адаптированы к местным условиям. Фактические данные для проведения мероприятий, касающихся старения населения, в системах здравоохранения весьма ограничены, особенно в странах с низким и средним уровнями доходов.

Genome-wide association studies (GWAS) have mapped risk alleles for at least 10 distinct cancers to a small region of 63 000 bp on chromosome 5p15.33. This region harbors the TERT and CLPTM1L genes; the former encodes the catalytic subunit of telomerase reverse transcriptase and the latter may play a role in apoptosis. To investigate further the genetic architecture of common susceptibility alleles in this region, we conducted an agnostic subset-based meta-analysis (association analysis based on subsets) across six distinct cancers in 34 248 cases and 45 036 controls. Based on sequential conditional analysis, we identified as many as six independent risk loci marked by common single-nucleotide polymorphisms: five in the TERT gene (Region 1: rs7726159, P = 2.10 x 10(-39); Region 3: rs2853677, P = 3.30 x 10(-36) and PConditional = 2.36 x 10(-8); Region 4: rs2736098, P = 3.87 x 10(-12) and PConditional = 5.19 x 10(-6), Region 5: rs13172201, P = 0.041 and PConditional = 2.04 x 10(-6); and Region 6: rs10069690, P = 7.49 x 10(-15) and PConditional = 5.35 x 10(-7)) and one in the neighboring CLPTM1L gene (Region 2: rs451360; P = 1.90 x 10(-18) and PConditional = 7.06 x 10(-16)). Between three and five cancers mapped to each independent locus with both risk-enhancing and protective effects. Allele-specific effects on DNA methylation were seen for a subset of risk loci, indicating that methylation and subsequent effects on gene expression may contribute to the biology of risk variants on 5p15.33. Our results provide strong support for extensive pleiotropy across this region of 5p15.33, to an extent not previously observed in other cancer susceptibility loci.

BACKGROUND Genome-wide association studies (GWAS) have identified that a ∼1 M region centromeric to the MYC oncogene on chromosome 8q24.21 harbors at least five independent loci associated with prostate cancer risk and additional loci associated with cancers of breast, colon, bladder, and chronic lymphocytic leukemia (CLL). Because GWAS identify genetic markers that may be indirectly associated with disease, fine-mapping based on sequence analysis provides important insights into patterns of linkage disequilibrium (LD) and is critical in defining the optimal variants to nominate for biological follow-up. METHODS To catalog variation in individuals of African ancestry, we resequenced a region (250 kb; chr8:128,050,768–128,300,801, hg19) containing several prostate cancer susceptibility loci as well as a locus associated with CLL. Our samples included 78 individuals from Ghana and 47 of African-Americans from Johns Hopkins University. RESULTS After quality control metrics were applied to next-generation sequence data, 1,838 SNPs were identified. Of these, 285 were novel and not yet reported in any public database. Using genotypes derived from sequencing, we refined the LD and recombination hotspots within the region and determined a set of tag SNPs to be used in future fine-mapping studies. Based on LD, we annotated putative risk loci and their surrogates using ENCODE data, which should help guide laboratory studies. CONCLUSIONS In comparison to the 1000 Genome Project data, we have identified additional variants that could be important in establishing priorities for future functional work designed to explain the biological basis of associations between SNPs and both prostate cancer and CLL. Prostate 74:579–589, 2014. © 2014 Wiley Periodicals, Inc.

Genome-wide association studies (GWAS) have identified 76 variants associated with prostate cancer risk predominantly in populations of European ancestry. To identify additional susceptibility loci for this common cancer, we conducted a meta-analysis of > 10 million SNPs in 43,303 prostate cancer cases and 43,737 controls from studies in populations of European, African, Japanese and Latino ancestry. Twenty-three new susceptibility loci were identified at association P < 5 × 10(-8); 15 variants were identified among men of European ancestry, 7 were identified in multi-ancestry analyses and 1 was associated with early-onset prostate cancer. These 23 variants, in combination with known prostate cancer risk variants, explain 33% of the familial risk for this disease in European-ancestry populations. These findings provide new regions for investigation into the pathogenesis of prostate cancer and demonstrate the usefulness of combining ancestrally diverse populations to discover risk loci for disease.

Introduction Attempting to curb the rising epidemic of hypertension, South Africa implemented legislation in June 2016 mandating maximum sodium levels in a range of manufactured foods that contribute significantly to population salt intake. This natural experiment, comparing two African countries with and without salt legislation, will provide timely information on the impact of legislative approaches addressing the food supply to improve blood pressure in African populations. This article outlines the design of this ongoing prospective nested cohort study. Methods and analysis Baseline sodium intake was assessed in a nested cohort of the WHO Study on global AGEing and adult health (WHO-SAGE) wave 2 (2014–2015), a multinational longitudinal study on the health and well-being of adults and the ageing process. The South African cohort consisted of randomly selected households (n=4030) across the country. Spot and 24-hour urine samples are collected in a random subsample (n=1200) and sodium, potassium, creatinine and iodine analysed. Salt behaviour and sociodemographic data are captured using face-to-face interviews, alongside blood pressure and anthropometric measures. Ghana, the selected control country with no formal salt policy, provided a nested subsample (n=1200) contributing spot and 24-hour urine samples from the SAGE Ghana cohort (n=5000). Follow-up interviews and urine collection (wave 3) in both countries will take place in 2017 (postlegislation) to assess change in population-level sodium intake and blood pressure. Ethics and dissemination SAGE was approved by the WHO Ethics Review Committee (reference number RPC149) with local approval from the North-West University Human Research Ethics Committee and University of the Witwatersrand Human Research Ethics Committee (South Africa), and University of Ghana Medical School Ethics and Protocol Review Committee (Ghana). The results of the study will be published in peer-reviewed international journals, presented at national and international conferences, and summarised as research and policy briefs.

BackgroundStudies on changes in the prevalence and determinants of obesity in older adults living in sub-Saharan Africa are limited. We examined recent changes in obesity prevalence and associated factors for older adults in Ghana between 2007/08 and 2014/15.MethodsData on adults aged 50 years and older in Ghana were collected in the WHO SAGE Wave 1 (2007/08; n=4158) and Wave 2 (2014/15; n=1663). The weighted prevalence of obesity, overweight, normal weight and underweight, and of high central adiposity was compared in Waves 1 and 2. Multinomial and binomial logistic regressions were used to examine whether the determinants of weight status based on objectively measured body mass index and waist circumference changed between the two survey periods.ResultsThe prevalence of obesity (Wave 1=10.2%, 95% CI: 8.9-11.7%; Wave 2=15.0%, 95% CI: 12.6-17.7%) and overweight (Wave 1=19.6%, 95% CI: 18.0-21.4%; Wave 2=24.5%, 95% CI: 21.7-27.5%) was higher in Wave 2 than Wave 1 and more than half of the population had high central adiposity (Wave 1=57.7%, 95% CI: 55.4-60.1%; Wave 2=66.9%, 95% CI: 63.7-70.0%) in both study periods. Obesity prevalence was 16% lower in males and 55% higher in females comparing Wave 1 to Wave 2. Female sex, urban residence, and high household wealth were associated with higher odds of overweight/obesity and high central adiposity. Those aged 70+ years had lower odds of obesity in both study waves. In Wave 2, females with physical activity level were more likely to be obese.ConclusionOver the 7-year period between survey waves, the population prevalence of overweight and obesity increased by 25% and 47%, respectively, while underweight reduced by 43%. These findings differed considerably by sex, which points to differential impacts of past initiatives to reduce overweight/obesity, potential high-risk groups in Ghana, and the need to increase surveillance.

BACKGROUND: In case-control studies, population controls can help ensure generalizability; however, the selection of population controls can be challenging in environments that lack population registries. We developed a population enumeration and sampling strategy to facilitate use of population controls in a breast cancer case-control study conducted in Ghana.METHODS: Household enumeration was conducted in 110 census-defined geographic areas within Ghana's Ashanti, Central, Eastern, and Greater Accra Regions. A pool of potential controls (women aged 18 to 74 years, never diagnosed with breast cancer) was selected from the enumeration using systematic random sampling and frequency-matched to the anticipated distributions of age and residence among cases. Multiple attempts were made to contact potential controls to assess eligibility and arrange for study participation. To increase participation, we implemented a refusal conversion protocol in which initial non-participants were re-approached after several months.RESULTS: 2,528 women were sampled from the enumeration listing, 2,261 (89%) were successfully contacted, and 2,106 were enrolled (overall recruitment of 83%). 170 women were enrolled through refusal conversion. Compared with women enrolled after being first approached, refusal conversion enrollees were younger and less likely to complete the study interview in the study hospital (13% vs. 23%). The most common reasons for non-participation were lack of interest and lack of time.CONCLUSIONS: Using household enumeration and repeated contacts, we were able to recruit population controls with a high participation rate. Our approach may provide a blue-print for others undertaking epidemiologic studies in populations that lack accessible population registries.