Chronic diseases, the silent killer in Ghana

and how traditional wisdom could hold the anecdote

Africa, the land of malaria, HIV, and… hypertension.

“If HIV, with a national prevalence of 3.2%, constitutes a Millennium Development Goal challenge and commands multi-million dollar funding from Ghana’s development partners, why is hypertension, with a national prevalence of 28.7%, ignored?”. This statement is from “Ghana’s neglected chronic disease epidemic: a developmental challenge” published in the Ghana Medical Journal by Ama de-Graft Aikins.

Source: Novartis Foundation

Her point is a powerful one. The stereotype of Africa being a land of infectious diseases has allowed the chronic disease epidemic to sneak up on Ghana. In fact, HIV has a lower prevalence in Ghana than in Washington D.C.. Treatment for malaria has become more widespread and affordable, which has led to deaths being cut in half over the last decade. With drastically less attention than infectious diseases, chronic diseases remain a serious health risk for millions of Ghanaians.

Dr. Aikins has published a string of papers all trying to blow the whistle on the rise of chronic diseases in Ghana and propose solutions. She reveals, “By 2003 at least four (chronic disease) conditions — stroke, hypertension, diabetes and cancer — had become one of the top ten causes of death in at least each regional health facility”. We are seeing epidemic levels of chronic diseases in our Electronic Medical Recrod data as well; hopefully we will publish something on the matter to share the information publicly. Unfortunately, there is not enough aggregated data in Ghana to even accurately document this trend, but health care providers are well aware of the epidemic.

Dr. Naa, my colleague at the HIV clinic, and I had a long conversation about how managing hypertension has become a huge problem for her patients. There are generic drugs that can treat hypertension and are covered by Ghana’s national health insurance. Dr. Naa has found the non-generic drugs to be more effective, but these are too expensive for her average patient. Either people take the generics and hope they do something, or they just take nothing and pray for the best.

Another problem is that because of the focus on infectious diseases, the Ghanaian healthcare system was not built for chronic disease management, but rather for acute care. Having a primary care physician is not common. You fall sick, go to the hospital, get your acute issue taken care of, and leave. Chronic diseases are often discovered after it’s too late.

While development has brought access to malaria treatments, antibiotics, and ARVs to treat infectious diseases, it has had many negative implications on the Ghanaian diet.

“Our diet has been bastardized.”, said Kwame Otu, a Ghanaian professor at the University of Virginia, when we were discussing how unhealthy the Ghanaian diet has become. In Ghana, processed foods, fried foods, and large portions of carbohydrates are now widely available and cheap, which poses serious threats to health. We now see fried rice and instant noodles being sold at fast food joints on every corner in Accra. These refined carbs have low amounts of fiber and a high glycemic index that leads to many of the chronic diseases Ghana is battling.

The main drivers of the chronic disease epidemic are an aging population, rapid urbanization, and unhealthy lifestyles. People are cooking less. Unhealthy foods are widely available and more affordable than ever. The interesting thing is that, despite fertile lands, Ghana imports 1.6 Billion dollars in food annually, with the largest portion of this going to $329 million in rice, $155m in chicken, and $123m in wheat. These imported products are cheaper than home grown ones, and consequently hurt the local producers. In a way, chronic diseases have been imported.

The transformation of the Ghanaian diet in recent years is akin to the Americanization of Mexican food. Instead of a diet that relied heavily on beans, various chilies, and used little meat to flavor dishes, the US is addicted to burritos, which are nothing but a vessel for meat, dairy, and carbs wrapped in more carbs.

What is ironic about the effects of modernization on health is that traditional Ghanaian cuisine contains many cooking techniques and ingredients that constitute a healthy diet.

Traditional vegetable stews are primarily eaten with fibrous yams. The stews are made with local eggplants, tomatoes, beans, and greens which are then cooked with a variety of spices. In all the stews and soups, Ghanaians use spices that have medicinal properties such as ginger (akekaduro), cloves (pepre), anise (nkitinkiti), and hot chili peppers like Kpaposhitɔ. Waakye leaves give a famous bean dish from the north of Ghana its deep red color. Even in the case of rice, Ghanaians have a local rice, which like brown rice is more protein- and fiber-rich than the short grain white rice imported from Asia. The traditional cuisine is a diet rich in seafood, many types of fish, crabs, and shrimp.

Yam with stew made of greens

There is also the ancient African practice of fermentation. Fermentation not only serves as an effective preservation technique, it enables the growth of probiotics, which have many health benefits. In Ghana, commonly fermented foods include gari, banku, and dɔkuno. Dɔkuno is fermented and then boiled corn dough, dipped into a side of spicy tomato salsa served with fish. I generally eat this for lunch everyday when I’m in Accra. It reminds me of the filling to a tamale and is even similarly wrapped in corn husks. Not only is dɔkuno delicious, but the probiotics inside improve digestion and production of vitamins. Probiotic microbes inhibit the growth of food spoilers and can prevent diarrhea. Some have been shown to reduce “bad cholesterol”.

Banku (fermented corn and cassava dough) with tilapia

Going back to the roots of traditional Ghanaian cuisine could be the solution to solving the chronic health epidemic.

I’ve found this philosophy to be true in my own life. Once I started cooking the Mexican foods of my ancestors, I was able to maintain a much healthier lifestyle in the US. Our ancestors were wise, and we should not let the temptations of the 21st century spoil the centuries of knowledge that were put into fine-tuning our cuisines. There are obviously powerful economic forces at play dictating the availability of certain foods, but we have no choice but to fight back against them. Our well-being depends on it.

Now more than ever the Akan proverb, “Aduane 3 y3 aduro na aduro 3 y3 aduane” should resonate with us, which means, “Let your food be your medicine”.

Began writing to share my experiences in Ghana over the past decade. Originally from Ann Arbor, MI. I obtained a Ph.D. in Biostatistics from Harvard in 2020.