The spatial patterns of diabetes mellitus in Ghana: A spatial autocorrelation technique
DOI:
https://doi.org/10.64712/jgeorr.v1i1.760Keywords:
Diabetes mellitus, spatial patterns, spatial autocorrelation, hotspot, coldspot, interventionAbstract
Diabetes mellitus (DM) is an emerging health problem worldwide, and low- and middle-income nations like Ghana carry a considerable load. However, DM spatial patterning in Ghana is largely under-researched, hence, effective interventions are difficult. This research analyses the spatial pattern of Type 1 (T1DM) and Type 2 (T2DM) diabetes in the Central Region of Ghana to identify DM clusters (hotspots and coldspots) for resource prioritization and management. A retrospective cross-sectional design was employed to examine 8,992 DM cases retrieved from thirteen (13) hospitals over the period 2008 - 2019. ’The results revealed substantial temporal and spatial heterogeneity in DM distribution. For T1DM, significant clustering varied annually, with persistent Low-Low clusters in southeastern MMDAs (e.g., Gomoa East) suggesting potential protective factors or under-diagnosis, and intermittent High-High clusters in urban centres like Cape Coast Metro, likely influenced by better healthcare access and urban lifestyles. The analysis for T2DM identified more stable patterns, with the Komenda Edina Eguafo Abirem (KEEA) district consistently emerging as a significant Low-High outlier. Key hotspots for T2DM included KEEA, Cape Coast Metro, and Twifo Hemang Lower Denkyira. The study highlights the uneven distribution of DM in the Central Region, emphasizing the role of spatial analysis in public health planning. By identifying high-risk areas, the Ministry of Health, Ghana Health Service and analogous agency must implement can strategically focus screening programs, educational campaigns, and resource allocation in areas requiring intensive intervention.
References
Agyemang, C., Meeks, K., Beune, E., Owusu-Dabo, E., Mockenhaupt, F. P., Addo, J., ... & Stronks, K. (2016). 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. BMC Medicine, 14(1), 166. https://doi.org/10.1186/s12916-016-0709-0
Anselin, L., & Rey, S. J. (2014). Modern spatial econometrics in practice: A guide to GeoDa, GeoDaSpace and PySAL. Chicago, IL: GeoDa Press.
Bahendeka, S., Kaushik, R., Swai, A. B., Otieno, F., Bajaj, S., Kalra, S., ... & Karigire, C. (2019). EADSG guidelines: insulin storage and optimisation of injection technique in diabetes management. Diabetes Therapy, 10(2), 341-366. https://doi.org/10.1007/s13300-019-0574-x
Beaglehole, R., Bonita, R., Horton, R., Adams, C., Alleyne, G., Asaria, P., ... & Watt, J. (2011). Priority actions for the non-communicable disease crisis. The Lancet, 377(9775), 1438-1447. https://doi.org/10.1016/S0140-6736(11)60393-0
Braimah, J. A., & Rosenberg, M. W. (2021). “They Do Not Care about Us Anymore”: Understanding the Situation of Older People in Ghana. International Journal of Environmental Research and Public Health, 18(5), 2337. https://doi.org/10.3390/ijerph18052337
CCTH. (2022). Annual Report. Cape Coast Teaching Hospital. Cape Coast
Damte, F. K. (2010). Prevalence of diabetes mellitus in the Assin North Municipality. [Unpublished master’s thesis]. University of Ghana.
Danne, T., Nimri, R., Battelino, T., Bergenstal, R. M., Close, K. L., DeVries, J. H., ... & Phillip, M. (2017). International consensus on use of continuous glucose monitoring. Diabetes Care, 40(12), 1631-1640. https://doi.org/10.2337/dc17-1600
Ghana Statistical Service (GSS) (2021). Ghana 2021 Population and Housing Census (PHC). General Reoprt. Volume 3C. Ghana Statistical Service. Accra. https://statsghana.gov.gh/searchread.php?searchfound=NzgwOTIyMTI4OTQuMDYz/search/soq24q5779
Harjutsalo, V., Sjöberg, L., & Tuomilehto, J. (2008). Time trends in the incidence of type 1 diabetes in Finnish children: a cohort study. The Lancet, 371(9626), 1777-1782. https://doi.org/10.1016/S0140-6736(08)60765-5
Heppenstall, A., Crooks, A., Malleson, N., Manley, E., Ge, J., & Batty, M. (2021). Future developments in geographical agent?based models: Challenges and opportunities. Geographical Analysis, 53(1), 76-91. https://doi.org/10.1111/gean.12267
Katey, D., Addo, A. A., Abass, K., & Morgan, A. K. (2022). Prevalence study of type 2 diabetes mellitus in the Ashanti region of Ghana: a systematic review of risk factors. Journal of Endocrinology, Metabolism and Diabetes in South Africa, 27(3), 93-99. https://hdl.handle.net/10520/ejc-m_jemdsa_v27_n3_a2
Kengne, A. P., Masconi, K., Mbanya, V. N., Lekoubou, A., Echouffo-Tcheugui, J. B., & Matsha, T. E. (2013). Risk predictive modelling for diabetes and cardiovascular disease. Critical Reviews in Clinical Laboratory Sciences, 51(1), 1–12. https://doi.org/10.3109/10408363.2013.853025
Krishnamoorthy, Y., Rajaa, S., Verma, M., Kakkar, R., & Kalra, S. (2023). Spatial Patterns and Determinants of Diabetes Mellitus in Indian Adult Population: A Secondary Data Analysis from Nationally Representative Surveys. Diabetes Therapy, 14(1), 63–75. https://doi.org/10.1007/s13300-022-01329-6
Mayer-Davis, E. J., Kahkoska, A. R., Jefferies, C., Dabelea, D., Balde, N., Gong, C. X., Aschner, P., & Craig, M. E. (2018). ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatric Diabetes, 19 Suppl 27(Suppl 27), 7–19. https://doi.org/10.1111/pedi.12773
Ministry of Health (15 November 2022). Twenty-four million adults in Africa are currently living with diabetes. Ministry of Health, Accra. https://www.moh.gov.gh/24-million-adults-in-africa-are-currently-living-with-diabetes/
Motala, A. A., Mbanya, J. C., Ramaiya, K., Pirie, F. J., & Ekoru, K. (2022). Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities. Nature Reviews Endocrinology, 18(4), 219-229. https://doi.org/10.1038/s41574-021-00613-y
Ngesa, O., Mwambi, H., & Achia, T. (2014). A flexible random effects distribution in disease mapping models. South African Statistical Journal, 48(1), 83-93. https://hdl.handle.net/10520/EJC154222
Ogle, G. D., James, S., Dabelea, D., Pihoker, C., Svennson, J., Maniam, J., ... & Patterson, C. C. (2022). Global estimates of incidence of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Atlas. Diabetes Research and Clinical Practice, 183, 109083. https://doi.org/10.1016/j.diabres.2021.109083
Ogugua, J. O., Olorunsogo, T. O., Muonde, M., Maduka, C. P., & Omotayo, O. (2024). Developing countries’ health policy: A critical review and pathway to effective healthcare systems. International Journal of Science and Research Archive, 11, 371-382. https://doi.org/10.30574/ijsra.2024.11.1.0069
Oti-Boateng, E., Ngesa, O., & Osei, F. B. (2016). Spatial modeling of diabetes cases in Ghana. International Journal of Science and Research, 5(8), 1404-1409. https://doi.org/10.21275/ART2016964
Patterson, C. C., et al. (2019). Trends and cyclical variation in the incidence of childhood type 1 diabetes. Diabetologia, 62(6), 1025-1034. https://doi.org/10.1007/s00125-018-4763-3
Sankoh, O., & Byass, P. (2012). The INDEPTH Network: filling vital gaps in global epidemiology. International Journal of Epidemiology, 41(3), 579-588. https://doi.org/10.1093/ije/dys081
Stahl-Pehe, A., Baechle, C., Lanzinger, S., Urschitz, M. S., Reinauer, C., Kamrath, C., ... & Rosenbauer, J. (2024). Trends in the incidence of type 1 diabetes and type 2 diabetes in children and adolescents in North Rhine-Westphalia, Germany, from 2002 to 2022. Diabetes & Metabolism, 50(5), 101567. https://doi.org/10.1016/j.diabet.2024.101567
Uloko, A. E., Musa, B. M., Ramalan, M. A., Gezawa, I. D., Puepet, F. H., Uloko, A. T., ... & Sada, K. B. (2018). Prevalence and risk factors for diabetes mellitus in Nigeria: a systematic review and meta-analysis. Diabetes Therapy, 9(3), 1307-1316. https://doi.org/10.1007/s13300-018-0441-1
UN (2024). World Diabetes Day: Diabetes and well-being. United Nations. Geneva. https://www.un.org/en/observances/diabetes-day
WHO (2023). Diabetes: the silent killer. Analytical factsheet, March 2023. https://files.aho.afro.who.int/afahobckpcontainer/production/files/iAHO_Diabetes_Regional_Factsheet.pdf
Wu, N. N., Zhao, D., Ma, W., Lang, J. N., Liu, S. M., Fu, Y., ... & Li, Q. (2021). A genome-wide association study of gestational diabetes mellitus in Chinese women. The Journal of Maternal-Fetal & Neonatal Medicine, 34(10), 1557-1564. https://doi.org/10.1080/14767058.2019.1640205
Xie, Y., Shekhar, S., & Li, Y. (2022). Statistically-robust clustering techniques for mapping spatial hotspots: A survey. ACM Computing Surveys (CSUR), 55(2), 1-38. https://doi.org/10.1145/348789
