CHAPTER THREE

3.1 INTRODUCTION

Health screening is a medical test that is offered to a group, or individual, to detect or

rule out the presence of diseases, conditions and general health risks. Our objective on

Wednesday, July 10, 2024, was to screen the inhabitants of Seth Okai. The

community was welcoming and provided immense support during our preparation for

the screening. The screening program, organized at the community center,

commenced at 9:00 AM and concluded at 4:00 PM. A total of 176 individuals

attended the screening, with 65% of participants being female. Various stations were

set up to collect biodata, anthropometric measurements, laboratory samples, and offer

consultations. There was a waiting area setup where participants sat to wait for their

turn. The first point of contact was where biodata was received alongside assessment

of respiration. Participants will then move to the blood pressure station where there

was a sphygmomanometer to check the blood pressure of patients. The next station

was the laboratory station where blood was taken and used to screen for sickling,

blood grouping and typhoid fever. The next station was the anthropometry station and

finally they were sent to counselling team to advise them based on all the results from

the various stations. The other two tables were for data entry and a mini refreshment

setup. In a nutshell the screening was a successful one, despite the tedious nature of it.

3.2 METHODOLOGY

3.2.1 Study design

The screening was conducted as a cross-sectional study.

3.2.2 Study site

The study site for the screening was Seth Okai.

3.2.3 Participants

Inhabitants of the Seth Okai community were recruited for the screening. A total of

176 participants were screened.

3.2.4 Participants information

Upon arrival, participants' names and ages were registered. Each participant received

a form with slots for blood pressure measurement, anthropometry, laboratory tests,

and consultations.

3.2.5 Blood pressure measurement

An automated sphygmomanometer was used. Participants were seated comfortably

with their arms resting at heart level. The sphygmomanometer cuff was wrapped

around the upper arm, just above the elbow. The cuff was inflated until blood flow

through the arm stopped and the radial pulse could not be felt. Air was then slowly

released, and the sphygmomanometer displayed the blood pressure and pulse.

3.2.6 Anthropometric measurement

Anthropometric measurements, which assess the size, shape, and composition of the

human body, were taken using an OMRON Body Composition Meter. Participants

stood barefooted on the device and held out the handle bars with their arms stretched

out for the readings to be taken. Measurements included weight, height, body mass

index (BMI), percentage muscle mass, visceral fat, waist and hip circumferences,

metabolic rate, and percentage body fat.

3.2.7 Laboratory procedures

[Link] Blood sample collection

Capillary blood samples were collected. Participants' fingers were examined and

cleaned with a 70% alcohol swab before a sterile lancet was used to prick the finger.

Blood was collected for various tests.

[Link] Sickle cell testing

Blood samples were tested for sickle cell disease. Results were recorded as either

positive or negative.

[Link] Typhoid testing

Blood samples were tested for typhoid using specific test kits. Results were recorded

as either positive or negative.

[Link] Blood grouping

Blood group and Rh factor were determined for participants using standard blood

grouping reagents.

3.2.8 Consultation

The final station was the consultation area where experienced clinical students

reviewed the findings from the laboratory tests, provided advice on healthy living,

especially for individuals with risk factors for hypertension, and offered counseling

and referrals for newly diagnosed conditions.

3.2.9 Data management

All collected health data were recorded on forms and backed up on a computer. The

data was later analyzed to identify prevalent health issues and risk factors within the

community.
3.3 RESULTS

3.3.1 Demographic characteristics of participants

The health screen survey encompassed a diverse demographic, with a total of 176

participants. The age distribution revealed that the largest cohort comprised

individuals aged 5-14 years, representing 21.6% of the total population. This was

followed closely by participants over 59 years of age, who accounted for 21.0%.

Other notable age groups included those under 5 years (10.8%), 30-39 years (10.8%),

and 40-49 years (10.8%). Smaller segments were noted in the 15-19 years (9.7%), 50-

59 years (9.7%), and 20-29 years (5.7%) age brackets. These figures highlight a

significant representation of young individuals and elderly participants, indicating a

broad spectrum of ages within the screened population.

Table 3.1 Age distribution

Age Groups Frequency Percentage

<5 19 10.8

5-14 38 21.6

15-19 17 9.7

20-29 10 5.7

30-39 19 10.8

40-49 19 10.8

50-59 17 9.7

>59 37 21.0

Total 176 100.0

The sex distribution within the screened population showed a marked predominance

of females. Out of the 176 participants, 115 were female, making up 65.3% of the

total, while males constituted 34.7% with 61 participants. This disparity suggests that

females were more likely to participate in the health screening than their male

counterparts.

Table 3.2 Sex distribution

Sex Frequency Percentage

Female 115 65.3

Male 61 34.7

Total 176 100.0

3.3.3 Body mass index (BMI)

Body Mass Index (BMI) analysis classified participants into four categories:

underweight, normal weight, overweight, and obese. A significant portion of the

population (42.1%) was underweight, while 32.7% fell within the normal weight

range. Overweight individuals constituted 17.5%, and those categorized as obese

made up 7.6% of the participants. This distribution indicates that a substantial 67% of

the population had BMI values outside the normal range, pointing towards prevalent

weight-related health issues.

Table 3.3 BMI categories

BMI Frequency Percentage

Normal 56 32.7
Underweight 72 42.1

Overweight 30 17.5

Obese 13 7.6

Total 171 100.0

Table 3.4 BMI by age

<5 5-14 15-19 20-29 30-39 40-49 50-59 >59 Total

Normal Frequency 3 16 10 2 5 6 8 22 72

Percentage 17.6 43.2 58.8 20.0 29.4 31.6 47.1 59.5 42.1

Overweight Frequency 0 0 1 5 9 5 4 6 30

Percentage 0.0 0.0 5.9 50.0 52.9 26.3 23.5 16.2 17.5

Obese Frequency 1 0 0 1 3 6 2 0 13

Percentage 5.9 0.0 0.0 10.0 17.6 31.6 11.8 0.0 7.6

Underweight Frequency 13 21 6 2.0 0.0 2.0 3.0 9.0 56.0

Percentage 76.5 56.8 35.3 20.0 0.0 10.5 17.6 24.3 32.7

Total Frequency 17 37 17 10 17 19 17 37 171

Percentage 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 3.5 BMI by sex

BMI Male Female Total
BMI Underweight Frequency 21 35 56.0

categories

Percentage 36 31 32.7

Normal Frequency 35 37 72

Percentage 59.3 33.0 42.1

Overweight Frequency 2 28 30

Percentage 3 25 17.5

Obese Frequency 1 12 13

Percentage 2 11 7.6

Total Frequency 59 112 171

Percentage 100.0 100.0 100.0

3.3.4 Sickle cell disease

The screening for sickle cell disease yielded predominantly negative results, with

97.4% of the 78 participants testing negative. Only 2.6% (2 individuals) were found to

be positive for the disease, indicating a low prevalence within the screened

population.
Table 3.6 Sickle cell categories
Sickle Cell Disease Frequency Percentage

Positive 2.0 2.6

Negative 76.0 97.4

Total 78.0 100.0

3.3.5 Typhoid

Similar to the sickle cell disease results, the typhoid screening also showed a low

prevalence. Out of 49 participants, 95.9% tested negative, and only 4.1% (2

individuals) tested positive for typhoid.

Table 3.7 Typhoid categories

Typhoid Frequency Percentage

Positive 2.0 4.1

Negative 47.0 95.9

Total 49.0 100.0

3.3.6 Blood group distribution

Blood group analysis showed a diverse distribution among the 175 participants. The

most common blood group was O+, accounting for 46.3% of the population. This was

followed by B+ (22.3%), A+ (17.1%), and smaller percentages for other blood groups

including A-, B-, AB+, AB-, and O-. The dominance of the O+ blood group is

consistent with global trends.

Table 3.8 Blood group distribution
Blood Grouping Frequency Percentage

A+ 30 17.1

A- 5 2.9

B+ 39 22.3

B- 6 3.4

AB+ 5 2.9

AB- 5 2.9

O+ 81 46.3

O- 4 2.3

Total 175 100

3.3.7 Blood pressure

Blood pressure measurements indicated that the majority (79.8%) of the 129

participants had normal blood pressure readings. However, 20.2% were found to have

high blood pressure, suggesting a significant subset of the population may be at risk

for hypertension-related health issues.

Table 3.9 Blood pressure categories

BP Frequency Percentage

High 26 20.2

Normal 103 79.8

Total 129 100.0

 3.3.8 Waist to hip ratio (WHR)

The Waist to Hip Ratio (WHR) assessment categorized 108 participants into normal

and abnormal groups. The results showed a near even split, with 51.9% having

abnormal WHR and 48.1% falling within the normal range. Age-wise, abnormal

WHR was more prevalent among older participants, particularly those aged 40-59

years.

Table 3.9 WHR categories

WHR Frequency Percentage

Abnormal 56 51.9

Normal 52 48.1

Total 108 100.0

Table 3.10 WHR by age

<5 5-14 15-20 20-29 30-39 40-49 50-59 >59 Total

Normal Frequency 0 1 3 9 13 8 6 16 56.0

Percentage 0.0 50.0 100.0 90.0 76.5 42.1 35.3 43.2 51.9

Abnormal Frequency 3 1 0 1.0 4.0 11.0 11.0 21.0 52.0

Percentage 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 48.1

Total Frequency 3 2 3 10.0 17.0 19.0 17.0 37.0 108.0

Percentage 2.8 1.9 2.8 9.3 15.7 17.6 15.7 34.3 100.0
Figure 3.1 WHR by sex

3.4 DISCUSSION

The health screening report for 2024 offers an in-depth analysis of the health status of

the participants, highlighting several critical areas of concern and opportunities for

public health interventions. The screening involved 176 participants, with a

significant gender disparity, where 65.3% were females and 34.7% were males. The

age distribution showed a notable concentration in the younger (5-14 years, 21.6%)

and older (above 59 years, 21.0%) age groups. This demographic information is

essential for tailoring specific health interventions and resources to the most affected

age groups.

The BMI data revealed that a large portion of the population had abnormal BMI

readings. Specifically, 42.1% were underweight, 17.5% were overweight, and 7.6%

were obese, while only 32.7% had a normal BMI. In Ghana, a study by Amoah in

2003 found out that the overall crude prevalence of overweight and obesity among

adults aged 25 years and older in both rural and urban Accra was 23.4 % and 14.1 %

for females and males, respectively. The rates of overweight (27.1 % v. 17.5 %) and
obesity (20.2 % v. 4.6 %) were both higher in women than in men (Amoah, 2003),

this finding is similar to what was found in the screening. Children under five years of

age remain the most vulnerable group to malnutrition and micronutrients deficiency

(Chege et al., 2017). The high prevalence of underweight individuals, particularly

among the younger age group, suggests potential nutritional deficiencies, which could

be linked to socioeconomic factors affecting food availability and quality. On the

other hand, the presence of overweight and obese individuals indicates a growing

concern of overnutrition, likely due to lifestyle changes and dietary habits. Females

exhibited a higher prevalence of abnormal BMI compared to males, highlighting the

need for gender-specific health and nutrition programs. Ghana has successfully

reduced underweight prevalence in children under five from 23% in 1993 to 11%

(GSS, 2015) through improved healthcare, maternal and child health programs, better

nutrition education, and increased food security. However, the health screening shows

42.1% of the broader population is underweight, especially among younger age

groups, indicating ongoing nutritional deficiencies. This disparity suggests that while

targeted interventions for young children have been effective, similar efforts are

needed for other vulnerable groups to improve overall nutrition.

Hypertension was identified in 20.2% of the screened population, with the remaining

79.8% having normal blood pressure. This prevalence rate, while concerning, is lower

than other regional studies. For example, a systematic review in Ashanti Region of

Ghana reported a hypertension prevalence of around 37.4% (Tannor et al., 2022). In

broader sub-Saharan Africa, the prevalence 57.0% ranging from 22.3 to 90.0% (Bosu

et al., 2019), suggesting that the screened population has a relatively lower burden of

hypertension. This underscores the importance of regular monitoring and management

of blood pressure to prevent long-term health complications such as cardiovascular

diseases.

The prevalence of sickle cell disease was relatively low at 2.6%, and typhoid was

observed in 4.1% of the participants. Although these conditions are not major health

concerns within this population, continuous monitoring and targeted health education

can help maintain low prevalence rates and manage existing cases effectively.

The most common blood group among the participants was O+ (46.3%), followed by

B+ (22.3%) and A+ (17.1%). Understanding the blood group distribution is vital for

effective blood donation campaigns and ensuring adequate blood supply for medical

emergencies and procedures. This distribution is consistent with general patterns

observed in Ghana and sub-Saharan Africa, where blood group O is typically the most

common (Doku et al., 2019).

The WHR results indicated that 51.9% of the participants had an abnormal WHR,

suggesting a high risk of cardiovascular diseases and metabolic disorders. The

abnormal WHR readings emphasize the need for lifestyle interventions focused on

reducing central obesity and improving metabolic health. Studies in Ghana and sub-

Saharan Africa have similarly highlighted the increasing trend of central obesity,

particularly among urban populations, which is associated with a higher risk of

metabolic syndrome and cardiovascular diseases (Banson et al., 2023).

The prevalence of hypertension in this study is lower than other regional studies,

which could be due to demographic differences, such as age distribution and lifestyle

factors unique to the population.

The high percentage of underweight individuals, particularly among children and

adolescents, points to potential nutritional deficiencies and the need for improved

food security and nutrition programs.

The significant portion of the population with abnormal WHR highlights the urgent

need for targeted interventions to reduce central obesity and associated health risks.

CONCLUSION

The screening at Seth Okai identified several health concerns, including high rates of

underweight and overweight individuals, elevated blood pressure in 20% of

participants, and a significant proportion with abnormal waist-to-hip ratios.

Continuous health monitoring and community health education are essential to

address these health issues. Follow-up measures are crucial to improve the overall

health status of the community.

RECOMMENDATION

The health screening has identified several key areas that require public health

interventions, including malnutrition, hypertension management, and promoting

healthy lifestyle choices to mitigate the risk of chronic diseases. Addressing these

issues through community health programs, education, and regular screenings will be

crucial in improving the overall health status of the population. Future screenings and

longitudinal studies will be beneficial in tracking health trends and evaluating the

effectiveness of implemented health interventions.

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[Link]