This report is one of three synthesis documents produced via an integrated assessment (IA) that aims to increase understanding of artisanal and small-scale gold mining (ASGM) in Ghana. Given the complexities surrounding ASGM, an IA framework was utilized to analyze economic, social, health, and environmental data, and co-develop evidence-based responses with pertinent stakeholders. The current analysis focuses on the health of ASGM miners and community members, and synthesizes extant data from the literature as well as co-authors’ recent findings regarding the causes, status, trends, and consequences of ASGM in Ghana. The results provide evidence from across multiple Ghanaian ASGM sites that document relatively high exposures to mercury and other heavy metals, occupational injuries and noise exposure. The work also reviews limited data on psychosocial health, nutrition, cardiovascular and respiratory health, sexual health, and water and sanitation. Taken together, the findings provide a thorough overview of human health issues in Ghanaian ASGM communities. Though more research is needed to further elucidate the relationships between ASGM and health outcomes, the existing research on plausible health consequences of ASGM should guide policies and actions to better address the unique challenges of ASGM in Ghana and potentially elsewhere.

Artisanal and small-scale gold mining (ASGM) is inherently risky, but little is known about mining-associated hazards and injuries despite the tremendous growth worldwide of ASGM and the benefits it offers. The current study aimed to characterize the physical injuries associated with ASGM in Ghana to guide policy formulation. A cross-sectional survey was carried out in the Tarkwa mining district of the Western Region of Ghana in 2014. A total of 404 small-scale miners were recruited and interviewed regarding their occupational injury experiences over the preceding 10 years using a paper-based structured questionnaire. Nearly one-quarter (23.5%) of the miners interviewed reported getting injured over the previous 10 years, and the overall injury rate was calculated to be 5.39 per 100 person years. The rate was significantly higher for women (11.93 per 100 person years) and those with little mining experience (e.g., 25.31 per 100 person years for those with less than one year of work experience). The most injury-prone mining activities were excavation (58.7%) and crushing (23.1%), and over 70% of the injuries were reported to be due to miners being hit by an object. The majority of the injuries (57%) were lacerations, and nearly 70% of the injuries were to the upper or lower limbs. Approximately one-third (34.7%) of the injuries resulted in miners missing more than two weeks of work. One-quarter of the injured workers believed that abnormal work pressure played a role in their injuries, and nearly two-fifths believed that their injuries could have been prevented, with many citing personal protective equipment as a solution. About one-quarter of the employees reported that their employers never seemed to be interested in the welfare or safety of their employees. These findings greatly advance our understanding of occupational hazards and injuries amongst ASGM workers and help identify several intervention points.

Breast cancer is a heterogeneous disease composed of multiple subgroups with different molecular alterations, cellular composition, clinical behaviour, and response to treatment. This study evaluates the occurrence of the various subtypes and their clinical and pathological behaviour in the Ghanaian breast cancer population at the Korle Bu Teaching Hospital (KBTH). Retrospective review of case notes of patients who had completed treatment for breast cancer at the KBTH within the last 5 years was conducted between April 2011 and March 2012. Subtypes were determined by immunohistochemistry classification based on expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2). A total of 165 cases contributed to this study. The mean age at diagnosis was 52.5 ± 12.1 years. Tumour size ranged from 0.8 cm to 15 cm with a mean of 4.9 ± 2.8 cm and median of 4 cm. Tumour grade was Grade I 8.3 %, Grade II 60.8 % and Grade III 30.8 %. ER, PR and HER2/neu receptor positivity was 32.1, 25.6 and 25.5 % respectively. Almost half (49.4 %) of the study population had triple negative tumours. Luminal A, luminal B and non-luminal HER2 were 25.6, 12.2, and 12.8 % respectively. No statistically significant association was seen between subtype and tumour size, tumour grade, lymph node status and age at diagnosis. Triple negative tumour is the most occurring subtype in the Ghanaian breast cancer population treated at the Korle Bu Teaching Hospital. Lack of association seen between subtypes and their clinical and pathological behaviour could be due to small sample size.

Tobacco use over the life-course threatens to increase disease burden in older adulthood, including lower income countries like Ghana. This paper describes demographic, socioeconomic, health risks and life satisfaction indices related to tobacco use among older adults in Ghana.

Though cancer has become a major source of morbidity and mortality globally, few countries in Sub Saharan Africa have data on cancer incidence. This study aims to describe the profile of cancers seen at the Korle Bu teaching hospital which is a major referral centre in Ghana for cancers and other health conditions. Data for the study was obtained from the cancer registry of the hospital and covered the period from January 2012 to December 2012. The public health unit actively collects data on all cancer cases presenting to any department/unit of the hospital to feed the cancer registry. A total of 1136 patients with cancer were studied. Their ages ranged from 1 year to 92 years with a mean of 52.3 ± 15.9 years and a median of 54 years. Patients were predominantly female (70.2%) and majority had attained secondary level of education or higher. The most prevalent cancers seen in men were those of prostate, pharynx and colorectal while in the females, the corresponding cancers were breast, cervix and uterus. Breast and prostate cancers were the commonest among females and males respectively who presented with cancer at the Korle Bu teaching hospital in 2012.

Edentulism affects the quality of life and general health of an individual. But in ageing individuals, it has been observed to have greater impact, manifesting in functional, psychological and social limitations. With an increasing older adult population in Ghana, its burden is likely to increase. This study was thus carried out to explore the association between edentulism and quality of life among older Ghanaian adults. 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. Participants included a nationally representative sample of adult’s aged 50 years and older living in Ghana. Quality of life was measured using the 8 item WHOQOL measure and a single item measure which was a question “How would you rate your overall quality of life?”. To assess the association between edentulism and the independent variables, a bivariate analysis was carried out. A Poisson regression model was then performed, adjusting for age, sex, income, education and the diagnosis of a chronic disease condition. A Spearman’s correlation analysis was also carried out between the single and multi item measure of quality of life to assess how well they correlate. Edentulism was observed to be associated with significantly lower levels of SWB among older adults using both the single-item and multiple-item measure (WHOQOL). It, however, showed no association with happiness. Among edentulous respondents, females and those with no formal education reported significantly lower quality of life. The WHOQOL correlated positively and strongly with the single-item measure. Edentulism may not be life threatening and yet it has been shown to have a negative effect on the quality of life of older adult Ghanaians. More emphasis may thus need to be placed on the oral health of the aging population in Ghana to avoid it.