Published in PLOS One on 2026-09-29, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Thomas Hormenu, Ebenezer Oduro Antiri, Eric Awlime-Ableh, Juliet Elikem Paku, Edward Edem Nartey, Shaibu Bukari, Adeladza Kofi Amegah
Source: PLOS One • DOI 10.1371/journal.pone.0359530
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
The prevalence of cardiometabolic diseases like obesity, hypertension, diabetes, and dyslipidaemia is increasing rapidly, particularly in low- and middle-income countries (LMICs). Informal workers in Ghana, who account for the majority of the national workforce, contribute significantly to the country’s socioeconomic growth. Often, their work predisposes them to cardiometabolic diseases. This study examines the cardiometabolic burden, its associated factors, and the diagnostic heterogeneity among this unique population.
This study used cross-sectional data on 948 informal workers (traders, fisherfolk, artisans, farmers, and drivers) in the Cape Coast Metropolis, Ghana. Sociodemographic, lifestyle, anthropometric, and biochemical data were obtained in accordance with standard procedures. Multiple diagnostic criteria were used to characterise diabetes, prediabetes, and obesity. Diagnostic concordance was evaluated using Venn diagrams and UpSet plots, and independent associated factors were identified using multivariate logistic regression.
The prevalence of obesity, hypertension, prediabetes, and diabetes was 45.46%, 40.19%, 29.54%, and 13.40%, respectively. Women and middle-aged adults (45–59 years) were most impacted. There was significant heterogeneity in classification criteria, with just 9.28% of obese participants and 2.36% of diabetic participants being diagnosed by all diagnostic criteria. While the absence of childhood obesity was associated with lower odds of obesity (aOR = 0.43, 95% CI: 0.30–0.61), diabetes (aOR = 0.64, 95% CI: 0.42–0.99), and hypertension (aOR = 0.63, 95% CI: 0.46–0.88), older age (≥60 years) was strongly associated with obesity (aOR = 2.54, 95% CI: 1.51–4.32) and hypertension (aOR = 4.82, 95% CI: 3.06–7.68). Low physical activity was significantly linked to hypertension (aOR = 1.73, 95% CI: 1.16–2.62), and elevated triglycerides were associated with diabetes (aOR = 2.16, 95% CI: 1.21–3.75) and hypertension (aOR = 1.84, 95% CI: 1.13–3.04).
The burden of cardiometabolic diseases among Ghana’s informal workers is disproportionately high and diagnostically diverse. The findings emphasise the critical need for sex- and occupation-sensitive health interventions, life-course prevention strategies, and context-specific diagnostic guidelines to reduce cardiometabolic disease risk among informal workers in LMICs.
Introduction
Cardiometabolic diseases such as obesity, hypertension, diabetes, and dyslipidaemia have reached epidemic proportions worldwide [1,2], with low- and middle-income countries (LMICs) bearing a disproportionate share of the burden [3,4]. In sub-Saharan Africa, the rising incidence of these diseases alongside the persistent burden of infectious diseases is driving a rapid epidemiological change [5], with important occupational health implications for workers in LMICs, who are largely informal and exposed to socioeconomic contexts that promote the onset and persistence of cardiometabolic diseases [6,7].
The informal economy, characterised by small, unregistered businesses and unprotected labour, is a substantial portion of the global workforce, especially in LMICs [8–10]. This sector employs more than 89% of the working population in Ghana, encompassing farmers, fisherfolk, artisans, traders, drivers, and other occupational groupings that function outside of formal regulatory frameworks [11,12]. Despite its critical role, this sector is plagued by hazardous work conditions, lack of social security, absence of, and disregard for occupational health and safety protections, and limited access to healthcare [13–15]. For these workers, achieving basic household consumption goals often takes precedence over health-related goals [16,17]. Thus, they may be disproportionately affected by non-communicable diseases (NCDs) such as cardiometabolic diseases due to the combination of financial limitations, low health literacy, and occupational hazards such as prolonged sedentary behaviour of traders, irregular eating habits, limited access to healthcare, psychosocial stress from unstable income, and physically demanding work without sufficient rest intervals [6,7,13,18]. Despite the growing burden of these cardiometabolic diseases, their exact distribution within Ghana’s informal workforce remains poorly understood.
Reading this evidence
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© 2026 Thomas Hormenu, Ebenezer Oduro Antiri, Eric Awlime-Ableh, Juliet Elikem Paku, Edward Edem Nartey, Shaibu Bukari, Adeladza Kofi Amegah. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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