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The Kumasi Study


In Memoriam of Jacob Plange-Rhule


It is with great sadness that we report the death of Jacob Plange-Rhule, physician, academic, and researcher. He was born on July 27, 1957, in Winneba, Ghana, and he died from complications of COVID-19 in Accra, Ghana, on April 10, 2020, aged 62 years. He is survived by his wife, Gyikua, and three children (The Lancet: Obituary; BMJ Obituary).

Jacob was an outstanding individual, serving as President of the Ghana Medical Association and of the Ghana Kidney Association, as Rector of the Ghana College of Physicians and Surgeons and in the Board of Directors of the World Hypertension League.

For us, however, Jacob was a dear friend, an amiable colleague, an affable companion and motivator, an extremely capable physician, an inquisitive researcher, an exceptional mentor and a strong defender of the idea that African doctors trained abroad should resist the temptation of careers in Western countries and return to build capacity and improve healthcare in their own country.


We worked together for many years and managed to establish research links with Kumasi, starting exploring the unmet needs relating to hypertension and renal disease since the late 1990s (1). At that time resources were scarce and the detection and management of hypertension in the Ashanti region were extremely difficult, with thousands of people not being reached in rural areas with the appropriate diagnostic tools and drug therapy for those diagnosed could not be sustained. We therefore developed an ambitious programme of research, eventually funded by The Wellcome Trust, to assess the burden of hypertension, its unmet needs, and to trial for the first time in sub-Saharan Africa a community-based programme of population reduction in salt intake to help reduce the burden of cardiovascular disease. The programme was extremely successful and a number of important milestones were achieved with the skills, resilience, motivation, support and co-ordination of Jacob and his team.


The programme carried out an extensive household survey and population census with painstaking precision to establish the sampling frame for the hypertension programme (2), demonstrated the feasibility of carrying out blood pressure measurements and 24h urine collections in sub-Saharan Africa's rural settings (3), established the prevalence of hypertension and its level of detection, management, control (4) and barriers (5), developed strong methodological approaches to a community-based cluster randomised trial (6), estimated sources of salt in the Ashanti diet (7), explored the role of body weight in determining blood pressure in lean African populations (8)(9), carried out a large population-based assessment of salt consumption using 24h urine collections and completed a 6-months intervention in 12 villages in the Ashanti region of Ghana (10), established reference values for renal and blood pressure parameters (11)(12) and haematological indices (13) in African populations. Jacob has left us before we could complete the writing up of some essential papers recently completed on the 10-year follow-up. We shall make sure we will take the work to the end. R.I.P.


The prevalence of hypertension is highest amongst people of African descent living in the industrialised countries and in sub-Saharan Africa, and it is the most important factor leading to stroke and chronic renal disease in those countries. Hypertension is becoming a public health priority even in sub-Saharan Africa where detection and appropriate management of hypertension are still not widely available. Salt intake is an important determinant of population blood pressure. In addition, salt intake is a modifiable environmental factor and it is possible by nutritional education to reduce population blood pressure. People of African descent are particularly sensitive to the blood pressure-lowering effects of dietary salt reduction. Populations in sub-Saharan Africa are particularly suited for such an intervention because the majority of the dietary salt is purchased as common salt and added to the food during cooking or at table.

The project aims at reducing dietary salt intake by means of health education and promotion in a population in West Africa. It also aims at reducing, as a consequence, the average level of blood pressure in such a population.

The project is a community-based cluster randomised trial of dietary salt reduction by education and health promotion involving twelve communities in the Ejisu-Juabeng (rural) and Kumasi (semi-Urban) Districts of the Ashanti Region of Ghana. It involves the recruitment of participants into one of two arms of the study (‘control’ and ‘intervention’ clusters). The intervention cluster of villages will be exposed to a vigorous campaign of nutritional education to reduce salt intake. There will be re-enforcement of the educational activities throughout the six months’ period of the intervention.

Study team

 ISHIB2003 Distinguished Research Award

This award is presented annually to an ISHIB member who has demonstrated exceptional work reducing health disparities in ethnic minority populations.

Franco ISHIB

ISHIB2003 Awards Winner
Distinguished Researcher
Francesco P Cappuccio, MD, MSc
St George's Hospital Medical School
London, England

Chronic Disease Prevention in Ashanti, West Africa

Lecture at the University of Warwick for the launch of Africa@Warwick (2010)

by Professor Francesco P Cappuccio

View here

Principal Investigator
  • F P Cappuccio (WMS)
  • J B Eastwood (SGUL)
  • S M Kerry (SGUL/QMUL)
  • J Plange-Rhule (KATH, Kumasi, Ghana)
  • M A Miller (WMS)
Research Fellows
  • F B Micah (KATH, Kumasi, Ghana)
  • S Antwi (KATH, Kumasi, Ghana)
  • R O Phillips (KATH, Kumasi, Ghana)
  • R Martin-Prepah (KATH, Kumasi, Ghana)
  • C Ji (WMS)
  • F Fratelli (WMS)
  • The Association of Physicians of Great Britain & Ireland
  • The Wellcome Trust

In progress