Subnational spatial co-distribution of tuberculosis and diabetes mellitus across Ghana's 16 regions following administrative reorganisation: An ecological analysis

Background

National administrative boundary reorganisations, increasingly common across sub-Saharan Africa, create discontinuities in surveillance data alignment that complicate subnational burden estimation for infectious and non-communicable diseases alike. Ghana's expansion from 10 to 16 administrative regions in 2019 provides a tractable case for demonstrating how publicly available surveillance and survey data can be used to characterise subnational co-distribution of tuberculosis and diabetes mellitus (DM) under a revised boundary structure. DM is an established risk factor for active TB, yet population-level evidence on their geographic co-distribution at the subnational level in West Africa remains scarce, and no prior study has characterised this co-distribution at the subnational level across Ghana's current 16-region structure-a gap this study addresses directly by leveraging the post-2019 administrative framework to generate region-specific evidence for programme planning.