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Life sciences · Journal article
Global Epidemiology · August 22, 2026
Early or partial results. Treat as a signal, not a conclusion.
This cross-sectional study of 12,360 first-year university students in Ghana found substantial hidden morbidity: 6.5% had screening-detected elevated blood pressure and 12.2% had screening-detected sickle cell status that they had not self-reported. Self-reported health information showed low sensitivity (6.88% for hypertension, 5.53% for sickle cell) and high specificity (>99%), indicating young adults substantially underestimate or are unaware of emerging health conditions. The findings suggest reliance on self-report alone misses a clinically important burden of undiagnosed disease in early adulthood.
Cross-sectional screening study; secondary analysis. First-year students at the University Hospital of the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; enrolled in screening programme.. Intervention: Screening for elevated blood pressure (clinically measured) and sickle cell status (laboratory-confirmed). Compared with: Self-reported health information. n = 12,360. University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
799 students (6.5%, 95% CI: 6.03–6.90) had screening-detected, hidden elevated blood pressure not self-reported 1503 students (12.2%, 95% CI: 11.58–12.74) had screening-detected, hidden sickle cell status not self-reported Self-reported hypertension sensitivity 6.88% (95% CI: 5.18–8.57), specificity 99.40% (95% CI: 99.26–99.54)
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Clinicians should not rely solely on self-reported health information when assessing young adults for early detection of hypertension and sickle cell disease, particularly in populations with limited prior screening access. The low sensitivity of self-report suggests opportunistic screening at university health encounters may identify substantial undiagnosed morbidity, though generalisability beyond this single university setting is unknown.
A single-centre cross-sectional screening study reporting prevalence of undiagnosed conditions via secondary analysis; descriptive in nature with no intervention or comparator arm, limited to hypothesis generation about hidden morbidity in one university population.
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Clinicians should not rely solely on self-reported health information when assessing young adults for early detection of hypertension and sickle cell disease, particularly in populations with limited prior screening access. The low sensitivity of self-report suggests opportunistic screening at university health encounters may identify substantial undiagnosed morbidity, though generalisability beyond this single university setting is unknown.
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Hidden morbidity represents a significant public health concern because undiagnosed conditions can progress silently and worsen long-term health outcomes. The risk of non-communicable disease begins to rise in early adulthood, yet many young adults remain unaware of emerging health problems and opportunities for early detection and intervention are frequently missed. This study examined hidden morbidity among first-year students by comparing self-reported health information with screening outcomes for elevated blood pressure and sickle cell status. We conducted a secondary analysis of cross-sectional screening data collected at the University Hospital of the Kwame Nkrumah University of Science and Technology in Kumasi, Ghana. Self-reported health information was compared with clinically measured blood pressure and laboratory-confirmed sickling status, with the screening results considered as the reference standards. Hidden morbidity refers to screening-detected health conditions not reported by students. Factors associated with hidden elevated blood pressure and sickle cell status were examined using multivariable logistic regression analysis. Among 12,360 students screened, 799 (6.5%, 95% CI: 6.03-6.90) had screening-detected, hidden elevated blood pressure, and 1503 (12.2%, 95% CI: 11.58-12.74) had screening-detected, hidden sickle cell status. Self-reported hypertension had low sensitivity (6.88%, 95%CI: 5.18, 8.57) and high specificity (99.40%, 95%CI: 99.26, 99.54) for detecting participants with elevated blood pressure during screening. Similarly, self-reported sickle cell status showed low sensitivity at 5.53% (95%CI: 4.41, 6.65) and high specificity at 99.60% (95%CI: 99.48,99.72). Age, sex, and body mass index were associated with elevated but hidden blood pressure. This study demonstrated that hidden morbidity was rife among this sample of university students, with a substantial proportion unaware of their elevated blood pressure and sickle cell status. The difference between self-reported and screening-detected health conditions underscores the need not to rely solely on self-reported health information among young adults.
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