Ghana’s 2025 physical activity report card: children, adolescents and CAWD

Abstract

BACKGROUND: Regular physical activity in childhood and adolescence supports cardiometabolic health, mental wellbeing, and learning, yet many countries lack routine surveillance and actionable, benchmark-linked accountability tools. The Active Healthy Kids Global Alliance (AHKGA) "Report Card" approach synthesizes the best available national evidence to grade physical activity behaviours and their determinants, enabling cross-country comparisons and policy dialogue. Ghana last published a Report Card in 2018; since then, new evidence and policy developments warrant an updated appraisal, including attention to children and adolescents with disabilities and/or chronic conditions (CAWD). METHODS: We compiled and synthesized Ghana-specific evidence used for the 2025 Ghana Report Card within the AHKGA Global Matrix 5.0 framework. Ten common indicators were graded for the regular population (ages 5-17 years) using the Global Matrix 5.0 rubric bands (A + to F; INC for insufficient evidence). Data sources included national school-based surveillance (Global School-based Student Health Survey (GSHS) 2012 fact sheets/microdata), peer-reviewed studies (2009-2022), theses, policy documents, and program-based budgets. When multiple eligible estimates were available, we applied transparent synthesis rules (e.g., unweighted means for Active Transportation). CAWD grades were assigned only when disability-relevant, benchmark-aligned evidence or defensible structured consensus supported grading. RESULTS: Ghana's highest grades were Sedentary Behaviour (B+) and Active Transportation (B), while Overall Physical Activity was graded D-. Key benchmark-linked estimates included: 25.0% meeting an MVPA proxy guideline (Overall Physical Activity), 27.6% participating in sport ≥ 3 times/week (Organized Sport), 73% active travel to/from school (Active Transportation; unweighted mean), and 78.4% below the "high sedentary time" threshold (Sedentary Behaviour). Physical Fitness was graded C- (mean percentile ~ 40-42 across three field tests). School (D) and Community & Environment (D-) reflected low effective PE delivery and limited access to acceptable, publicly accessible spaces in an Accra-based audit proxy. Government was graded B based on rubric-aligned policy, implementation, and funding/accountability scoring (mean score 67%). For CAWD, 7/10 indicators were INC; assignable grades were Family & Peers (C-), Community & Environment (F), and Government (D+). CONCLUSIONS: Ghana's 2025 Report Card highlights persistently low physical activity levels alongside gaps in school delivery, community environments, and surveillance systems. The CAWD results are dominated by evidence insufficiency, underscoring an urgent need for disability-disaggregated surveillance and inclusive infrastructure, alongside strengthened PE implementation and safer active travel systems.