A Community-Based Cross-Sectional Survey of Serum Uric Acid Level and Associated Determinants in Freetown, Sierra Leone

Background : Sub-Saharan Africa faces a dual burden of infectious and non-communicable diseases (NCDs), yet epidemiological data on serum uric acid (SUA) and hyperuricemia remain scarce in low-income countries like Sierra Leone. Elevated SUA is linked to gout, hypertension, and metabolic disorders, but its determinants in African populations are poorly understood. Methods : We conducted a community-based cross-sectional study of 1,066 adults in Freetown, Sierra Leone, from October 2024 to January 2025. SUA levels, blood pressure, blood glucose, and socio-demographic/lifestyle factors were assessed. Hyperuricemia was defined as SUA > 420 µmol/L. Logistic and linear regression models evaluated associations between SUA, cardiometabolic risk factors, and self-reported symptoms. A mini meta-analysis compared our findings with prior African studies. Results : The median SUA level was 341 µmol/L (IQR: 266–443), with a hyperuricemia prevalence of 29.9%. Men had significantly higher SUA (OR = 1.70, p  < 0.001) and prevalence (57.9% in highest-risk community). Hyperuricemia was independently associated with elevated systolic blood pressure (adjusted OR = 1.57) and blood glucose (OR = 1.29), while higher body temperature (OR = 0.56) and SpO ₂ (OR = 0.95) were protective risk factors. SUA levels and hyperuricemia significantly varied geographically. Meta-analysis revealed SUA levels in Sierra Leone (373 µmol/L) far more exceeded the African average level (283 µmol/L, p  < 0.001). Conclusions : This first comprehensive study in Sierra Leone highlights a high burden of hyperuricemia, particularly among men, with significant links to hypertension and metabolic dysregulation. The findings underscore the need for SUA screening and dietary interventions in resource-limited settings. Further research should explore genetic and environmental drivers of SUA elevation in African populations.