The Black Stars appeared to be in control after Ernest Nuamah converted a penalty in the 27th minute before Felix Afena-Gyan doubled their lead six minutes later.
However, The Gambia responded strongly, with Mohamed Badamosi converting a penalty in the 37th minute to reduce the deficit. Captain Omar Colley then equalised in the 42nd minute, sending the teams into half-time level at 2–2.
The visitors carried their momentum into the second half and took the lead for the first time in the 68th minute through Ebrima Colley.
Ghana pushed forward in search of an equaliser, but The Gambia scored again late in the second half to seal an impressive away victory.
Match details
• Ghana: Ernest Nuamah 27' (pen), Felix Afena-Gyan 33'
• The Gambia: Mohamed Badamosi 37' (pen), Omar Colley 42', Ebrima Colley 68', The Gambia 90'
The defeat leaves Ghana with zero points from their opening two Group C fixtures, following their 2–0 loss to Côte d’Ivoire in Bouaké.
The Gambia, meanwhile, have collected six points from two matches, having opened their campaign with a 2–1 victory over Somalia.
The Black Stars enjoyed more possession but struggled to contain the visitors, who made their opportunities count to complete the comeback.
Ghana must now recover from back-to-back defeats as their pursuit of a place at the 2027 AFCON becomes increasingly difficult.