During the 7th December 2008 general elections, no presidential candidate received more than 50% of the votes therefore a run-off election was held between the candidates with the most votes. Nana Akuffo-Addo polled 4,159,439 representing 49.13% whiles John Atta-Mills polled 4,056,634 representing 47.92% during the first round.

Voter turnout during the first round was 8,671,272 (69.52%) but increased to 9,094,364 (72.91%) during the second round. Invalid votes during the second round reduced to 92,886 (1.02%) after a 205,438 (2.37%) in the first round.

The second round of the election was held on the 28th December 2008 but due to logistical problems with distributing ballots, the Tain District alone had its run-off on 2 January 2009.
The eventual winner, John Atta-Mills won by 4,521,032 (50.23%) beating Nana Akuffo-Addo who polled (49.77%) as declared on 3rd January 2009.