Background Most childhood diarrheal illnesses are a result of the faeco-oral transmission of infected food, water, and unclean fingers. The present paper was conducted to estimate the prevalence of hygienic disposal of stools (HDS) and its associated factors, and further quantify the impact of HDS on diarrheal diseases among children under two years. Methods A cross-sectional design was used to evaluate three rounds of the Ghana Demographic Health Survey (GDHS) from 2003–2014 involving 4869 women with children aged under two years. The outcomes were prevalence of HDS and diarrheal diseases. Poisson regression model was employed to assess risk factors associated with HDS and dominance analysis was used to rank the important risk factors. Inverse Probability Weighting Poisson Regression Adjustment (IPWPRA) with Propensity Score 1:1 density kernel-based matching was employed to assess impact. Results The pooled prevalence rate of HDS was 26.5%(95%CI = 24.6–28.4) and it ranged from 18.7% (95%CI = 16.4–21.2) in 2014 to 38.8%(95%CI = 35.3–42.4) in 2003. Diarrhea diseases pooled prevalence was 17.9%(95%CI = 16.4–19.5) and ranged from 13.3%(95%CI = 11.1–15.9) in 2014 to 25.4%(95%CI = 22.2–28.9) in 2003. The overall growth rate for HDS and prevalence of diarrhea diseases, decreased by 21.6% and 11.4% respectively. The most important risk factors of HDS from dominance analysis included; age of the child, wealth index, and differences in region. From pooled data wealth index, increasing age of the child, and regional disparity constituted approximately 72% of the overall impact (Weighted Standardized Dominance Statistics (WSDS) = 0.30, 0.24, and 0.19 respectively). In 2014, they constituted approximately 79% (WSDS = 0.139, 0.177 and 0.471 respectively). The average prevalence of diarrheal diseases among children of women who practiced HDS reduced over the period of the GDHS compared to those whose mothers did not practice HDS [2008 ATE(95%CI) = -0.09(-0.16–0.02), 2014 ATE(95%CI) = -0.05(-0.09–0.01) and Pooled data ATE(95%CI) = -0.05(-0.09–0.02)]. Conclusion This analysis has provided empirical evidence of the impact of practicing HDS in Ghana from a national household survey. Implementation of the WASH agenda in this low-income setting requires a synergy of interventions and collaborations of actors (government, private and development partners) to improve water and sanitation facilities and to increase hygiene education to prevent the spread of diseases including diarrhea by 2025.

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We estimated the prevalence of unmet needs of healthcare services (UNHS) and its associated factors among a cohort of older Ghanaian adults. World Health Organization (WHO) Study on Global AGEing and Adult Health for Ghana was used with a total of 4735 participants. Logistics regression analysis was performed using Stata 16 to assess associated factors. The overall UNHS was 3.7% (95% CI = 2.7-4.8) and the prevalence was significantly high amongst older adults aged 60 to 69 years (5.9%). Could not afford the healthcare (56.4%) was the main contender for UNHS. UNHS was influenced by; those aged 60 to 69 years [OR (95% CI) = 1.86 (1.19-2.91)]; no formal educational [aOR (95% CI) = 4.71 (1.27-17.38)], and no NHIS [OR (95% CI) = 1.78 (1.03-3.09)]. Participants needed care for joint pain (25.4%), and communicable diseases (19.1%). The inability to access healthcare was relatively higher for older adults more advanced in age, with low education, and for those without health insurance. Health system strengthening including financial protection by expanding the National Health Insurance Scheme to all Ghanaians in line with Ghana’s Universal Health Coverage Roadmap would reduce the unmet healthcare needs of older adults.

Background: Opportunistic infections are the leading cause of morbidity and mortality among immuno-compromised patients. Oropharyngeal candidiasis (OPC) dominates opportunistic fungal infections associated with HIV/AIDS. Objective:We determined the distribution and prevalence of antifungal resistance in Candida isolates recovered from patients infected with HIV and presenting with OPC. Methods: HIV-infected patients with provisional diagnosis of OPC were consecutively enrolled between May 2017 and June 2018. After patient data collection, oral swabs and blood specimens were collected for culture and CD4 T-lymphocyte estimation, respectively. Presumptive Candida isolates were speciated and their antifungal susceptibilities to fluconazole, flucytosine and amphotericin B, including minimum inhibitory concentration was determined using the E-test. Results: Of 286 patients enrolled, 67.8% (194) cultured positive for Candidaspp. The mean age of culture positive patients was 40.7 ±15.2 with more female enrollment (63.4%,123/194). The CD4 counts ofculture positive patients were low (211.1 ±235.6 cells/μL) and 68.6% (133) of them were on anti-retroviral therapy (ART) with 10.3% (20/194) having previous exposure to fluconazole. Seven different Candidaspecies, with the following distributions were isolated: C. albicans (69.1%, 134), C. tropicalis (10.3%, 20), C. glabrata (6.7%, 13), C. parapsilosis (5.7%, 11), C. krusei(4.1%, 8), C. dubliniensis(2.6%, 5),and C. lusitaniae (1.5%, 3). Of all C. albicans isolates tested, 29.1%, 1.5% and 2.3% were resistant to fluconazole, amphotericin B and flucytosine, respectively. Non-C. albicans isolates showed 45%, 3.3% and 8.3% resistance to fluconazole, amphotericin B and flucytosine, respectively. Conclusion: C. albicans accounted for majority of oropharyngeal candidiasis(OPC), with non-C. albicans showing significantly higher resistance to fluconazole. Positive culture was independent of gender, previous exposure to antifungal drugs, ART status and duration. Without any contraindication, flucytosine and Amphotericin B may be considered for OPC not responding to fluconazole therapy