Search

Quantitative data on geographical accessibility to healthcare remain generally limited in sub-Saharan Africa. This study sought to generate quantitative evidence regarding health care access in the Ashanti region of Ghana. Dasymetric mapping technique and GIS tools were used to estimate the total population living within the World Health Organization (WHO)'s recommended 5 km distance to the nearest health facility. An estimated 81.4% of the population had access to general primary health care, 61.4% to secondary-level health care and, only 14.3% to tertiary health care. Despite the high levels of accessibility to general primary health care, accessibility remains poor in some selected districts, especially rural districts in the region. About 30% of the population are more likely to have to travel long distances to access healthcare, particularly specialist services which are available only at secondary and tertiary centres. There is the need for intensified efforts to address inequities in geographic accessibility to healthcare so as to minimise inequalities in health outcomes as well as achieve the desired improvements in population health.

The pathophysiology of functional dyspepsia (FD) remains poorly understood, but alterations of the small intestinal microbiome have been observed. The place of probiotics in treatment is uncertain. We performed a systematic review and meta-analysis of the currently available randomized, controlled trials (RCTs) to evaluate the potential beneficial effects and risks of probiotics in FD. Pubmed, EMBASE, Scopus, Web of Science and the Cochrane Controlled Trials Register were searched (up to May 2019) for RCTs evaluating the effects of probiotic supplementation compared to placebo in adults with FD. Two reviewers independently assessed eligibility, trial quality and extracted information from identified articles. To compare the effects of probiotics with placebo, risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random effects models. Six trials, including 422 participants were included but only three RCTs could be included in the meta-analysis. Lactobacillus strains showed potential positive effects in terms of improving upper gastrointestinal (GI) symptoms in patients with FD. Probiotic supplementation tended to improve global dyspepsia score (n = 3 RCTs, risk ratio [RR]: 1.35, 95% CI 0.99 to 1.84; P = 0.061) and bacterial composition in the GI tract. Probiotics were well tolerated without any serious adverse events. While the available data suggest that supplementation with probiotics may improve GI symptoms in patients with FD, the evidence is insufficient to draw clear conclusions regarding efficacy. Thus, high-quality RCTs are needed to establish the beneficial effects of probiotic supplementation on FD outcomes.