Vulvovaginal candidiasis (VVC) has been reported globally as a condition affecting a significant number of women. It is a global burden among women with 75% experiencing an episode in their lifetime (1). An investigation carried out on the prevalence of recurrent vulvovaginal candidiasis in five European countries and the U.S revealed that, over 40% of women reported at least four acute episodes of VVC in a 12-month period (2). Also, studies show a rise in VVC in Asia and Africa (3). In South Asia, a prevalence of 55.5% was recorded among pregnant women receiving care at a gynecological and obstetrics unit in a tertiary healthcare facility (4) whereas, in Africa, a recent study found a total prevalence of 43.3% among pregnant women in South East Nigeria (5).

In Ghana, 36.5% prevalence was recorded among pregnant women in the middle belt (6) and 30.7% in the southern belt (7). Gestational mothers experience this condition due to the change in pH and sugar content of vaginal secretions resulting in the overgrowth of the causative organism (8). Apart from the biological causal pathway, lifestyle and hygiene practices have also been reported to influence the infection rate greatly (9).

Some pregnant women indulge in unhealthy practices as a result of inadequate knowledge, enhancing their vulnerability to the disease. A study among antenatal care attendees on genital hygiene practices identified some risky activities such as the use of antiseptic solutions for genital cleansing and the use of synthetic underwear. Other findings have identified practices such as not changing underwear daily, wearing inadequately-dried underwear and using herbal combinations to wash the private part for easy baby delivery (10). Again, a survey on the analysis of genital hygiene behavior among women revealed that most pregnant women undergo vaginal douching (11).

Improper antibiotic use, which is an associated factor of increased prevalence has also been identified among gestational mothers (12). Among the risk factors, antibiotic use was ranked highest followed by sexual intercourse, humid weather and use of feminine hygiene products (13). Antibiotics destroy the protective bacteria flora in the vagina and allow the overgrowth of yeast. A previous study indicated that 28%–33% of women who undergo antibiotic therapy experience symptomatic genital candidiasis (14). Short courses of oral antibiotic therapy have been identified with increased prevalence of symptomatic VVC (15, 16).

A good knowledge may influence healthy practices and enhance preventive measures hence limiting the rate of infection. Also, knowledge of the various signs and symptoms is crucial for early detection, reporting, and treatment. Knowledge on various vaginal discharges is key for the detection of the infection. A common sign associated with the infection is abnormal discharge. however, a study by Varghese (17) found that, abnormal vaginal discharge was perceived by most women as normal. This indicates a challenge in the detection of normal vaginal discharge. A common gynecological complain among pregnant women is the inability to differentiate between normal and abnormal vaginal discharge leaving a gap in knowledge (18).

Most studies in Ghana (6, 7) focused on prevalence of the disease. However, there was no further investigation to identify the predisposing factors associated with such rate of occurrence. It is, therefore, relevant to assess the knowledge and practices of these women for appropriate intervention measures, hence this study seeks to assess the relationship between knowledge, practices and occurrence of VVC among pregnant women at the Ho Teaching Hospital of Ghana.

The study examined the knowledge, practices and occurrence of candidiasis among expectant mothers. It focused on the association between related practices and the prevalence of VVC. Practices such as the use of feminine hygiene wash, perineal pads and the use of antibiotics among others were ascertained. A strong association was found between frequent antibiotic use and the occurrence of candidiasis. A 27.1% prevalence of VVC was observed with a link to antibiotic use. However, there was no relationship found between knowledge and the other practices in relation to the infection.

A slightly elevated 27.1% prevalence was recorded compared to the 25% reported at Yemen (19), However, this occurrence is lower than the 29.2% prevalence indicated in a systematic review and meta-analysis conducted in Africa (20) and the 30.7% recorded in the Ho Municipality among gestational mothers (7). The dichotomy in these observed prevalences could be associated with the difference in sample size, study design and geographical location. While this study engaged 336 participants, that which was carried out in Yemen and the Ho Municipality involved 250 and 176 study subjects respectively. Given that VVC is common infection among pregnant women, there is a need to heighten awareness and screening of such mothers in the current study jurisdiction. This will foster early case detection and treatment to aid the mitigation of associated discomfort and the risk of complication during pregnancy.

An association was found between antibiotic use and the occurrence of VVC. This conforms with some recent studies which found associations between antibiotic usage and the prevalence of the infection. A study by Dou, Li (21) indicated that the widespread use of antibiotics contributes to an increased prevalence of Candida vaginal infection. Their study identified pregnancy, diabetes mellitus, contraceptive and antibiotic use as predisposing factors for the infection. Also, reports from another study indicated that about 28%–33% of women on antibiotic therapy develop symptomatic genital candidiasis (14). Again, a retrospective study conducted between 2014 and 2016, revealed that the use of gynecological antibiotics, systemic antibiotics, oral contraceptives as well as vaginal contraceptives were associated with an increase in the risk of vulvovaginal candidiasis (2). Another study characterized antibacterial therapy, whether administered systemically or locally to the vagina, as the most common and predictable cause or triggering factor for symptomatic VVC (15). It is therefore evident that, antibiotic use has an impact on the occurrence of VVC in most cases Hence, patients must be educated on the potential side effects of antibiotics, including the risk of candidiasis, and encourage them to take antibiotics only as prescribed and to complete the full course.

The study did not find the use of perineal pads, feminine hygiene wash, regular changing of underwear, use of cotton underwear, drying underwear under the sun and ironing of underwear to be significantly associated with VVC among the study participants. This finding aligns with the results of a study on the impact of supportive nursing instructions on the recurrence of VVC during pregnancy. Their research similarly showed no notable association between practices such as using daily protective pads, wearing cotton underwear, changing wet underwear frequently, employing vaginal douching, performing vaginal douching during menses, and the recurrence of vulvovaginal candidiasis infection during pregnancy (22). This could be due to the fact that pregnancy significantly alters hormone levels, particularly estrogen and progesterone. These hormonal changes can make the vaginal environment more conducive to the overgrowth of Candida species, which is the primary cause of VVC. Such biological factors can outweigh the influence of personal hygiene practices, making them less significant in determining recurrence.

The question on the causative organism, thus fungi was missed by majority, 62.20% of the study participants referred to it as a bacterial infection though a good knowledge was recorded with other questions on knowledge. Burning sensation, itchy vagina and abnormal vaginal discharge was rightly associated by the study participants with the infection. Questions on signs and symptoms were answered correctly. On the contrary, a previous study recorded poor knowledge on the signs and symptoms among pregnant women (23).

Findings on knowledge, practices, and prevalence of candidiasis among pregnant women emphasize the necessity of addressing this widespread but often ignored condition in maternal healthcare. Our findings revealed that though there is good knowledge on the signs and symptoms, there still remains a gap on the knowledge of the causative agent.

A high prevalence of VVC (27.1%) was reported among the expectant mothers visiting Ho Teaching Hospital for antenatal care. The findings thus suggests that candidiasis is a common condition among pregnant women, necessitating heightened vigilance in prenatal care and the creation of evidence-based therapeutic guidelines. Generally, these mothers had good knowledge on VVC, although most could not associate VVC as a fungal infection. The study identified antibiotics usage as a contributing factor to VVC, which may also lead to antimicrobial resistance. There is therefore the need for education on rational use of antibiotics among the study population. Since this study is limited in assessing the antibiotics categorisation and duration of usage, it is recommended that future prospective studies are conducted to address this limitation.