UN Secretary General Ban Ki-moon has been leading calls for improved sanitation on World Toilet Day. Billions still suffer from a lack of proper toilets and the accompanying, heightened risk of serious illness.
The United Nations says 2.4 billion people around the world don't have access to decent sanitation and more than a billion are forced to defecate out in the open. The world's population is currently just under 7.5 billion.
The UN launched World Toilet Day (19.11.2015) with a strong public health message. Poor sanitation, it said, increases the risk of illness and malnutrition, especially for children.
The UN also said that women and girls in particular need safe, clean facilities.
Secretary General Ban Ki-moon said in a statement that one in three women around the world had no access to safe toilets. "As a result they face disease, shame and potential violence when they seek a place to defecate."
In Ghana's Northern region, it's estimated that seven out of ten people - men, women and children - have no access to toilet facilities, neither in their home nor in public spaces.
But some people who have access to public toilets prefer the bush. "Inside the toilet it is always hot, it is better to consider the forest. Also they don't keep them clean. That's the main reason why I won't use a public toilet," one man in Tamale told DW.
DW visited a public toilet in Tamale where people pay a small gratuity. It was in a filthy condition.
"Toilets can't always be cleaned. Sometimes the caretaker will have additional work somewhere else so he has no time to keep things clean," the toilet attendant said.
An estimated 18,000 Ghanaians, including 5,000 children under the age of five, die every year from ailments related to poor sanitation.
Convention and customs?
The UN Millennium Development Goals, which are supposed to be achieved this year, call for the halving of the proportion of the population without access to basic sanitation.
Ban said that by many accounts, this will be "the most-missed target."
In 2013, the UN launched a campaign to end defecation in the open by 2025. In sub-Sharan Africa, 36 percent of the population were not using toilets in 1990. Twenty-five years later that figure now stands at 25 percent.
In a World Toilet Day press release, the UN says open defecation is deeply rooted in poverty, but has also been linked to convention and customs in some countries and societies. It represents some of the only times other than worship where women from rigid family circumstances may meet one another.
Maxwell Suuk in Tamale contributed to this report.