Typhoid fever is common among crowded and impoverished populations with inadequate sanitation and is transmitted through ingestion of water or food that has been contaminated by faeces or less commonly, urine of infected humans. Typhoid fever is a systemic prolonged febrile illness caused by certain Salmonella serotypes including Salmonella typhi, S. paratyphi A, S. paratyphi B and S. paratyphi C. (Crump et al., 2004). Typhoid is an infection of the gut that affects the whole body. It is spread from feces-to-mouth in contaminated food and water and often comes in epidemics (many people sick at once). Typhoid fever is a systemic infectious disease characterized by high continuous fever, malaise, and involvement of lymphoid tissues and spleen.
Humans are the only host for Salmonella typhi and there are no known environmental reservoirs (WHO, 2003). Typhoid fever remains a major public health problem in many developing countries. It is a sporadic disease in developed countries, occurring mainly in travelers returning from overseas. It can also produce the occasional point-source epidemic (Ackers et al., 2000).
The illness begins with mounting fever, headache, vague abdominal pain and constipation, which may be followed by appearance of rashes. During the third week, the patient reaches a state of prolonged apathy, toxemia, delirium, disorientation and coma followed by diarrhoea. Serious epidemic forms of diarrhoea, e.g. typhoid (enteric fever), need a co-ordinated community approach. If left untreated, it can lead to complications affecting various organ systems (Fauci et al., 2008). The disease is communicable for as long as the infected person excretes S. typhi or S. Paratyphi in the feces or urine.
Theoretically, it is possible to eliminate the salmonellae that cause enteric fever since they survive only in human hosts and are spread by contaminated food and water. However, given the high prevalence of the disease in developing countries that lack adequate sewage disposal and water treatment, elimination is currently unrealistic (Fauci et al., 2008).
A study in Ethiopia indicated that, the prevalence of typhoid fever cases is high, so coordinated epidemiological surveillance is necessary to know the true burden of the disease (Crump et al., 2010 and Beyene et al., 2008).
Occurrence of typhoid can be reduced through improved sanitation and hygienic performance and access to clean water yet it is reported that typhoid prevalence is high. Increased health services, disease awareness and improved attitude of residents reduce the prevalence of typhoid fever.
However, if water quality, sanitation facilities and hygienic practices are not constant, it would be difficult to control and prevent typhoid effectively. According to WHO, 2006, faecal pathogens are frequently transferred to the water borne sewage system, through flush toilets and pit latrines subsequently contaminating surface and ground water. Typhoid outbreaks do occur if control and preventive measures are not taken in a timely manner. Poor waste disposal and hygiene of workers in food handling and preparation activities would provide an obvious infection route.
Typhoid fever is one of the leading causes of morbidity and mortality across the world (Nagashetty et al., 2010). Typhoid is caused by a bacterium of the genus Salmonella. Salmonella infection in humans can be categorized into two broad types, that caused by low virulence serotypes of Salmonella enteric which cause food poisoning, and that caused by the high virulence serotypes Salmonella enteric typhi (S. typhi), that causes typhoid, and a group of servers, known as S. paratyphi A, B and C, which cause Paratyphoid (Kanungo et al., 2008). Humans are the only host of this latter group of pathogens. Salmonella typhi is a highly adapted human-specific pathogen (Bhan et al., 2005). A recent estimate found that 22 million new typhoid cases occur each year in the world with some 200,000 of these resulting in death (Crump et al., 2004). Indicating that the global burden of this disease has increased steadily from a previous estimate of 16 million (WHO, 1997). However, case-fatality rates have decreased markedly (Crump et al., 2004). Generally, typhoid is endemic in impoverished areas of the world where the provision of safe drinking water and sanitation is inadequate and the quality of life is poor. Although contaminated food and water have been identified as the major risk factors for typhoid prevalence, a range of other factors have been reported in different endemic settings such as poor sanitation, close contact with typhoid cases or carriers, level of education, larger household size, closer location to water bodies, flooding, personal hygiene, poor life style, and travelling to endemic areas. In addition, climatic variables such as, rainfall, vapour pressure and temperature have an important effect on the transmission and distribution of typhoid infections in human population (Wang et al., 2012).
However, no previous study has been reported in the literature regarding to the prevalence of Typhoid fever infection in the population of Ejere health center. Therefore the aim of this study is to generate data on the prevalence of Typhoid fever infection in Ejere health center. These data may help partly in the planning of Typhoid fever control and prevention for the districts’ health sector, both governmental and NGOs (Non-governmental organization), and also the studies was to encourage many researchers to investigate the prevalence of typhoid infection regarding to the study area.
However, despite all the efforts taken to control, the disease continues to occur in Ejere District leading to significant morbidity (District health workers, 2020 personal communication).The objective of this study was to assess the temporal occurrence of typhoid fever in Ejere District for the past three years.
Many diseases are caused by food, water and hands that are contaminated by disease-causing organisms or “pathogens” that come from faeces. The diseases caused by these pathogens are called faecal–oral diseases because faecal material is ingested (Fig. 1). These diseases, which include typhoid is responsible for much sickness and many deaths each year.
After ingestion in food or water, typhoid organisms pass through the pylorus and reach the small intestine. They rapidly penetrate the mucosal epithelium via either micro fold cells or enterocytes and arrive in the lamina propria, where they rapidly elicit an influx of macrophages that ingest the bacilli but do not generally kill them. Some bacilli remain within macrophage of the small intestinal (Black et al., 1985).
Water is a source of diseases of typhoid and paratyphoid which affect the alimentary canal. In home and school it is essential that hands should be washed after defecating or urinating, for infection can be transferred in unclean hands used to prepare food or handle eating pots. Unwashed hands, exposed septic sores, contaminated water and flies can also spread infection to food during its preparation (Soper and Smith, 1986).
In areas where drainage and sanitation are poor, water runs over the ground during rainstorms, picks up faeces and contaminates water sources. This contributes significantly to the spread of diseases such as typhoid (Kolsky, 1998).
Typhoid begins like a cold. Temperature goes up a little more each day (Fig. 2). Pulse rate relatively slow and sometimes diarrhea and dehydration. Trembling or delirium (mind wanders) and person very ill.
Typhoid bacilli are drained into mesenteric lymph nodes where there is further multiplication and ingestion by macrophages. It is believed that typhoid bacilli reach the bloodstream principally by lymph drainage from mesenteric nodes, after which they enter the thoracic duct and then the general circulation. As a result of this silent primary bacteremia the pathogen reaches an intracellular haven within 24 hours after ingestion throughout the organs of the reticulo-endothelial system (spleen, liver and bone marrow), where it resides during the incubation period, usually of 8 to 14 days. The incubation period in a particular individual depends on the quantity of inoculums (the introduction of pathogenic organisms into body to produce immunity to the specific diseases), i.e. it decreases as the quantity of inoculum increases, and on host factors. The incubation periods ranging from 3 days to more than 60 days have been reported.
The clinical presentation of typhoid fever varies from a mild illness with low-grade fever, malaise, and slight dry cough to a severe clinical picture with abdominal discomfort and multiple complications. Many factors influence the severity and overall clinical outcome of the infection. They include the duration of illness before the initiation of appropriate therapy, the choice of antimicrobial treatment, age, the previous exposure or vaccination history, the virulence of the bacterial strain, the quantity of inoculums ingested, host factors (e.g. HLA type, AIDS or other immunosuppression) and whether the individual was taking other medications such as H2 blockers or antacids to diminish gastric acid. Patients who are infected with HIV are at significantly increased risk of clinical infection with S. typhi and S. paratyphi (Black et al., 1991). Acute non-complicated disease: Acute typhoid fever is characterized by prolonged fever, disturbances of bowel function (constipation in adults, diarrhoea in children), headache, malaise and anorexia. Bronchitis cough is common in the early stage of the illness. During the period of fever up to 25% of patients are show exanthema (rose spots), on the chest, abdomen and back (Andualem et al., 2014).
Abdominal discomfort develops and increases. It is often restricted to the right lower quadrant but may be diffuse. The symptoms and signs of intestinal perforation and peritonitis sometimes follow, accompanied by a sudden rise in pulse rate, hypotension, marked abdominal tenderness, rebound tenderness and guarding, and subsequent abdominal rigidity. A rising white blood cell count with a left shift and free air on abdominal radiographs are usually seen. Altered mental status in typhoid patients has been associated with a high case-fatality rate. Such patients generally have delirium, rarely with coma (Sinha et al., 1999).
The disease is communicable for as long as the infected person excretes S. typhi or S. paratyphi in the feces or urine. A study by Beyene et al. (2008) showed Salmonella typhus is widespread in the community. Being an important communicable disease in the national list, typhoid fever has received considerable control efforts at national, regional and district levels. However, despite all the efforts taken to control, the disease continues to occur in Ejere district leading to significant morbidity.
The aim of this study was to assess the prevalence of typhoid fever infection in the Ejere health centers in the past three years (2018–2020).
This study was give better information about the level of typhoid fever infections in the study area. Incorporating the result of this work with other similar findings to take appropriate health care measures will contribute for the social and economic wellbeing of the community in the region.