- A doctor in bongo will never refer to the test as a ‘typhoid test’, they prefer to use the term ‘widal test’.
Typhoid is one of the most common known disease in Tanzania. Almost all patients that visit hospitals in Tanzania do at least know the word “typhoid”, to the extent that a patient may not even narrate the whole history to a doctor, instead he/she will just ask to be tested for it.
A doctor in bongo will never refer to the test as a ‘typhoid test’, they prefer to use the term ‘widal test’.
Though of the awareness of the name of the disease, I doubt people have vast knowledge over the disease. Mind you, we still have plenty of typhoid cases here in Tanzania.
Getting familiar with typhoid
You must understand that typhoid is a bacterial infection caused by salmonella typhi, and its symptoms vary from mild to severe and usually begins six to 30 days post exposure.
In my practice, I have met patients suffering from either mild or severe form of the disease, but you may seldom witness typhoid cases in a tertiary hospital, assuming it is almost obsolete, since a lot of cases are dealt with at lower levels.
There is a gradual onset of fever over a period of time but what are the other symptoms? The general public do suspect typhoid just because they know its name and they use abdominal pain/vomiting/diarrhoea, as the only indicator/diagnostic symptom. Of course weakness, abdominal pain, constipation, and headaches also commonly occur.
Diarrhoea is not common and vomiting is usually severe.
Some people develop a skin rash with rose coloured spots and in severe cases the patient may even be confused.
Did you know that you can carry the bacteria without being affected? Yes, some people can carry the bacterium without being affected, however, they are still able to spread the disease to others. The bacteria causing typhoid grows in blood and intestine.
How does it spread?
It is spread by eating or drinking food or water contaminated by faeces of an infected person. Shocked?
The risk factors are poor hygiene and sanitation or recent travel to the typhoid endemic areas.
Can we clamp down typhoid cases?
In Tanzania, we insist people to adopt the habit of hand washing, drinking clean water and practise good sanitation and hygiene.
However, it is said that there is a typhoid vaccine which of course we don’t have one in Tanzania. World Health Organisation (WHO) endorsed the use of typhoid vaccine in 1999, to decrease rate of typhoid fever. Personally, I have not seen one in Tanzania.
But one of the most important warning, which health care providers do forget to caution typhoid patients is that they should not prepare food for others until it has been confirmed that an individual’s infection is cleared.
Is it treatable?
Typhoid can be managed with antibiotics. In Tanzania standard treatment guideline recommends the use of ciprofloclaxillin or chrolamphenical. However, doctors may use their acumen to suggest other drugs.
In some countries, where resistance to those drugs has been confirmed, they use alternate antibiotics like azithromycina or ceftriaxone.
Let us take a cursory glance at the history. The discovery of ORS (Oral Rehydration Therapy) in the 1960s provided a simple away to prevent deaths related to diarrhoea disease in general public.
In 2015, there were 12.5 million new cases globally, the disease is most common in India. Children are most commonly affected, and in US 400 new cases are reported every year.
In 2015, 149,000 deaths worldwide occured, which had lowered since 1990 from 181,000.
Can typhoid kill? The risk of death may be as higher as 20 per cent without treatment, and with treatment it is about 1-4 per cent.
Malaria and typhoid, is it one?
They do share rather similar symptoms and of course I have personally witnessed people suffering from both malaria and typhoid.
Thus due to overlapping of the symptoms between the two, the clinical diagnosis approaches may be subject to huge errors in highly endemic areas.
However, the erroneous interpretation of widal test may lead to misdiagnosis and mistreatment, but mere clinical diagnosis is unacceptable.
How do we diagnose it in Tanzania?
In some areas it is still being diagnosed clinically, while in other places they use widal test. Though the use of widal test is a confirmatory test, it is losing ground due to the new guidelines of NHIF especially in dispensaries and health centres, where most typhoid patients primarily attend.
One of the studies published in the Journal of Public Health and Epidemiology on ‘The prevalence and constrains of typhoid fever and its control in endemic areas of Singida region in Tanzania’, by Allen Malisa and Honest Nyaki, it was observed:
120 respondents were selected, whereby it was observed that despite considerable control efforts, the disease [typhoid] continues to persist in Singida urban leading to significant morbidity and mortality.
It was further revealed that annually typhoid fever prevalence records revealed a fluctuating trend with annual incidence rate of 580-1400/100,000 persons and an overall increase from 771-942 cases/100,000 persons between 2003 and 2007.
While 88 per cent of the respondents were aware of the typhoid fever disease, 535 were unaware of its control methods, an acute shortage of diagnostic laboratory services which indicated that 75 per cent of health facilities had no such services.
Inadequate knowledge about personal hygiene, scarcity/lack of access to safe water, improper drainage systems and problems of unsanitary toilets in Singida urban were some of the obstacles to effective typhoid fever control .
In details, the author adds that 57 (47.5 per cent) people took lab tests before medication, 63 (52.5 per cent) weren’t sub jected to lab test before medication.
The author is a medical doctor, public health activist and a researcher.