Determination of the prevalence of typhoid in provincial and selected district hospitals in Kenya

Abstract

Accurate and reliable detection of typhoid infection in Kenya has been riddled with many problems. Some uncertified health reports have consistently indicated high infection rates in most parts of the country. The most common diagnostic tool in most health facilities has largely been clinical impressions. In some cases Widal test more rarely isolation of the causative agent through culture has been carried out during routine practice. It has hence been difficult to estimate accurately the prevalence and disease burden associated with typhoid in Kenya from records maintained by Provincial and some selected District Hospitals. The aim of this study was to estimate the prevalence of typhoid by creating accurate data and analyzing the same appropriately.

This study examined specimens in laboratory by culturing to isolate Salmonella typhi. All samples came from patients who were clinical suspects of typhoid fever. Data analysis was conducted using statistical package for social sciences (SPSS) version 10.0. Comparative analysis of typhoid specific morbidity showed that some parts of the country namely Nyanza, Eastern and Rift Valley were most affected. The results showed no significant statistical difference between the sexes infected (c2=0.56; df=1;p=0.454). It demonstrated that there was no difference in infectivity among different age groups, (c2=0.174;df=1;p=0.677).

The study has shown that typhoid cases have been clinically over diagnosed leading to consequent unnecessary high treatment costs and probable drug resistance in patients.

The data showed a proportion of 1:20 for confirmed cases to those that were clinically diagnosed. There was a statistical difference between Widal test and culture confirmed cases (c2=36.851; p=0.000; df=1). It was also demonstrated that there were other infections (brucellosis, Escherichia coli, shigellosis), which were clinically similar to typhoid in presentation. The results could serve as a guide to policy makers on areas of emphasis in the ongoing prevention and health promotion measures in terms of immunization, sanitation, health education and operational research. The study results will benefit health workers in their day-to-day practice when diagnosing typhoid. It also forms a basis for further research by interested parties including insurance industry, government/local authority agents et cetera, for planning purposes.