Abstract

Typhoid fever is a significant cause of illness and death especially among children in developing countries due to poor sanitation and unsafe food and water supply particularly where the water is contaminated by human feaces. The main objective of this study was to assess the knowledge of parents on the management of typhoid fever in the mile16 community.

A descriptive cross-sectional study design and a simple random sampling technique was used in the study. A total of 100 patients who met the inclusion criteria were recruited in the study and the main instrument for data collection was a structured questionnaire. Data were analyzed using Microsoft excel 2016 and SPSS and presented in tables and figures.

The results of the study showed that the overall proportion of patients with adequate knowledge on the causes and clinical manifestation of typhoid fever was 71 (71.00%). Regarding the preventive and control measures of typhoid fever, all 100 (100.0%) of the participants agreed that vaccination and drinking of treated water can help prevent typhoid fever.

According to the study 63 (63.00%) of the participants cited inadequate knowledge about typhoid fever as a major challenge. In conclusion findings from the study revealed that, majority of the participants had adequate knowledge on the causes, clinical manifestation and complications of typhoid fever.

From The study it is recommended that prevention of typhoid fever should be practiced daily such as hand hygiene, eating properly cooked food, avoid eating unwashed fruits or drink dirty water and reporting to any medical facilities in case of any clinical symptoms of the disease.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Typhoid fever (TF) also known as enteric fever is a life-threatening illness caused by the bacterium Salmonella Typhi. Typhoid fever is an infection of the intestinal tract and occasionally the bloodstream. It is caused by the bacteria, Salmonella Typhi. Most cases are acquired during travel to underdeveloped countries.

Anyone can get typhoid fever, but the risk is greatest among travelers visiting countries where the disease is common. Occasionally, local cases can be traced to exposure to a person who is a chronic carrier. Typhoid fever is not common in the United States, Canada, Western Europe, Australia, or Japan, but it is common in many other countries especially African countries (CDC, 2018).

The World Health Organization (WHO) estimates that 16–33 million people are infected worldwide each year. Typhoid, or enteric, fever leads to 200,000 deaths annually; 80% of these in Asia and the rest primarily in Africa and South America. Recent studies in Asia suggest that the incidence of enteric fever is highest in children aged, 5 years and that young children experience similar rates of fever (Uttam et al., 2017). In Bilbies District (population 664,000) in Lower Egypt, the estimated incidence of typhoid fever was calculated to be 13 cases per 100,000 persons per year.

Also, the results of population-based surveillance in Fayoum governate indicate that incidence of typhoid fever was 59 cases per 100,000 persons per year (Crump et al., 2019).

In Assiut, incidence estimates have been derived from hospital-based syndromic surveillance, which may not represent the population with TF about 1000 patient annually (Assuit Health Affairs Directorate). Typhoid fever is an infection that causes clinical symptoms of fever, abdominal pain, body rashes, terry stool, weakness, poor appetite, headaches, generalized aches, pains, lethargy and hepatosplenomegaly will be detectable in about 50% of patients (W.H.O, 2017).

A study from the Gambia reported 18% S. typhi in 246 positive blood cultures and in 1993 a study in the Ivory Coast revealed that bacteremia, including S. enteritis, was more frequent among HIV-positive than in HIV-negative patients.

Although some studies in Ghana have addressed the epidemiology of TF with the exception of a recent study, none has estimated the incidence of TF in the African setting due to lack of information about the health seeking behavior of ill persons and a well-defined coverage area for a hospital as a reliable denominator of incidence. Consistent data on TF incidence are urgently needed to identify endemic areas for vaccination trials and preventive measures subsequently, to implement vaccination and other preventive strategies.

The uncertain distribution of TF in Africa currently limits the ability of national leaders to make evidence-based public health decisions regarding the deployment of TF vaccines and other preventive measures.

In the foreseeable future, other major causes of febrile illness (e.g., Streptococcus pneumoniae and Hemophilus influenzae type b) will likely decline due to the introduction of vaccines against these pathogens. The lack of credible data on TF in many African countries has also limited awareness of the disease among clinical and public health providers. Fever-related diseases are mostly diagnosed solely on the basis of clinical signs and symptoms. Diagnosis of typhoid fever is made when the Salmonella bacteria is detected with blood culture or stool culture. Besides this, several other tests were also performed for early diagnosis of typhoid fever like immunochromatographic assay. During the first week of illness, 60-80% of TF patients not previously treated with antimicrobials have the causative organism in their bloodstream.

However, even with good laboratory facilities, the organism cannot always be isolated because of antimicrobial use, insufficient volume of blood collected, or timing of specimen collection in relation to onset of disease. Historically, blood culture sensitivity for S. Typhi has ranged from 60% to 80%.

However, because factors that might impact the isolation of S. Typhi from blood are not routinely reported, (Crump et al,2002) chose to apply a conservative blood culture sensitivity of 50% to all conducted studies. (Gilman et al,2016). reported that in a study looking at the isolation of S. Typhi, the sensitivity of bone-marrow culture was 90% and blood culture 40%. Blood culture facilities are often limited to major hospitals in many developing countries and consequently, access to appropriate diagnostic facilities is a limiting factor for typhoid diagnosis and surveillance. Therefore, a multi-country standardized TF surveillance program in sub-Saharan Africa is urgently needed. (Ali et al,2017).

Knowledge according to Winifred (1989) is accumulated facts, truth, principles and information to which human mind has access. Knowledge can be defined as the sum of conceptions, views and propositions which has been established and tested (Conforth, 1996). The Nigerian Education Research Council – NERC (1982) asserted that an educated and knowledgeable person is one who understands, among other things the basic facts concerning health and disease which protects his or her own health and that of the community. WHO (1995) also maintained that, if a person is well informed in the area of health, he or she would be able to reject practices that imperil his or her health?The individual will also be well equipped to make the right decision concerning him or herself and the surrounding and will play active role in improving the society in which the person lives.

In the context of this study, knowledge refers to the act of having adequate information and understanding of the concept, signs and symptoms, preventive measures, modes of transmission and management practices of typhoid fever by parents in children. Adequate or high-level knowledge of the concepts, signs and symptoms, preventive measures and mode of transmission of typhoid is capable of guaranteeing proper preventive practices of typhoid among pediatric patients.

Contaminated water or ice, food and drinks purchased from street vendors, raw fruits and vegetables grown in fields fertilized with sewage, ill household contacts, lack of hand washing and toilet access, and evidence of prior Helicobacter Pylori infection, were the most commonly reported risk factors. (Michael et al, 2017). Complications of typhoid disease include typhoid meningitis, encephalomyelitis, cranial or peripheral.

Widal test, which was first introduced by F. Widal in 1896, is widely used in the diagnosis of typhoid fever. This is because it is relatively cheaper, easy to perform and requires minimal training and low sophisticated equipment. In most health facilities in Cameroon, the Widal test is always confirmed with a second test which is the stool culture test. Antibiotic therapy is the only effective treatment for typhoid fever. Commonly prescribed antibiotics include: Ciprofloxacin (Cipro), Azithromycin (Zithromax) and Ceftriaxone. (ministry of public health, 2016)

Prevention and control sanitation and hygiene are important to prevent typhoid. Careful food preparation and washing of hands are crucial to prevent typhoid (WHO, 2015) To maintain rural health, water-borne diseases can be reduced by introducing health interventions like proper water and sanitation facilities (Michael et al., 2017).

Studies carried out by Khan in Karachi Pakistan in 2017 indicates that children of age between 1 to 10 years are at a higher risk of contracting typhoid disease. Reports from the Cameroons’ Public Health ministry shows a frequent diagnosis of typhoid fever in children in health facilities in Cameroon and has resulted in a public scare. It is thus considered an endemic disease in Cameroon. One major challenge in the treatment of this disease in Cameroon is the high costs of its drugs. Control strategies to the disease is a possible way out to reduce the disease spread. However, absence of information and knowledge associated to the risk factors of typhoid fever especially in children in Cameroon has made it not really possible to bring about effective control strategies to manage the disease.

1.2. Problem Statement

Enteric fever is an infection of the intestinal tract and occasionally the bloodstream.  It is caused by the bacteria, Salmonella Typhi. Inadequate knowledge has been admitted as a prerequisite for the adoption of desirable health behavior.

WHO (1995) asserted that when a person is well-informed, the individual will be equipped to make the right decision concerning his or her health and will take an active role in improving the society in which he or she lives. Parents should have adequate knowledge of typhoid fever so as to prevent their children from contracting it and learn how it should be properly managed.

Contaminated water, food and drinks purchased from street vendors, raw fruits and vegetables grown in fields fertilized with sewage, ill household contacts, lack of hand washing, and toilet access, are the most commonly reported risk factors of typhoid fever. Typhoid is found to be amongst the main bacterial diseases not only in Cameroon but also in other underdeveloped and developing countries in the world. It is the low level of knowledge on typhoid fever and its preventive practice may militate against the effective performance of its management measures.

Regrettably, in the Mile 16 community, there is a lack of knowledge on typhoid and its management measures by the parents, as many of them are still deficient in proper hygiene safety measures and the majority shy away from getting proper health education on preventive measures of typhoid and how it’s treated. It is against this background of the cases and magnitude of typhoid diseases, its associated implications and complications, and the need for safety and health promotion that the researcher was motivated to assess the knowledge of parents on the management of typhoid fever in children.

1.3 Research Questions

1. What do parents of the Mile 16 community know about typhoid fever, its causes, signs, and symptoms?
2. What do parents of the Mile 16 community know about managing and preventing typhoid fever in children?
3. What challenges do parents face in preventing and managing typhoid fever in children?

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