Abstract

Typhoid is bacterial disease transmitted faecally through the ingestion of contaminated food or water containing Salmonella typhimurium, S.enteritidis related to the serotype paratyphi A, B. Typhoid remains a substantial cause of morbidity and mortality in many low- and middle-income countries including Cameroon were unhygienic handling of food and water is common.

According to WHO 2017, there exists inadequate sanitation systems in many parts of the Cameroon whereby many people still practice open defecation and many more do not have the services to prevent faecal, solid and liquid domestic waste from contaminating the environment. UNICEF, 2020, declares that open defecation remains a persistent inequality, with poorer people more likely to practice open defecation with fewer countries on track to eliminate open defecation by 2030. Sanitation necessary for healthy living which is supposed to ameliorate the situation for pressed-up persons is virtually absent.

The concept of WASH in communities is not only to promote hygiene and increase access to quality health but also to support national and local interventions to establish equitable, sustainable access to safe water and basic sanitation services in every community/society

This study aimed to determine the association of water, sanitation and hygiene with the occurrence of typhoid in the Dockyard 1&2 community.

This study was a hospital and community based analytical cross-sectional study design conducted in the Dockyard 1&2 community-Limbe, South West Region Cameroon. A simple random sampling technique was used to select health area and facility of interest. Data was collected through face to face interview using a structured questionnaire, discussions, observations and stool culture test. Statistical analysis was done using SPSS version 26. A multivariate logistic regression was used to determine water, sanitation and hygiene risk factors associated to typhoid fever occurrence. Variables with P-values < 0.05 were considered statistically significant.

Findings revealed that a prevalence rate of 28.9% of typhoid fever was gotten in this study. It is worth noting that 100% of participants had knowledge about typhoid fever. This study revealed that level of education was significantly associated with acquiring typhoid fever as well as area of residence with statistical significance of χ2 =33.038; p<0.000 and χ2 =18.214; p = .000, respectively. Again, in this study we found out that respondents who said no not regularly washing their hands before meals and after toilet use were about 6 times more likely to contract typhoid than those who regularly washed their hands. Also, individuals who ate food cooked at roadsides and restaurants were respectively about 7 times and 2 times more likely to contract typhoid than those who regularly eat food at home.

To conclude, the prevalence of typhoid is still high, 28.9% in the Dockyard 1&2 communities, and it is associated to area of residence, poor hand hygiene, and area of cooked food. Therefore the understanding and avoidance of factors influencing the occurrence of typhoid in these communities is important in the management and prevention of the infection in the Dockyard 1&2 communities.

CHAPTER ONE

INTRODUCTION

1.1. Background of the Study

Typhoid remains a major cause of morbidity and mortality in many low- and middle-income countries, with an estimated 17.8 million new episodes annually [1]. By 2015, both Asia and sub-Saharan Africa became the regions with the lowest coverage of improved drinking water and improved sanitation [2, 3]. Typhoid remains a systemic bacterial illness of public health importance transmitted from person to person due to faecal contamination of food and water [4]. The causative agents, Salmonella typhimurium, S.enteritidis related to the serotype paratyphi A, B and is exclusive to humans who are the natural host and reservoirs [5].

Humans can become chronic carriers and food handling practices among carriers can result in food contamination and Salmonella typhi transmission. However, use of sewage contaminated water for irrigation and domestic use is considered critical in maintaining typhoid endemicity in developing countries [5]. Since the major routes of transmission of typhoid are through drinking water or eating food contaminated with Salmonella typhi, the World Health Organization (WHO) recommends provision of safe water as one of the preventive measures for typhoid [5].

Typhoid is common among crowded and impoverished populations with inadequate sanitation and without effective treatment; typhoid has a case fatality rate of 10%–30% [6]. Studies show that Salmonella species can survive for days in ground water/sea water and for months in contaminated food and the infectious dose may vary between organisms [7]. Behaviours associated with faecal contamination of food and water has dominated perspectives on typhoid transmission [9]. Determinants related to the residential setting, namely the conditions of the living environment including infrastructure, and microbiological and physicochemical characteristics, warrant attention for their potential to influence risk of transmission. Outside of faecal contamination of drinking water, a statistically high-incidence of typhoid has been associated with local climate, elevation, and proximity to altered land and hydrologic systems [10-13].

Understanding the relative strengths of the association between different components of WASH and typhoid risk factors can create an opportunity to leverage the efforts of the Joint Monitoring Programme to better understand the risk of typhoid within and across countries [14] and may lead to more cost-effective strategies for implementing various WASH components that can provide the strongest protection against typhoid [15].

Designing such a strategy requires a detailed understanding of the strength of the association between different components of WASH and typhoid. While there appears to be a clear association between typhoid and the levels of WASH practices, the degree of association varies from study to study. Population levels of access to improved WASH are monitored by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) in over 190 countries since 1990 [16].

The JMP WASH classification has three categories: drinking water, sanitation, and hygiene, and each category has service ladders indicating different levels of improvement. For instance, the drinking water category has five service ladders: Safely managed, Basic, Limited, Improved, Unimproved, and Surface water. JMP maintains estimates on each of the different categories that can be compared across each of the 190 countries that cover almost all of the low and middle income countries [17].

1.2. Problem Statement

Typhoid has been a significant public health issue in low and middle-income countries, including those in Africa, with 17.8 million approximated cases every year [18]. As of the year 2018, approximately 21 million cases and 222,000 typhoid-associated deaths occurred annually in the world; however, the infection is life threatening in communities and informal squatter settlements that have limited water, sanitation, and hygiene infrastructure [19].

Previous studies focused on sanitation and hygienic conditions that contribute to typhoid such as household level hygiene, food and water contamination, including handling practices has been carried out in other areas in Cameroon, but very few studies have been carried out in the Dockyard community.

Following the population displacement due to the Anglophone crisis of the south and north-west regions, shortage and lack of portable water, inadequate hygiene and sanitary conditions mostly aggravated by overcrowding has led to a number of health risks.

Working among those prone to diseases caused by unsafe drinking water, improper hygiene and unsanitary environment, the purpose is to help reduce the burden of typhoid by improving on WASH practices of the community for its control and prevention which will help achieve the Sustainable Development Goals (SDGs) which calls for universal sanitation access and ending open defecation by 2030.

1.3. Research Questions

1. What is their knowledge as far as typhoid risk factors are concern in this community?
2. What are the current WASH practices statuses in the community and their association with typhoid fever occurrence?
3. What is the prevalence of typhoid fever in this community?

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