INVESTIGATING THE PREVALENCE OF THYPHOID FEVER IN BASIC HEALTH CENTER OBA ILE AKURE NORTH LOCAL GOVERNMENT ONDO STATE

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ABSTRACT
Typhoid fever is a bacterial infection that can spread throughout the body, affecting many organs. Without prompt treatment, it can cause serious complications and can be fatal. It's caused by a bacterium called Salmonella typhi, which is related to the bacteria that cause salmonella food poisoning. investigate the prevalence of typhoid fever in Oba-Ile Akure North Local Government. The methodology involve the use of questionnaires and review of existing records to gather necessary information from the people in the study area. The study was carried out through the use of structured questionnaire which was administered. One hundred (100) questionnaires were distributed and they were all filled correctly and retrieved. Stratified and systematic sampling techniques were employed for the research work. The data collected were analyzed statistically using frequency distribution table and percentage table. Therefore, it was deduced from the analysis that 21(33%) of the respondents had their treatment in health centre, 35(55%) got theirs in medicine store, 6(9%) said religious store while 2(3%) said no treatment. It also shown that 71(71%) of the respondents said unhygienic practice causes typhoid fever, 21(21%) said no while 8(8%) of the respondents were not sure. The result from the hospital record in 2019 also shows that there were 5 cases of typhoid fever in January, 4 in February,5 in March, 6 in April, 1 in May, 4 in June, 6 in July, 7 in August, 10 in September, 5 in October, 6 in November and 6 in December, with the overall of 71 cases. September has the highest cases of typhoid fever while February and May have the least cases. The result from the hospital record in 2020 also shows that there is 8 cases in January, 7 in February,5 in March, 8 in April, 10 in May, 6 in June, 8 in July, 8 in August, 10 in September, 8 in October, 9 in November and 6 in December, with the overall of 95 cases. Majority of the respondents got their treatment from medicine store. This study recommends that Residents must encourage to seek treatment from the health centre and the importance must be emphasize also residents should also be sensitized on the importance of washing hands with soap and clean safe water after visiting the latrine and before preparing or eating food. 


TABLE OF CONTENTS
Title page i
Declaration ii
Certification iii
Abstract iv
Dedication v
Acknowledgements vi
Table of contents vii-viii
List of tables ix
List of figures x

CHAPTER ONE
Introduction 1-2
Background of the study 3-5
Statement of the problem 6
Objectives of the study 7
Research questions 7
Significance of the study 8
Definition of terms 9-10

CHAPTER TWO
Literature review                                                                                                                   11-12
Epidemiology of typhoid fever                                                                                             12-13
Etiology                                                                                                                                 13-14
Pathophysiology                                                                                                                    14-16
Symptoms and complication                                                                                                16-18
Risk factors                                                                                                                             18
Prevention of typhoid fever                                                                                                 18-19
Treatment                                                                                                                            19-20

CHAPTER THREE
Research methodology                                                                                                           21
Description of the study area                                                                                                  21
Study design                                                                                                                            24
Sampling techniques                                                                                                               24
Sample size determination                                                                                                      24
Instrument for data collection                                                                                                 24
Methods of data collection                                                                                                      25
Method of data analysis                                                                                                           25

CHAPTER FOUR 
Data analysis and presentation                                                                                          26-36

CHAPTER FIVE 
Discussion of findings                                                                                                       37-38
Conclusion                                                                                                                           38 
Recommendation                                                                                                              38-39
References                                                                                                                        40-47
Appendix                                                                                                                            48


LIST OF TABLES
TABLE PAGE
Age range of the respondents                                                                                                    26
Transmission of typhoid fever in the study area                                                                       27
respondents source of water supply in the study area                                                               28
preventive measure of typhoid fever in the study area                                                              29
toilet facility of the respondents in the study area                                                                     30
respondents that suffer from typhoid fever in the last 6 month                                                31
place of treatment of those that had typhoid fever in the study area                                         32
unhygienic practice that causes typhoid fever                                                                           33


LIST OF FIGURES
FIGURE                     PAGES
1 Map of Ondo State showing Akure North                                                                        22
2 Map of Oba-Ile showing the study area                                                                              23
3 The figure showed hospital record of typhoid fever between Jan-Dec 2018 in Oba-Ile.   34    
4 The figure showed hospital record of typhoid fever between Jan-Dec 2019 in Oba-Ile.    34
5 The figure showed hospital record of typhoid fever between Jan-Dec 2020 in Oba-Ile.    36






CHAPTER ONE
1.0 INTRODUCTION 
Typhoid fever is a bacterial infection that can spread throughout the body, affecting many organs. Without prompt treatment, it can cause serious complications and can be fatal. It's caused by a bacterium called Salmonella typhi, which is related to the bacteria that cause salmonella food poisoning. Typhoid fever is highly contagious. An infected person can pass the bacteria out of their body in their poo or, less commonly, in their pee. If someone else eats food or drinks water that's been contaminated with a small amount of infected poo or pee, they can become infected with the bacteria and develop typhoid fever. (National Health Service, 2021). Salmonella is classified into two major groups: the invasive and the non-invasive. The invasive Salmonella, otherwise called typhoidal Salmonellae causes enteric fevers (Samal et al., 2017). Typhoidal Salmonellae include Salmonella Typhi and Paratyphi. The non-invasive Salmonella are termed non-typhoidal Salmonellae (NTS) and are made up of Salmonella species, which usually cause gastroenteritis (Samal et al., 2017). Typhoid and paratyphoid fevers are collectively referred to as enteric fevers, which pose a considerable burden to about 5.5 billion people living in low- and middle-income countries (LMICs) (Antillón et al., 2017) Typhoid and paratyphoid fevers are caused by related but different strains of Salmonella spp, and there is considerable overlap in symptoms. 

Typhoid has the likelihood of resulting in death without prompt treatment. Untreated enteric fever has a case fatality rate of 10% or higher (Ekdahl et al., 2005), while typhoid fever has a case fatality rate of 10%–30% (Malisa et al., 2010), without effective treatment. Again, it is important to mention that some Salmonella serovars are host-specific. Salmonella Typhi and A, B, and C are associated with humans (Luxemburger et al., 2005, Whitaker et al., 2009).

Meanwhile, there are differences in global data estimates of typhoid fever, but all point to a worrying situation of dramatic increases in Sub-Saharan Africa -for (Von et al., 2016, Gordon et al., 2008) instance, typhoid fever has been estimated by some studies to cause between 9.9 and 24.2 million cases and 75,000–208,000 deaths per year (Buckle et al., 2010, Mogasale et al., 2014). Invasive salmonellosis in humans is largely caused by fecal-oral transmission of Salmonella enterica subspecies enterica serovars Typhi (S. Typhi) and Paratyphi A (S. Paratyphi A), typically resulting in systemic typhoid fever (TF) and paratyphoid fever (PF), and nontyphoidal S. enterica (NTS) serovars causing self-limiting enterocolitis and bacteremia among children and adults in sub-Saharan Africa. Globally, TF accounts for 21.7 million cases and 217 000 deaths annually whereas invasive nontyphoidal Salmonella (iNTS) disease accounts for 3.4 million cases and >680 000 deaths (Crump, 2004, Feasey et al., 2015) Currently available typhoid vaccines include the parenteral unconjugated Vi polysaccharide (ViPS) and oral live attenuated Ty21a vaccines, both of which have been recommended by the World Health Organization (WHO) since 2008, and parenteral typhoid conjugate vaccine (TCV), which was prequalified by the WHO in December 2017 (Wong et al, 2015,   Crump et al., 2015, Andrews et al., 2019).

1.1 BACKGROUND OF THE STUDY
Salmonella is most commonly involved bacteria in its significant involvement in human mortality and morbidity is a major health concern. In 2006, The World Health Organization (WHO) estimated incidence of 16 to 33 million typhoid fever cases globally every year, with 500,000 to 600,000 deaths and case fatality rate of between 1.5 and 3.8% (WHO, 2006). With more than 80% of global cases, South Asia is the most commonly reported region for the acquisition of typhoid fever since 1996 to 2005 (Health Protection Agency, 2009). The rate of incidence is 110 cases/100, 000 population (Crump, 2004). There are several hospital-based studies carried out in Pakistan that describe high incidence rate of typhoid fever in children (Ahmad et al., 2000, Bhutta et al., 2018). However, hospital-based data does not reflect the actual disease status in normal community. Especially in remote areas where people live under low socioeconomic conditions and without basic necessities of life such as water, food, electricity and transport, incidence rate is much higher and often associated with small disease outbreaks. Consumption of unsafe drinking water and inadequate sanitary conditions also contribute in increased rate of typhoid fever. In remote places, people usually rely on private and unsafe drinking water reservoirs for example ground wells are frequently found in these localities and act as only reservoir of drinking water without proper quality check (Barbara et al., 2001). According to an estimate in 2003, water borne infections claim 250,000 deaths each year in Pakistan among which typhoid fever is the leading cause (Shah et al., 2003). However, only Egypt and South Africa contributed to this estimate for the African continent. A previous global estimate of the burden of typhoid fever indicated that south-central and east-central Asia had the highest incidences of typhoid fever with more than 100 cases per 100,000 people annually; Africa was estimated to have a medium incidence (10–100 cases per 100,000) (Marks et al., 2017) The estimated number of typhoid fever cases in low- and middle-income countries in 2010 after adjusting for water-related risk was 11.9 million (95% confidence interval: 9.9–14.7) cases with 129,000 (75,000–208,000) deaths. (Mogasale et al., 2014) It is clear that the incidence of typhoid fever in Africa is still not yet well understood. Out-of-sample validation of the model against data from nine Typhoid Fever Surveillance in Africa Program sites showed that the model has mixed success in predicting incidence for locations outside the estimation sample (Antillón et al., 2017). The paucity of epidemiological data regarding invasive Salmonella disease in sub-Saharan Africa led the World Health Organization (WHO) to call for a continent-wide approach in generating more accurate disease incidence and antimicrobial susceptibility data in 2008 (WHO, 2008). 

In Nigeria, typhoid fever remains a major disease because of factors such as increased urbanization, inadequate supplies of potable water, regional movement of large numbers of immigrant workers, inadequate facilities for processing human waste, overburdened health-care delivery systems, and overuse use of antibiotics that contribute to the development and spread of antibiotic-resistant S. Typhi (Talabi, 2018, Akinyemi et al., 2005).  However, the true incidence of typhoid fever is difficult to evaluate in Nigeria because of the lack of a proper coordinated epidemiological surveillance system. Nevertheless, information on typhoid fever prevalence has been documented by several researchers in some states in Nigeria ranging from 0.071% in Oyo to 47.1% in Osun (Obaro et al., 2015). Blood culture–positive typhoidal Salmonella remains the pivotal determinant to estimate true burden. Unfortunately, only few hospitals, specifically, referral hospitals, perform blood culture for diagnosing typhoid cases. The rate of hospitalization and prolonged illness of patients with typhoid fever in high-burden regions due to treatment failure with empirical therapy is a continuing public health concern (WHO, 2003). Since the early 1990s, the spread of multiple drug resistant (MDR) S. Typhi strains (resistant to first-line drugs: ampicillin, chloramphenicol, and trimethoprim–sulfamethoxazole), and more recently, ciprofloxacin has been observed in parts of Asia and Africa, making the treatment of typhoid fever more challenging (WHO, 2003). Over the years, a similar resistance pattern was observed in Nigeria (Adeleye et al., 2018, Feasey et al., 2012, Oboegbulam et al., 2015). Currently, the two internationally licensed typhoid vaccine(Steele et al., 2016).  have not yet been considered for incorporation into the Expanded Immunization Program of health policy in Nigeria. An additional barrier to reducing typhoid fever incidence in Nigeria is the lack of access to safe drinking water and improved sanitation facilities (Hall et al., 2014). The present study was undertaken to generate comprehensive and reliable data on S. Typhi blood culture positivity with a view to outline the longitudinal trends of typhoid fever in parallel with key contextual factors and to assess the trends of antimicrobial resistance in S. Typhi in Nigeria.

1.2 STATEMENT OF THE PROBLEM 
Typhoid fever is a serious disease caused by bacteria. The bacteria are transmitted by eating food or drink water that has been contaminated by infected person with the disease. The bacterial are found in infected stool. The cases of typhoid fever have always been increasing in Oba-Ile, Akure North Local Government Ondo State. Many do not maintain hand hygiene after toileting, some left food uncovered, the rate of the spread of typhoid has always been increasing. Some people treat typhoid 2 times in a month. Some of this patient will not complete their treatment plan and this has been the major challenge, poor knowledge about the mode of transmission. Therefore, this topic aimed to investigate the prevalence of typhoid using Oba-Ile as case study.

1.3 OBJECTIVES OF THE STUDY
The objectives of this study are to;
investigate the prevalence of typhoid fever in Oba-Ile Akure North Local Government.
identify the preventive measures of typhoid fever in the study area
examine unhygienic practices that causes typhoid in the study area

1.4 RESEARCH QUESTION
Is there consistent occurrence of typhoid fever in Oba-Ile Akure North Local Government?
Is there any preventive measure for typhoid fever in the study area?
Are there unhygienic practice that causes typhoid in the study area?

1.4 SIGNIFICANCE OF THE STUDY
Typhoid fever is a disease that can be transmitted through faeco-oral route, hence there is need for proper washing of hand hygiene after toileting. This study will help the people in Oba-Ile to have knowledge about typhoid fever and it will also help them to identify its mode of transmission and how it can be prevented. This study will also help to reduce morbidity and mortality rate due to typhoid fever. This Study will also help to reduce expenses of typhoid fever treatment because when the prevention has been known and practice hence productivity will increase. It will also serve as base line for other researchers.

1.5 DEFINITION OF TERMS 
Drug: Is a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body.

Fever: is a body temperature that's higher than is considered normal.

Gastroenteritis: is the inflammation of the stomach and intestines, typically resulting from bacterial toxins or viral infection and causing vomiting and diarrhoea.

Gastrointestinal infections: are viral, bacterial or parasitic infections that cause gastroenteritis, an inflammation of the gastrointestinal tract involving both the stomach and the small intestine. 

Incidence: Is the occurrence, rate, or frequency of a disease, crime, or other undesirable thing.

Poisoning: is injury or death due to swallowing, inhaling, touching or injecting various drugs, chemicals, venoms or gases. 

Reservoir: Is a place where anything is collected and stored, generally in large quantity;

Salmonellosis: is a common bacterial disease that affects the intestinal tract. 

Surveillance: is the monitoring of behavior, many activities, or information for the purpose of information gathering, influencing, managing or directing

Typhoid: fever is a life-threatening infection caused by the bacterium Salmonella Typhi.

Disease: is a disorder of structure or function in a human, animal, or plant, especially one that produces specific symptoms or that affects a specific location and is not simply a direct result of physical injury.

Sanitation: is the measures, methods, and activities that prevent the transmission of diseases and ensure public health.


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