Typhoid Fever in Sub-Saharan Africa: Challenges of Diagnosis and Management of Infections

ABSTRACT

Typhoid fever; caused by Salmonella enterica serovar Typhi (S. Typhi); is a disease transmitted by the faecal-oral route. It continues to be a public health problem in many developing countries in sub-Saharan Africa. School-age children; especially those from resource-poor settings with inadequate water and sanitation systems; are dispropor- tionately affected. It is estimated that a total of 400;000 cases occur annually in Africa; an incidence of 50 per 100;000 persons per year. Lack of effective diagnosis often leads to inappropriate treatment and management of these infections. Additionally; the emergence and spread of S. Typhi strains having multiple resistance to nearly all commonly available drugs in most developing countries has been a major challenge to health care systems; reducing the effective treatment options for the disease; increasing treatment costs and increasing the risk of complications and death. Although not much data from sub-Saharan Africa has been published; it seems clear that typhoid is common in Nigeria; Mali; Ethiopia and Kenya. Given the importance of information on disease incidence for targeting control measures; including improved sanitation and water supply; vaccination and assessing impact; priority should be given to strengthening surveillance systems for typhoid fever