Typhoid fever study

John Crump
John Crump
Prof John Crump hopes a new University of Otago-backed study will clarify key issues in the spread of typhoid fever in Fiji and highlight the high incidence of the "neglected disease" in Oceania.

Otago researchers have been key partners in the study, which found  poor sanitation facilities appeared to be a major source of Salmonella Typhi, the cause of typhoid fever, in Fiji.

Otago Global Health Institute co-director, Prof Crump said typhoid fever was endemic in Fiji.

The disease had increased over the past decade and the research showed transmission was mainly through consumption of contaminated surface water and unwashed produce.

The research concluded that "improved sanitation facilities and protection of surface water sources and produce from contamination by human faeces" were likely to contribute to typhoid control in Fiji.

Prof Crump, an  international typhoid fever specialist who oversaw the study design, said typhoid fever was a substantial cause of morbidity and mortality in many low and middle-income countries.

It was also a "serious concern"  Oceania had fallen behind both Asia and sub-Saharan Africa, having become the region with the "lowest coverage of improved drinking water and improved sanitation".

Oceania was now thought to have the highest typhoid fever incidence by region, but this was "under-appreciated" even among  researchers, partly because of higher case numbers in other, more populous areas, he said.

Namrata Prasad, a Fijian who is  an Otago masters of public health graduate, was the first joint author of the paper and led the analysis of the study, just published in tropical medicine journal PLoS  Neglected Tropical Diseases.

This is believed to be the first study to investigate sources and modes of transmission of typhoid fever in Fiji.

People without access to improved sanitation facilities or with damaged "improved" sewerage systems were at particular risk, the study found. Those with typhoid fever were more likely to have someone within their household build their toilet. In Fiji a common sewerage "improvement" was using buried steel drums as the sewage receptacle. But such drums were subject to flooding, corrosion and leakage, leading to contamination of surface water and crops by human faeces.

Related research showed  gardens of typhoid fever patients were more often placed closer to the household toilet or septic tank than in control households.


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