THE ROLE OF NURSES IN MANAGEMENT OF THYPHOID IN WEST AFRICA

Background Of The Study: Typhoid fever is a systemic prolonged febrile illness caused by certain Salmonella serotypes including Salmonella typhi, S. paratyphi A, S. paratyphi B and S. paratyphi C. It emerged as an important infectious disease in the early 19th century. The illness begins with mounting fever, headache, vague abdominal pain and constipation, which may be followed by appearance of rashes. During the third week, the patient reaches a state of prolonged apathy, toxemia, delirium, disorientation and/or coma followed by diarrhoea. If left untreated, it can lead to complications affecting various organ systems (Fauci et al., 2008). Infection occurs in all age groups with a higher incidence and more variable clinical presentation in children. Since the late 1940s typhoid fever was successfully treated with one of the several antibiotics, chloramphenicol, ampicillin and trimethoptrim-sulphamethoxazole. However, from 1990, multidrug resistant strains to the previously useful antibiotics have emerged, and treatment for such strains requires the use of more expensive quinolone antibiotics such as oral ciprofloxacin or third generation cephalosporins such as ceftriaxone (WHO, 2003). Human beings are the only reservoir and host for typhoid fever, and the disease is transmitted by faecally contaminated water and food in endemic areas especially by carriers handling food. The World Health Organization (WHO) estimates for annual global incidence of typhoid fever, about 21 million cases with >600,000 deaths. Cases are more likely to be seen in areas like India, South and Central America, and Africa with rapid population growth, increased urbanization, and limited safe water, infrastructure, and health systems (Willke et al., 2002, John et al., 2004).

Typhoid fever is a major health problem in developing countries where safe water supplies and adequate sewage disposal are often lacking. Epidemiologic data on typhoid fever in endemic countries is lacking or incomplete. Case identification may be based on clinical, bacteriological or serologic diagnosis; or typhoid fever may be clumped with other diseases or conditions such as fever of unknown origin (Abucejo et al., 2001). Typhoid fever has important socioeconomic impact because, most of the time, several months are necessary for a patient to recover and be able to work again. So accurate diagnosis of typhoid fever at an early stage is important not only for etiological diagnosis, but also to identify individuals that may serve as a potential carrier, who may be responsible for acute typhoid fever outbreaks (Gopalakrishnan et al., 2002). Several options exist for diagnosing enteric fever: clinical signs and symptoms; serological markers; bacterial culture; antigen detection; and DNA amplification. The clinical diagnosis of typhoid fever is difficult because the manifestations of the disease are diverse and there are many causes of prolonged fever in typhoid endemic regions. Signs such as relative bradychardia or leucopoenia may be useful but give a low specificity. The culture of blood, bone marrow and stool are the most reliable diagnostic methods but these are expensive techniques and the infecting organism may be dead on arrival at the hospital if the patient has taken antibiotics before clinical samples can be taken. Serological diagnosis is predominantly by the Felix-Widal test, first standardized in the 1950s. Although ELISA and immunoblotting suggest possibilities, the commercially available kits for the serodiagnosis of enteric fever have not performed well in large studies (Wain and Hosoglu, 2008). Typhoid fever remains a major public health problem in the developing world with very poor estimates of the number of cases and deaths annually. Continued research on the epidemiology, ecology, pathogenesis, diagnosis, treatment and prevention of typhoid can most optimally be pursued in the endemic regions which, unfortunately, also suffer from a lack of research capacity, funding support, and institutional infrastructure. Much needs to be done to promote and strengthen typhoid fever and other infectious disease research in these regions if true progress is to be made. Information across sub-Saharan Africa is very scarce and the issues clearly require urgent and rapid action, particularly in West and East Africa (Ethiopia and Kenya) which seems to have a high burden of typhoid fever (Pang, 2008). In the light of the above, this study aims at examining the knowledge and risk perception towards typhoid fever among Onikokoro Community, Olorunda Local Government, Ibadan Oyo State.

1.2 Statement Of The Problem

Typhoid fever is a bacterial disease transmitted by the fecal-oral route (Keddy et al., 2016; Shukla et al., 2014). The infection typically occurs from the ingestion or consumption of food or drinks infected with bacteria, usually transported by flies from the feces or urine of infected individuals (Keddy et al., 2016; Shukla et al., 2014). In Onikokoro Community, these flies transport disease to people’s homes, not only as a result of the poor conditions of the environment, but also due to the open defecation practiced by some of the villagers. The disease has been a significant public health issue in low and middle-income countries,

Furthermore, poor knowledge and risk perception towards typhoid fever contributed to the prolonged transmission of diseases in the community. The aim of this study was to assess the role of nurses in management of thyphoid in west Africa a case study of Onikokoro Community, Olorunda Local Government, Ibadan Oyo State.