Typhoid Fever Advisory

What is typhoid fever?

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  • Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi.
  • It is spread through water and food sources that have been contaminated with faecal material containing Salmonella Typhi bacteria.
  • Symptoms include high grade fever of 39 to 40 degrees Celsius, stomach pains, weakness, headache, loss of appetite and a rash of flat rose coloured spots on the chest in severe cases. Symptoms usually develop 1 – 3 weeks after exposure.
  • It is diagnosed after a stool sample or blood is tested for the presence of Salmonella Typhi. It is treatable in mild cases but can be life-threatening in severe cases.
  • If one suffers from typhoid fever and recovers, he or she may still continue to carry the bacteria even after the symptoms have disappeared (carrier).

How can one prevent typhoid fever?

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  • Drinking safe water:
    Contaminated drinking water is a particular problem in areas where typhoid fever is endemic. For that reason, drink only bottled water or water that has been transported and /or stored in clean containers and properly treated by boiling or chemical disinfection.
  • Eating foods that are thoroughly cooked and still hot and steaming
    : Avoid food that’s stored or served at room temperature. Hot, steaming food is best.
  • Avoiding eating raw fruits and vegetables if they cannot be well washed, peeled or cooked
    : This is because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can’t peel and/or cook (Cook it, Peel it or Leave it!).
  • Avoiding foods and beverages from street vendors
    : Food and juices from street vendors are more likely to be contaminated.
  • Practice regular hand washing
    : Wash hands with soap and water before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer for times when water is not available
  • Proper disposal of feces
    using latrines/toilets.
  • Vaccination:
    Protective for 3 years. The typhoid vaccine is not 100% effective (limited protection) and is therefore not a substitute for proper hygiene and sanitation practices.

AVOID INFECTING OTHERS

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If you’re recovering from typhoid fever, these measures can help keep others safe:

  • Take your antibiotics.
    Follow your health worker’s instructions for taking your antibiotics, and be sure to finish the entire prescription.
  • Wash your hands often.
    This is the single most important thing you can do to keep from spreading the infection to others. Wash hands thoroughly with soap and water for at least 30 seconds, especially before eating and after using the toilet.
  • Avoid handling food.
    Avoid preparing food for others until your health worker says you are no longer contagious.

TREATMENT FOR TYPHOID FEVER

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  • Antibiotic therapy
    : is the only effective treatment for typhoid fever.
  • Drinking fluids
    : This helps prevent the dehydration that results from prolonged fever. If you’re severely dehydrated, you may need to receive fluids intravenously.
  • Surgery:
    If there is intestinal perforation, surgery is needed to repair the perforation (hole).

Malnutrition in Africa and the link to under-development

Malnutrition is known to be a direct or indirect cause of illness and death. It directly causes death especially if severe forms go untreated or indirectly by rendering those affected especially children under 5 years vulnerable to preventable infections. Globally malnutrition accounts for up to 35% deaths among children under five years old. Three forms of malnutrition, which are wasting, stunting and intrauterine growth retardation are the major contributors to child mortality, accounting for 2 million deaths annually. Despite concerted efforts by both global and local players to remedy the situation, malnutrition still abounds globally. As a result, between 2000 and 2015, there was slow progress towards the realization of the health-related Millennium Development Goals (MDGs) especially those that targeted maternal and child health. In September 2015, the United Nations adopted the Sustainable Development Goals where Goal 2.2 targets “by 2030 end all forms of malnutrition, including achieving by 2025 the internationally agreed targets on stunting and wasting in children under five years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women, and older persons”.

Africa, especially the sub-Saharan region represents one of the regions where under-nutrition is most prevalent. More specifically, a recent WHO (2013) report revealed that an estimated 160 million children under 5 years are stunted of whom 36% are in Africa alone. In addition, micronutrient malnutrition, or “hidden hunger” particularly deficiencies in Vitamin A, Iron and Iodine remain a pervasive problem in this region.

In the Africa region, underlying factors include traditional practices that may adversely affect maternal and child feeding and health & reproductive care. In addition, poor access to diversified foods, low use of fortified foods, seasonal fluctuation in food supply and diet quality limit achievement of optimal nutrition. Low agricultural productivity is mostly due to poor access to land, information and inputs to improve farm production. High daily workload for women, teenage pregnancy, too frequent births and lack of knowledge of good child care practices have also been listed as underlying factors.

Implications

A vicious cycle exists between malnutrition and diarrhoea among children; malnourished children being more susceptible to severe episodes of diarrhoea and diarrhoea in turn affecting a child’s nutrient intake and ability to absorb nutrients. Children stunted by malnutrition are not only short for their ages but their bodies and brains can incur lasting damage. Research shows that stunted children are more susceptible to disease, tend to do poorly in school, and earn less as adults than their well-nourished peers. The World Bank also estimates that malnourished children are at risk of losing more than 10% of their lifetime earning potential. Costs of Hunger in Africa studies have revealed that countries in Africa are likely losing up to 2 – 17% of their GDPs due to child undernutrition. According to the Lancet (2013) deficiencies in essential vitamins and minerals have important adverse effects on child survival and development. For example, iron deficiency anemia not only impairs cognitive performance in children but also, increases the risk of death due to illness and is associated with a higher risk of mortality during pregnancy and delivery.

There is therefore likely to be slow progress towards the realization of the health, nutrition, education and economic development related Sustainable Development Goals in Africa unless the poor nutrition status of women and children is addressed.

The SUN framework

A global push for action and investment to improve maternal and child nutrition: the Scaling Up Nutrition (SUN) movement has emerged to address this critical issue. The SUN Framework calls for the implementation and scaling up of two complementary approaches;

The first one is direct effective nutrition-specific interventions, focusing on pregnant women and children under two with direct interventions such as the promotion of good nutritional practices, micronutrients, and complementary feeding. This approach is premised on the critical window of opportunity or the 1000-day period between conception to age 24 months due to the potential for nutrition interventions in this period to have a high impact. Evidence shows that proper nutrition during the 1000 days between a woman’s pregnancy and her child’s second birthday gives children a healthy start in life. Poor nutrition during this period leads to irreversible consequences such as stunted growth and impaired cognitive
development.

The second is a broad multi-sectoral nutrition-sensitive approach that tackles the determinants of undernutrition by promoting agriculture and food security, access to and consumption of nutritious foods, social protection, care practices and access to health care. This is because tackling undernutrition is not a health sector issue per se but depends on complex linkages between the health, agriculture, welfare, education and economic development sectors.

References

  1. UNICEF, 2015 UNICEF Data: Monitoring the situation of children and women. data.unicef.org

  2. World Bank, 2013
    web.worldbank.org

  3. African Union, NEPAD, WFP and ECA. 2013. Cost of Hunger in Africa: Social and Economic Impact of Child Undernutrition in Egypt, Ethiopia, Swaziland and Uganda.

  4. African Union, NEPAD, WFP and ECA. 2015. Cost of Hunger in Africa: Social and Economic Impact of child Undernutrition in Burkina Faso, Ghana, Malawi and Rwanda.

MALARIA – PREVENTION

 

In 2015 Sub-Saharan Africa was home to 89% of malaria cases and 91% of deaths from malaria. The World Health Organisation (WHO) states that 3.2 billion people are at risk from malaria which is almost half the population of the world.  These are frightening statistics and ones that need to be dramatically reduced through preventative and curative measures.

What is Malaria?

Malaria is transmitted by bites from the female Anopheles mosquito which releases the parasite Plasmodium.  This parasite is released into the bloodstream and lies dormant in the liver for between 5 and 16 days, asexually multiplying in numbers.  These new malarial parasites are then released back into the blood stream and infect red blood cells.  Recurrence of malaria happens because some parasites remain in the liver and are released at a later stage.

One disturbing fact is that an uninfected mosquito will become infected if she decides to feed off a person who is infected with malaria and so the cycle begins again.

Vector Control

Vector control is a vital part of malaria prevention and has shown to be successful in reducing malaria cases.  The WHO recommend two core measures for preventing malaria carrying mosquitos from biting humans thus controlling malaria: –

  • Long-lasting Insecticidal Nets (LLINs)
  • Indoor Residual Spraying (IRS)
  • Other Supplementary Methods

Long-lasting Insecticidal Nets (LLINs)

Studies have shown that insecticide treated mosquito nets (ITNs) can reduce the death of children under 5 by 20%.  Plain mosquito nets do prevent the mosquitos from entering the sleeping area but they don’t kill them.  The WHO prefer to use Long-lasting Insecticidal Nets (LLINs) which are effective for up to 3 years.

going indoors to begin with.  If half of the people within a village or community use LLINs, the number of mosquitos in the area will be drastically reduced.

These nets are generally distributed freely among the affected population.  However, it is an expensive exercise to replace the nets every three years so manufacturers are trying to come up with a net which is effective for five years:  this will save a massive $3.8 billion dollars over a ten year perios.

Indoor Residual Spraying (IRS)

Indoor Residual Spraying (IRS) is responsible for coating the walls and surfaces of a dwelling with an insecticide.  Although the spraying doesn’t stop humans from being bitten, it does kill the mosquitos after they have fed from humans and rested on a surface, this in turn stops the mosquito transmitting the disease to other people.  For IRS to work in an area, at least 80% of the households must practice it.

Supplementary Methods

Larvae Source Management (LSM) tries to destroy the mosquitos in their breeding ground.  By the reducing the number of larvae and pupae in an area, the mosquito numbers are significantly lowered.

People living in malarial areas should consider putting netted fly screens on their windows and doors to prevent the insects from entering.  Insecticide treated blankets, curtains and clothing are also possibilities which can save humans from being bitten by mosquitos.

MALARIA – CURE

MALARIA – CURE

Malaria is a treatable disease. The most important factor is to rid the infected body of the Plasmodium parasite as quickly as possible to prevent malaria from becoming life threatening. Ridding the body of the parasite also ensures that the disease isn’t transmitted to others via biting mosquitos, as a person with malaria will infect an uninfected mosquito.

Diagnostic Testing

It is vital that a person who is believed to have contracted malaria is tested within 24 hours of the first sign of fever. If the results are positive, a safe antimalarial drug will be administered which will prevent complications from setting in and lead to a quick recovery.

Treatment

The World Health Organisation (WHO) recommends using Artemisinin-based Combination Therapies (ACTs) for simple malaria cases. They list five different ACTs which can be administered to patients with uncomplicated malaria; which one is chosen will depend on the local strains of P. falciparum malaria. ACTs are now used in 79 countries as the first line of defence.

P vivax infections can be treated with chloroquine. However, some areas in the world now breed chloroquine resistant mosquitos so an ACT should be used in these areas.

Sufferers from severe malaria will be treated with injectable artesunate. When the patient is well enough they will be put on an oral course of ACTs.

One-Dose Cure

P. falciparum malaria is the most common in Africa. The cure requires drugs to be taken over a three-day period. This is not easy for health workers to oversee, especially if the patients are not admitted to a clinic and are at home. Scientists are trying to develop a one-dose drug which will ensure that the patient receives the required treatment in one easy to take dose which will be overseen by the health worker or doctor. This will save lives as patients often feel better and don’t see the need to continue taking their medication.

Recurrence of Malaria

The obvious reason for another bout of malaria is being bitten again by a mosquito which is carrying the malaria parasite.

Recrudescence is another bout of the same illness caused by malaria parasites remaining in the red blood cells. Recrudescence occurs shortly after the first attack or it can be delayed.

A relapse is caused by malaria parasites remaining in the liver. This re-attack is usually delayed.

Vaccine

Scientists the world over are desperately trying to develop a malaria vaccine. Developing a vaccine is an exceptionally costly task, costing drug companies up to half a billion dollars.

RTS,S/AS01 is a malarial vaccine which has reached Phase 3 testing and is the front runner at the moment. However, if approved, it is only effective against Plasmodium falciparum malaria.

Problems of Resistance

Resistance to antimalarial drugs has occurred independently throughout the world and is a cause of great concern. Chloroquine resistant P. falciparum first developed in the late 1950s and early 1960s in South America, Oceania and Southeast Asia and has now spread to Africa.

In 2009, resistance to ACT was reported in Southeast Asia. Even though the patients were still recovering, it was taking 72 hours for the parasite to die rather than 30 hours.