Typhoid fever in children presenting to paediatric medical wards of Ahmadu Bello University Teaching Hospital Zaria: A 13-month review

Abstract

Abstract: Typhoid fever is a systemic infection caused by the  Gram-negative bacilli Salmonellae, transmitted via the feaco-oral
route. It commonly affects children, leading to complications and death if untreated. This is a report of typhoid fever admissions as seen at ABU Teaching Hospital Zaria over a 13-month period.

Objectives: To describe the clinical presentation and management outcomes of children admitted with typhoid fever during a
13-month period.

Materials and methods: A retrospective review of demographic, clinical presentation and treatment response of children managed for typhoid fever was conducted. Results were presented as means with standard deviation, proportions, tables, figures and Chisquares with p values. The prevalence of typhoid fever admissions was obtained over the period from 2008-2011.

Results: A total of 779 children were admitted from 1st January 2011 to 31st January 2012, out of which 39 (4.9%) had a diagnosis
of typhoid fever. There was a significant difference in prevalence of typhoid fever admissions from 2008-2010 compared to 2011 (X2 = 5.6651; p <0.019). The mean age was 7.2 (SD ± 4.3) years and 71.8% resided in the same neighbourhood. All the children
had pre-admission antibiotics, while 93.3% had abdominal pain, 64.1% had diarrhoea, 89.7% had fever and 69% had  epatomegaly.
Widal test and blood cultures were positive in 46% and 10.3% respectively. Poor treatment response led to antibiotic switch for 1.1% started on chloramphenicol. Bowel perforation occurred in four (10.3%) who had laparotomy but there was no mortality, and all were discharged after recovery.

Conclusion: A surge was observed in typhoid fever admissions associated  with widespread use of preadmission antibiotics. Low rates of pathogen isolation and unaffordable costs precluded appropriate anibiotic choice for many at admission, and led to poor treatment response. Public health education should emphasize water hygiene and judicious use of antibiotics.

Keywords: Typhoid fever; Enteric fever; Children; Hospital admission.