Conference abstract

Typhoid over diagnosis and reporting in Nakaseke District, Uganda, 2016

Pan African Medical Journal - Conference Proceedings. 2017:6(8).20 Dec 2017.
doi: 10.11604/pamj-cp.2017.6.8.509

Contact the corresponding author
Keywords: Typhoid, diagnosis, reporting, Uganda

Typhoid over diagnosis and reporting in Nakaseke District, Uganda, 2016

Joy Kusiima1,&, Eric Ikoona2, Daniel Kadobera1, Alex Riolexus Ario1

1Uganda Public Health Fellowship Programme, Kampala, Uganda, 2Frontline Field Epidemiology Training Program, Kampala, Uganda

&Corresponding author
Joy Kusiima, Uganda Public Health Fellowship Program, Kampala, Uganda


Introduction: typhoid is a disease of public health importance in Uganda. A data audit conducted among 12 public health facilities for week 15 to week 21 in Nakaseke District recorded a high number of typhoid cases (342). Likewise, analysis of records in the MOH weekly surveillance system for week 18 to 21 estimated about 134 typhoid cases per 50,000 which are higher than the recommended threshold (20 persons per 50,000 populations) in the community.

Methods: in June 2016, a typhoid verification exercise was conducted in three health facilities in Nakaseke District. These facilities, which were purposively selected were: Nakaseke Hospital, Kiwoko Hospital, Semuto Health Centre IV and Kakuto Health Centre III. A suspected case was any patient with a diagnosis of typhoid/enteric fever or a positive laboratory test that is suggestive of typhoid between 1st December 2015 and 14th June 2016. The team extracted records from inpatient and outpatient registers, examined suspected typhoid patients, and reviewed laboratory and data collection procedures. Samples from five suspected cases where taken for culture and sensitivity testing.

Results: approximately 1,025 records of patients treated for typhoid were extracted. About 81.2% were clinical diagnoses. Females had a higher attack rate (6.3 per 1000 persons) compared to the males (3.1 per 1000 persons). Nakaseke and Kikamulo sub-county had highest attack rates estimated at 11.2 per 1000 persons and 7.8 per 1000 persons respectively. None of the facilities in the district were able to conduct blood culture and sensitivity tests and therefore all suspected typhoid diagnoses in the district were based on clinical symptoms and high typhoid O titers (O > 160). All five samples taken for blood culture at the Central Public Health Laboratory tested negative.

Conclusion: there was insufficient evidence to confirm an outbreak in this district which raises the urgent need to strengthen capacity of the hospitals in the district to conduct culture and sensitivity. A continuous quality improvement exercise is recommended to improve the diagnostic practices of typhoid among clinicians and health workers.