Domestic river water use and risk of typhoid fever: results from a case-control study in Blantyre, Malawi

Jillian S. Gauld, Franziska Olgemoeller, Rose Nkata, Chao Li, Angeziwa Chirambo, Tracy Morse, Melita A. Gordon, Jonathan M. Reid, Robert S. Heyderman, Neil Kennedy, Peter J. Diggle, Nicholas A. Feasey

Research output: Contribution to journalArticle

Abstract

Background
Typhoid fever remains a major cause of morbidity and mortality in low and middle-income settings. In the last 10 years, several reports have described the re-emergence of typhoid fever in southern and eastern Africa, associated with multidrug-resistant H58 Salmonella Typhi. Here, we identify risk factors for pediatric typhoid fever in a large epidemic in Blantyre, Malawi.
Methods
A case-control study was conducted between April 2015 and November 2016. Cases were recruited at a large teaching hospital, while controls were recruited from the community, matched by residential ward. Stepwise variable selection and likelihood ratio testing were used to select candidate risk factors for a final logistic regression model.
Results
Use of river water for cooking and cleaning was highly associated with risk of typhoid fever (OR 4.6 [CI: 1.6-12.5]). Additional risk factors included protective effects of soap in the household (OR 0.6 [CI: 0.4-0.98]) and more than one water sources used in the previous 3 weeks (OR 3.2 [CI: 1.6-6.2]). Attendance at school or other daycare was also identified as a risk factor (OR 2.7 [CI: 1.4-5.3]) and was associated with the highest attributable risk (51.3%).
Conclusions
These results highlight diverse risk factors for typhoid fever in Malawi, with implications for control in addition to the provision of safe drinking water. There is an urgent need to improve our understanding of transmission pathways of typhoid fever, both to develop tools for detecting S. Typhi in the environment, and inform water, sanitation, and hygiene interventions.
LanguageEnglish
Pages1-25
Number of pages25
JournalClinical Infectious Diseases
DOIs
Publication statusPublished - 30 May 2019

Fingerprint

Malawi
Typhoid Fever
Rivers
Case-Control Studies
Water
Salmonella typhi
Logistic Models
Southern Africa
Soaps
Eastern Africa
Sanitation
Cooking
Hygiene
Teaching Hospitals
Drinking Water
Fever
Pediatrics
Morbidity
Mortality

Keywords

  • salmonella typhi
  • WASH
  • water
  • sanitation
  • environment

Cite this

Gauld, Jillian S. ; Olgemoeller, Franziska ; Nkata, Rose ; Li, Chao ; Chirambo, Angeziwa ; Morse, Tracy ; Gordon, Melita A. ; Reid, Jonathan M. ; Heyderman, Robert S. ; Kennedy, Neil ; Diggle, Peter J. ; Feasey, Nicholas A. / Domestic river water use and risk of typhoid fever : results from a case-control study in Blantyre, Malawi. In: Clinical Infectious Diseases. 2019 ; pp. 1-25.
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abstract = "BackgroundTyphoid fever remains a major cause of morbidity and mortality in low and middle-income settings. In the last 10 years, several reports have described the re-emergence of typhoid fever in southern and eastern Africa, associated with multidrug-resistant H58 Salmonella Typhi. Here, we identify risk factors for pediatric typhoid fever in a large epidemic in Blantyre, Malawi.MethodsA case-control study was conducted between April 2015 and November 2016. Cases were recruited at a large teaching hospital, while controls were recruited from the community, matched by residential ward. Stepwise variable selection and likelihood ratio testing were used to select candidate risk factors for a final logistic regression model.ResultsUse of river water for cooking and cleaning was highly associated with risk of typhoid fever (OR 4.6 [CI: 1.6-12.5]). Additional risk factors included protective effects of soap in the household (OR 0.6 [CI: 0.4-0.98]) and more than one water sources used in the previous 3 weeks (OR 3.2 [CI: 1.6-6.2]). Attendance at school or other daycare was also identified as a risk factor (OR 2.7 [CI: 1.4-5.3]) and was associated with the highest attributable risk (51.3{\%}).ConclusionsThese results highlight diverse risk factors for typhoid fever in Malawi, with implications for control in addition to the provision of safe drinking water. There is an urgent need to improve our understanding of transmission pathways of typhoid fever, both to develop tools for detecting S. Typhi in the environment, and inform water, sanitation, and hygiene interventions.",
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Gauld, JS, Olgemoeller, F, Nkata, R, Li, C, Chirambo, A, Morse, T, Gordon, MA, Reid, JM, Heyderman, RS, Kennedy, N, Diggle, PJ & Feasey, NA 2019, 'Domestic river water use and risk of typhoid fever: results from a case-control study in Blantyre, Malawi' Clinical Infectious Diseases, pp. 1-25. https://doi.org/10.1093/cid/ciz405

Domestic river water use and risk of typhoid fever : results from a case-control study in Blantyre, Malawi. / Gauld, Jillian S.; Olgemoeller, Franziska ; Nkata, Rose; Li, Chao; Chirambo, Angeziwa ; Morse, Tracy; Gordon, Melita A.; Reid, Jonathan M.; Heyderman, Robert S.; Kennedy, Neil; Diggle, Peter J.; Feasey, Nicholas A.

In: Clinical Infectious Diseases, 30.05.2019, p. 1-25.

Research output: Contribution to journalArticle

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T1 - Domestic river water use and risk of typhoid fever

T2 - Clinical Infectious Diseases

AU - Gauld, Jillian S.

AU - Olgemoeller, Franziska

AU - Nkata, Rose

AU - Li, Chao

AU - Chirambo, Angeziwa

AU - Morse, Tracy

AU - Gordon, Melita A.

AU - Reid, Jonathan M.

AU - Heyderman, Robert S.

AU - Kennedy, Neil

AU - Diggle, Peter J.

AU - Feasey, Nicholas A.

PY - 2019/5/30

Y1 - 2019/5/30

N2 - BackgroundTyphoid fever remains a major cause of morbidity and mortality in low and middle-income settings. In the last 10 years, several reports have described the re-emergence of typhoid fever in southern and eastern Africa, associated with multidrug-resistant H58 Salmonella Typhi. Here, we identify risk factors for pediatric typhoid fever in a large epidemic in Blantyre, Malawi.MethodsA case-control study was conducted between April 2015 and November 2016. Cases were recruited at a large teaching hospital, while controls were recruited from the community, matched by residential ward. Stepwise variable selection and likelihood ratio testing were used to select candidate risk factors for a final logistic regression model.ResultsUse of river water for cooking and cleaning was highly associated with risk of typhoid fever (OR 4.6 [CI: 1.6-12.5]). Additional risk factors included protective effects of soap in the household (OR 0.6 [CI: 0.4-0.98]) and more than one water sources used in the previous 3 weeks (OR 3.2 [CI: 1.6-6.2]). Attendance at school or other daycare was also identified as a risk factor (OR 2.7 [CI: 1.4-5.3]) and was associated with the highest attributable risk (51.3%).ConclusionsThese results highlight diverse risk factors for typhoid fever in Malawi, with implications for control in addition to the provision of safe drinking water. There is an urgent need to improve our understanding of transmission pathways of typhoid fever, both to develop tools for detecting S. Typhi in the environment, and inform water, sanitation, and hygiene interventions.

AB - BackgroundTyphoid fever remains a major cause of morbidity and mortality in low and middle-income settings. In the last 10 years, several reports have described the re-emergence of typhoid fever in southern and eastern Africa, associated with multidrug-resistant H58 Salmonella Typhi. Here, we identify risk factors for pediatric typhoid fever in a large epidemic in Blantyre, Malawi.MethodsA case-control study was conducted between April 2015 and November 2016. Cases were recruited at a large teaching hospital, while controls were recruited from the community, matched by residential ward. Stepwise variable selection and likelihood ratio testing were used to select candidate risk factors for a final logistic regression model.ResultsUse of river water for cooking and cleaning was highly associated with risk of typhoid fever (OR 4.6 [CI: 1.6-12.5]). Additional risk factors included protective effects of soap in the household (OR 0.6 [CI: 0.4-0.98]) and more than one water sources used in the previous 3 weeks (OR 3.2 [CI: 1.6-6.2]). Attendance at school or other daycare was also identified as a risk factor (OR 2.7 [CI: 1.4-5.3]) and was associated with the highest attributable risk (51.3%).ConclusionsThese results highlight diverse risk factors for typhoid fever in Malawi, with implications for control in addition to the provision of safe drinking water. There is an urgent need to improve our understanding of transmission pathways of typhoid fever, both to develop tools for detecting S. Typhi in the environment, and inform water, sanitation, and hygiene interventions.

KW - salmonella typhi

KW - WASH

KW - water

KW - sanitation

KW - environment

U2 - 10.1093/cid/ciz405

DO - 10.1093/cid/ciz405

M3 - Article

SP - 1

EP - 25

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

ER -