Health in the Tropics: An In-Depth Analysis of Typhoid and Paratyphoid Fever

Introduction

The tropical diseases are referred to the indigenous diseases of the tropical or subtropical areas in the world and Typhoid fever is mainly bacterial infectious disease caused by specific nature of Salmonella bacteria that leads to express symptoms regarding the disease. Paratyphoid fever has similar symptoms of Typhoid fever and is caused by one of the three nature of Salmonella bacteria. In this study, a brief discussion regarding Typhoid and Paratyphoid disease as tropic illness is to be done by focussing on the pathophysiology, symptoms, causes and treatment opportunities of the illness in Kibera and Lwak areas.

Rationale of the choice of Topic

The increased incidence of typhoid and paratyphoid fever is found in Kibera and Lwak which are respectively urban slum and rural areas in Africa. This is evident as the study by Breiman et al. (2012) mentions that 247 cases of typhoid and paratyphoid are reported per 100,000 individuals with 596 cases per 100,000 individuals reported among 5-9 years of children and 521 cases per 100,000 individuals among 5-9 years of children in Kibera. In Lwak, it was seen that 29 cases per 100,000 individuals are reported with 28 and 18 cases respectively per 100,000 population among 2-4 years and 5-9 years of children (Breiman et al., 2012). This statistics indicates that there is dramatic increase in typhoid in the urban slum areas compared to rural areas.

Typhoid and paratyphoid fever has become an issue because in between 2006 and 2009 in Kibera, 2-4 year of children and 5-9 years of children are the highest affected by the fever in the area. There were 2242.6 cases reported per 100,000 individual in years (2-4 years of age) and 1788 per 100,000 individuals in years (5-9 years of age) from the area compared to 821.5 cases per 100,000 individuals of 0-1 year of age (Akullian et al. 2015). This indicates that the children are the most vulnerably affected individuals due to the disease in the area. It is also evident as the study informed that mean age of getting affected by typhoid in Kibera was 8.4 years indicating it affected mostly the children compared to the adult children above 10 years of age.

The incidence of paratyphoid and typhoid fever has currently become an issue because globally it has caused nearly 200,000 deaths each year with highest mortality rate showing in the areas of Africa and Asia mainly among children (Radhakrishnan et al. 2018). The study by Kurtz et al. (2017) mentions that under-developed immune system of the children makes them highly vulnerable to typhoid and paratyphoid disease. Thus, the study is important to be performed so that exact pathophysiology of the disease can be understood and causes can be identified to determine the best possible treatment and medical intervention required to support spread of the disease among children in Kibera and Lwak.

Pathophysiology of Typhoid and Paratyphoid Fever

The Typhoid is mainly caused by Salmonella enteric typhi bacteria and the parathyroid is caused by one of the three types of Salmonella bacteria. It is seen that all of the pathogenic Salmonella bacteria species which are present in the gut is engulfed through phagocytic cells that are later passed to the mucosa presenting the macrophages to the lamina propia (Biazus et al. 2017). However, the non-typhoidal Salmonella that is S.paratyphi gets into the system of the host through distal ileum. This is because they are found to have specialised fimbriae which adhere to epithelium present over the lymphoid tissues in the area of ileum known as Peyer patches. It is main point of relay of the macrophages which travels from the gut towards the lymphatic system for making the body further exposed to the infection (Al Reesi et al. 2016).

The Salmonella related to cause typhoid is seen to co-opt cellular machinery of the macrophages to assist in their proper reproduction to spread inside the body. This is because they are mainly carried to the thoracic duct through the mesenteric lymph nodes and then to be transferred to the reticuloendothelial tissues of the spleen, liver, lymph nodes and others. After reaching the spot, they are seen to multiply to reach critical density where afterwards the bacteria induces apoptosis of macrophages to break into the bloodstream for invading the entire body (Mouton et al. 2017).

Causes and Symptoms of Typhoid and Paratyphoid Fever

The lack of proper hygiene and sanitation is regarded to be key causes for the spread of typhoid and paratyphoid fever among the community. As mentioned by Bhutta et al. (2018), release of faeces in the open areas creates a suitable environment for typhoid and paratyphoid fever to spread in the community. This is because excreting in the open leads the files and others to sit on them during which the bacteria get attached to their body and when they visit foods environment the inspects releases the vector. The individuals by taking the contaminated food, as a result, get affected by the bacteria and shows symptoms of typhoid and paratyphoid disease (Basnyat and Karkey, 2019). In the urban slums of Kibera and in rural area in Lwak, it is seen that there is improper sanitation present in the areas due to which people are often found to defecate in the open leading the individuals get affected by the disease (Worrell et al. 2016). This is because open defecation increases chances of contamination of their food through flies and insects making them intake the vector in the body through food.

The lack of proper personal hygiene is found to be one of the key causes of typhoid and paratyphoid fever. This is because lack of action to wash hands in effective manner after defecation with water and soap leads the bacteria to be present in the hands of the individuals which enters the body while eating or drinking food or water (Aliyu et al. 2017). In Kibera and Lwak, it is seen that there is lack of proper health awareness regarding the way to maintain proper sanitation. This is evident as many people and mainly children in the area are found to lack basic education regarding the importance and way of washing hands before eating for drinking which has made them exposed to get highly affected by the disease. This is because children, as well as adults in the area, are found not to properly take actions to sanitise their hands after defecation leads the bacteria to be transmitted to the host through food while cooking and eating (Odek et al. 2017).

The open defecation leads to contaminate the water bodies by sweeping the waste materials and bacteria through the land into the well and ponds creating changes of getting affected by typhoid fever while drinking water from contaminated bodies (Kabwama et al. 2017). In rural areas such as a Lwak, it is seen that people mainly drink water from natural sources wells, ponds and rivers which are found to contaminated by bacteria due to open defecation as they are adjacent to the place used by people to excrete in the open (Obaro et al. 2017). Thus, increased prevalence in Lwak regarding thyroid and paratyphoid fever is seen as people use water for consumption that is unsafe and includes bacteria gathered in the bodies due to open defecation. In Kibera, it is seen that poor sewage system is maintained due to which often runoff from the water enters the waterways contaminating them to be unfit for drinking. This is evident as waste disposal is done as well as drainage system are present next to water system which is not well-maintained leading the people get easily affected by the disease (Crump, 2019).

The clinical symptoms of typhoid and paratyphoid fever include presence of mild fever at the initial stage which later raises to 104.9˚F, headache, muscle aches, weakness and fatigue, loss of appetite, abdominal pain, skin rashes, diarrhoea, dry cough, sweating and others (Kim et al. 2019). The individuals suffering from typhoid and paratyphoid in Kibera and Lwak are found to show similar symptoms such as high fever, weakness, fatigue, abdominal pain and others as mentioned. In some cases, fatal consequences related to typhoid fever are faced which include gastrointestinal haemorrhages, intestinal perforations, cranial neuritis and others (Gibani et al. 2018). The presence of fatal consequences regarding typhoid and paratyphoid in Kibera and Lwak is not separately known. However, global consideration of the disease is found to mention most of the affected people are below 15 years of age living in Kenya within rural and slum areas (Breiman et al., 2012). This indicates that the urban slum of Kibera and rural area of Lwak in Kenya requires effective treatment opportunities to ensure coping from the disease.

Diagnosis and Treatment for Typhoid and Paratyphoid Fever

The diagnosis for typhoid and paratyphoid is similar where stool samples from individuals identified to be affected by the individuals are taken and cultured in the laboratory. The stool samples are checked under the microscope to determine presence of type of Salmonella bacteria in the body (Wijedoru et al. 2017). In the regions of Kibera and Lwak, it is stool testing diagnosis process is frequently used in detecting typhoid and paratyphoid fever. However, due to lack of awareness and education regarding the disease, it is seen that often late diagnosis of individuals occurs where the disease is seen to have caused deteriorated health condition of the patient (Kavai and Kariuki, 2019). In Kenya, over the years antibiotics such as chloramphenicol, cotrimoxazole and ampicillin are used for treatment of typhoid and paratyphoid fever among individuals. However, it is seen that in current condition in Kenya, multi-drug resistance typhoid fever has been raised among individuals. This has led to create challenges for the medical professionals to determine the specific nature of antibiotics to be provided as primary medication intervention to cope with the disease (Mutai et al. 2018).

As a result of increased multi-drug resistance typhoid, it has led individuals in the areas of Kibera and Lwak suffering from the disease face hindrance in accessing proper treatment for better quality health. Moreover, the people from the area in Kibera and Lwak belong from lower social classes who do not have adequate finances to support their healthcare. In this condition, due to lack of effective financial ability, it is seen that infected individuals in the area are suffering from deteriorated health condition out of lack of ability to arrange proper medical intervention for coping from the disease (Akullian et al. 2015). The study by Zolnikov (2018) mentions that effective uptake of preventive activities is able to help individuals control and manage spread of typhoid and paratyphoid disease. In case of individuals in Kibera and Lwak, it is seen that increased prevalence of the disease in the area is due to lack of information among the people and facility to take preventive actions.

The study by Alba et al. (2016) informs that frequent washing of hands with hot water or normal water and soap are regarded as the best way to avoid spread of infection. This indicates people in Lwak and Kibera are to be educated regarding the way hand washing is to be done to maintain hygiene. They are to be educated to take prevention action of washing hands as compulsory activity after defecation, before eating foods, cooking and others. This is because it would help them to avoid entry of typhoid and paratyphoid causing bacteria in the body during eating or drinking. In contrast, the study by Simiyu and Jamka (2018) mentions that raw vegetables and fruits are to be proper washed before cooking and eating to avoid spread of infectious agents related to typhoid and paratyphoid fever. This is because typhoid-causing bacteria may be present on the vegetables or fruits due to their production in contaminated lands which are near open defecation areas. Thus, people of Kibera and Lwak are to be asked in compulsory manger to wash vegetables before cooking or eating them. The individuals in the area to be protected from typhoid are to be mentioned to avoid drinking untreated water. This is because it would make them exposed to the bacteria. Therefore drinking water is to be boiled before and stored in safe and closed bottle (Jabar and Sadeq, 2017). Moreover, open defecation is to be avoided and effective waste management in the place is to be established so that a bacterium causing typhoid and paratyphoid fever does not spread from one person to another due to unhygienic environment (Simiyu and Jamka, 2018).

Conclusion

The above discussion informs that typhoid and paratyphoid occurs as result of entry of Salmonella bacteria in the body. The prevalence of typhoid and paratyphoid fever is found to higher in Kibera which is an urban slum and in Lwak which is a rural area and is affecting mostly children below 10 years of age. The symptoms showed by people affected by the disease include high fever, weakness, stomach pain and others. The high prevalence of the disease in the area is due to lack of proper sanitation, open defecation, drinking of contaminated water, unhygienic cooking of food and others. The preventive actions to be taken by the individuals in Kibera and Lwak to control spread of typhoid and paratyphoid fever includes washing of hand before eating and cooking, washing of raw vegetables and fruits, avoid open defecation and others.

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