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Thursday, February 12, 2015

Overcoming Typhoid Fever through Proper Hygiene

With well over 21.5 million people in the world known to be infected by typhoid fever yearly and with 600,000 deaths recorded annual, especially from under-developed regions of the world, according to available statistics, typhoid fever is no doubt a major health challenge that needs to be tackled head on.Africa has been known to be worse hit by the scourge compared to other continents, with Nigeria taking a major chunk of the incidence rate in the continent among countries more affected.
Nigeria ranks third globally among countries without access to safe and portable water according to United Nations Children's Fund, UNICEF, resulting in the likelihood of illnesses due to water related diseases including typhoid fever.However, typhoid fever which has put over 95 percent of Nigerians at risk of ill health, representing over 160 million people in the country, according to African Health Journalists Association (AHJA), a partner of the International Centre for Journalists, is known as one of the killer diseases common in the country.
In an interview with Thisday, the Medical Director, The Vineyard Hospital, Isolo,Dr. Nicholas Ejikesaid the disease is still very much common in the country because majority of
Nigerians do not practice proper basic hygiene.He explained that in countries where there are less typhoid cases, people have the habits of washing off their hands properly and at all times when ever they use the toilets or are involved in one form of activity or the other.
According to him, “if Nigerians cultivate these same habits, it will save us a lot from most of these illnesses, including typhoid fever. Some people might argue that they did not visit any toilet or touch any thing dirty during the course of their daily activities, but the truth is we are in contact with various people and things daily, ranging from handshakes to handling money.
“When you enter a commercial bus and the conductor gives you change, do you know how many hands that money has passed through before reaching you? Do you as well know if they have typhoid bacterialaden in the money?” He said that is why at intervals, it is advised to wash hands regularly irrespective of activities performed at the time.
Ejike also expressed concern over Nigerians’ level of consciousness on what they eat and how they eat them, as well as what they drink. He said: “Inasmuch as we want to retain our cultures and age-long traditions in this country, it is common sense to know what type of water to drink and the ones not suitable for drinking. This is one of the major problems we are having, especially in rural areas. They will tell you that their water, which is probably from the river or lake where people go to/ to bathe is cleaner than the treated or bottled water been sold.”
According to him, most of such persons believe that this was the kind of water their fore fathers drank when they were alive. “But they also refuse to understand that different types of diseases are emerging every day and with different modes of infection.
“How many of our fore fathers experienced Ebola virus disease? How many of them experienced bird flu? So these set of people must understand that times are changing, so are new types of diseases emerging with varying modes of transmission.
“For typhoid fever, contaminated water is one of the modes of transmission, because if a person infected with typhoid contaminates the water, it could be transmitted to another person who drinks from it. This is more common with people who do not have easy access to sewage disposal systems and running water.
“Oral transmission of the bacteria comes through food, beverages, fruits and water handled by someone who sheds the bacteria through stool or urine. The infection could also come through hand-to-mouth transmission after using a contaminated toilet and neglecting hand hygiene," he added.
He explained that food should be properly cooked at least above degrees that can weaken the bacteria, adding that, “washing of fruit and vegetable should also not be compromised. Fruits bought from the market should be properly washed, while those that need to be peeled off must be done properly.”
Explaining the nature of the bacteria infection, he said once the bacteria enter the person’s body, they multiply and spread from the intestines into the bloodstream. He said:  "Even after recovery from typhoid or paratyphoid, a small number of individuals (called carriers) continue to carry the bacteria. These people can be a source of infection for others.” Explaining the symptoms of the infection, he said typhoid fever usually develop within one to three weeks after exposure to contaminated food, drinks or water and may be mild or severe depending on how the person's immune system is able to fight it.
"The various symptoms include high fever which can reach up to 39-40°C, malaise, headache, constipation in adults and diarrhea in children, loss of appetite, exhaustion, general weakness, dizziness, confusion and in severe condition enlarged spleen and liver or even death.”He, however explained that while these symptoms are visible, if the infected person is not treated, the bacteria can get into the blood stream, and at that stage, spread to other areas of the body. “If left untreated, the symptoms can get severe within weeks after infection, prompting damage to the organs of the body or leading to death,” he explained.
According to the World Health Organization (WHO), typhoid and paratyphoid fevers are caused by the bacteria Salmonella typhi and Salmonella paratyphi respectively, which aretransmitted through the ingestion of food or drink contaminated by the faeces or urine of infected people. WHO stated that symptoms usually develop 1–3 weeks after exposure, and may be mild or severe ranging from high fever, malaise,headache, constipation or diarrhea, rose-colored spots on the chest, and enlarged spleen and liver.
Experts are of the opinion that typhoid fever is regarded as an 'orphaned disease' because of the lack of attention given to it by most international and local health bodies who rather give more thought to such infectious diseases as HIV/AIDS, meningitis, pneumonia, hepatitis and cervical cancer, that are as much a burden or even less of a burden than typhoid fever. On the treatment of typhoid fever, a Resident Doctor with Irrua Specialist Teaching Hospital, Irrua, Dr. Great Asemota said the ailments can be treated using antibiotics. He explained that in most cases, patients do not need to be admitted in the hospital to be treated except in severe situations.
Asemota emphasized the need for diagnosis to be done before any treatment is being carried out. “Typhoid fever comes with different strains and during diagnosis this would determine which type of treatment to be used as each strain has its own specific type of treatment. “During diagnosis, samples of blood, stool or urine of the infected person is tested in the laboratory to know which strain of typhoid the person has, so that the appropriate antibiotics can be administered,” he said.
On whether there are vaccines available for typhoid, he explained that the oral and injectable vaccines are available. “The administration of the oral vaccine varies from dosage to dosage because the duration of protection following Ty21a immunization is not well defined. But whether there are presently such vaccines in Nigeria is something I can't tell at the moment," he added. He called on government and other corporate bodies to continue to create awareness on it. “This awareness is necessary such that when people are educated on the cause of the fever, it will help them guide against intake of untreated water, exposed beverages as well as contaminated food,” he said.
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