Debre Berhan University

College of Medicine and Health Science

Department of Public Health
Epidemiology

January 2019
Debre Berhan, Ethiopia
“Assessment of Prevalence and Risk
factors of Typhoid Fever at Ayer Tena
Health Center”
By Group-3
Sumitted to: Dr Esubalew T. (PhD)

2
 Group Members

S. No Name

1 Beletew Tegegnework

2 Debebe Tesfaye

3 Demelash Gesit

4 Mamush Sahlie

3
General Background & profile of Ayer Tena
Health Center

Fig- 1 The map for Debre Behan Ayer Tena Health center Catchment area 4
 General Background ….

• Debre Berhan Town found in Amhara region North

Shoa
• At distance of 130km from Addis Ababa, capital city
of Ethiopia and at 695km distance from Amhara
regional city, Bahir dar.
• Bounded from all 4 direction by Baso Wereda
• Found in Amhara Region of the country of 10º 00´00
´´latitude North and 39º 29´59·99´´longitude East
with an elevation of 2840 meter above sea level.

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 General Background ------

Serving Population Number of Kebles

Population of in Catchment area
Catchment area Total = 05
Total Pop.n = 38,177 Urban = 03
Male = 17,263 Rural = 02
Female = 20,914
Population of
Kebele 08
Population of Catchment area Total Pop = 11,405
Rural Population = 8,760 Male = 5,157
Urban Population = 29,418 Female = 6, 248
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 General Background…
HC worker profile
Table-1 HC worker profile
HO Nurse Laborat Pharma Midwife HIT Environm HEW Administr
ory cy ry ental ative
worker

Diploma 0 08 03 03 03 01 0 11

BSc 05 0 0 0 0 0 01 0

Total 05 08 03 03 03 01 01 10 15

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 CHAPTER ONE
1. Introduction
• Typhoid Fever is first identified by France physician in 1829.
• Is the most prevalent disease caused by genus of
entrobacteriacae bacteria, salmonella. (1)
– Gram negative rod, motile, flagellated bacteria
• Has different subspecies and classified to many serovars
• >2000 serovars that infect human, 4 serovars
arepathogenic; S.Typhi, S.Paratyphi A, S.paratyphji B &
S.choleritsis
• Among the 4 groups, Typhoid fever is caused by S.Typhi
(1, 5)

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 Introduction…
• Salmonella infections are usually spread by the
faecal-oral route through contaminated water, food
and poor sanitation
• Typhoid fever has high disease burden through out
the world
• It has symptoms like headache, high fever and
weakness, Stomach pain, diarrhea or constipation
and loss of appetite
• Remain un treated - 30% deaths (2)

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 Introduction…

• It has three factors that makes typhi more

pathogenic, which are secreted proteins and
surface antigens, Secreted proteins, fimbrial
and non fimbrial adhesions on the bacteria
help it to mediate biofilm adhesive to host
cells

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 2. Statement of the Problem
• Globally, it is estimated about 21million cases and has
fatality rate of 300,000 to 600,000 deaths annually
• Developing countries 12.5 million cases and most common

• Remains a significant public health problem in developing

countries, like Ghana is one of the 3 region with highest
report
• All region of Africa(East, West, South & North) and Asia are
more exposed countries
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 Statement of Prob..
• Even though there are health service for the
community, the Typhoid fever is high due to different
factors which contribute for occurrence of the
disease.
• Poor waste disposal and hygiene of workers in food
handling and food preparation activities would
provide an obvious infection route.

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 Statement of Prob..

• The study conducted at Mekele Hospital and

Health Center from May-November 2014
showed that 68% prevalence using widal O &
H test.(2)
• Study conducted in Jimma Hospital, South
West Ethiopia, from March to July 2000,
concluded that the poor sanitation associate
with the Typhoid fever

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 3. Significance of the study
• Since Ethiopia is under the developing
countries with high endemicity of typhoid
fever disease, many people are infected by the
salmonella typhi. Some researchers had been
conducted in different sites, there are without
clear cut off prevalence and low co-operation
and epidemiological surveillance.

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 Significance…

• Will provide the prevalence of the S.typhi

infection in the area and surrounding of which
population get the health service from the
studying health center
• Will initiate other researchers or will provide
as baseline data for further studies.

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 CHAPTER TWO
Objectives

1. General Objective
• To determine typhoid fever among patients
who had attended the Health center during
the study period

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 2. Specific objectives
• To establish the prevalence of typhoid in
patient who attended the HC during study
period
• To determine factors influencing typhoid
infections patient who attended the HC during
study period.

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 CHAPTER FOUR
Methodology and Study design
4.1 STUDY AREA AND PERIOD
• The study was conducted from 22/04/2011 to
08/04/2011 E.C in Debre Berhan Ayer Tena
Health Center, North Shoa Zone, Amhara
Region, Ethiopia.
• Debre Berhan town is found 130 km far from
Addis Ababa Capital city of Ethiopia and 695 km
far from Bahir Dar, regional capital city,
• It is the capital city of north shoa zone.

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 Methods And Materials…

4.2 STUDY DESIGN

• A facility based cross sectional study was conducted
amongst patients visiting Ayer Tena Health Center
• The patients who are suspected for Typhoid fever and
screened by laboratory test are included in the study
• Patients who have positive result for the widal test
taken as Typhoid fever diseased

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 Methods And Materials…

4.3 STUDY POPULATION

• The study population included all patients from Kebele 08 who
attended Ayer Tena Health Center during the study period.

4.4 SAMPLE POPULATION

• The sample population included all patients who are
suspected for Typhoid fever and eligible for widal test by the
time of data collection.

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 Methods And Materials…

4. 5 Sample Size Determination and Sampling technique

• By the time of data collection a total of 54 patients are
included in the study

• We used convenient sampling technique to select our

sample population and Sample size were determined by
the number of volunteers to participate in the study.

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 Methods And Materials…

4.6 Inclusion and Exclusion Criteria

Inclusion Criteria
• All patients from Kebele 08 and who are typhoid fever
suspected at the time of data collection and volunteer to
participate are included.

Exclusion Criteria
• The patients who have typhoid fever but unable to respond
are excluded.

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 Methods And Materials…
4.7 Study variables
Dependent Variable
• The dependent variable of the study was typhoid fever
Independent Variables

• Socio-demographic characteristics: - includes gender,

age, educational status, occupation, marital status

and religion
• Environmental factors: - include sanitation

• Behavioral factors: includes personal hygiene (hand

washing behavior), food consuming,
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 4.8 TOOLS FOR EVALUATION

• The tools used for this assessment project was

interview with questionnaire for the patients
who had attended Ayer Tena Health Center
and suspected for Typhoid fever during the
study period and collecting laboratory result
for each typhoid fever suspected patients.

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 Methods And Materials…

4.9 Ethical considerations

• Ethical clearance or consent letter was obtained
from Public Health Department of Debre Berhan
University.

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 CHAPTER FIVE
Result and discussion
Socio Demographic Characteristics
 During the study period, there were 54 patients screened and
diagnosed for Typhoid fever.
 From those, 39(72.2%) were females and 15(27.8%) were
males
 Mean age of the study participants was 25.7 years with SD of
10.1 with majority of the participants being in the age range
of 21-30 (51.9%) years.
 Out of 54 participants, 22(40.7%) were from Grade 9-12,
12(22.2%) were above grade 12 followed by grade 5-8 which
accounts 11(20.4%).

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 Table-2 Socio demographic status of participants
Variables Frequency Percent (%)
Age 1-10years 4 7.4
11-20 years 10 18.5
21-30 years 28 51.9
31-40 years 8 14.8
41-50 years 3 5.6
51-60 years 1 1.9
Total 54 100.0
Sex Frequency
Male 15 27.8
Female 39 72.2
Total 54 100
Education level Frequency Percent (%)
KG-4 9 16.7
Grade5-8 11 20.4
Grade9-12 22 40.7
12+ 12 22.2
Total 54 100
Occupation Frequency Percent (%)
Merchant 16 29.6
Food Han 4 7.4
Gov’t worker 15 27.8
Student 15 27.8
Other 4 7.4
Total 54 100
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Socio Demographic status of participants

Sex distribution(%)

28%
Female
Male

72%

Fig 2 Sex distribution of participants

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 Socio Demographic status …

Age group
30 28
F
re 25
q
u 20
e 15
n
10
c 10 8
y
5 4 3
1
0
1-10 11-20 21-30 31-40 41-50 51-60

Age Group by
years
Fig 3 Age group distribution of participants

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 Socio Demographic status…
Occupation Marital Status
18 F
F
r 16 r 30
e 16 15 15 e 25 25
q 14 q 25
u
e 12 u 20
n e
c 10 n
y 15
8 c
6 10
4 4 y
4 5 4
2
0 0
Merchant Food Gov't Student Others Single MarriedDivorced
Handler worker

Occupation of participants Marita status of participants

Fig 4 occupation and marital distribution of participants

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 Sero prevalence of typhoid fever
• Among the 54 typhoid fever suspected
patients, 10 (18.5%) were reactive for the
typhoid fever.

Widal test result

Rective
18%
Non Reactive

82%

Fig 5 Sero prevalence of participants

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 Associated risk factor
• The cross tabulation for the risk factors and
the typhoid fever was performed by using the
SPSS.16
• The calculation was performed for habit of
hand washing after toilet, habit of hand
washing before and after meal, and for type
food mostly consumed

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 Cont…

Table-3 Relation of habit of hand washing after toilet and sero prevalence
Variables Sero status
R NR Total
Habit of Sometimes 8 19 27
Hand Always 2 25 27
washing Total 10 44 54
after
toilet

The Odd Ratio for the habit of hand washing after toilet and
typhoid fever is 5.26, which indicates the participants who
had washed their hands sometimes have the chance of
developing typhoid fever 5.26times than participants who
had washed their hands always. 33
 Associated risk factor…
Table-4 Relation of habit of hand washing before and after meal and sero prevalence
Variables Sero status
R NR Total
Habit of Sometimes 7 34 41
Hand
washing
before and Always 3 10 13
after meal
Total 10 44 54

The Odd Ratio is 0.69 which indicates protective relationship

But the reality is that the relation is not negative relation.

05/02/2020 34
Table-5 Relation of habit of hand washing before and after meal and sero prevalence
Sero status
R NR Total
Vegetable 9 30 39
Food mostly used

Selling 1 13 14
food/packed
Total 10 44 54

The Odd Ratio is 3.9 which indicates the participants who

consumed vegetables have the chance developing typhoid
fever 3.9 times than who consumed packed/selling foods
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 Discussion
• When we compared this assessment result, it
indicates low prevalence of typhoid fever in
the study area than researches conducted in
Addis Ababa and Debre Berhan.
– May due to less participants for the population
and highly coldness of climate.
• When it compared to the research conducted
in Addis Ababa, this research has low
prevalence value.

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 Cont…

• The research conducted in A.A showed that

the habit of not washing before and after meal
has association with typhoid fever, but
assessment doesn’t have an association.

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 Recommendation
• Based on this assessment, positive assocition
of using vegetable and sometimes washing
after toilet have
• Making awareness for the community
• Making awareness on washing hand after
toilet are recommended.

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 References

1. Wikipedia, free encyclopedia, salmonella enterica enterica,2013

en.wikipedia.org/wiki/salmonella.en.b. www.cdc.gov/typhoid-fever/symptoms.html

2. Diagnosis and Treatment of Typhoid Fever and Associated Prevailing Drug Resistance

in Northern Ethiopia,

3. www.cdc.gov/typhoid-fever/symptoms.html

4. Typhoid fever in Ethiopia Article in The Journal of Infection in Developing Countries, February
2008 DOI: 10.3855/jidc.160 · Source: PubMed

5.www.emedicinehealth.com/typhoid_fever_enteric_fever/article_em.htm#

what_are_the_causes_of_typhoid_fever

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 ACKNOWLEDGEMENT
• We would like to thank Dr. Esubalew T. (PhD) for his valuable
teaching of Epidemiology course and gave us this chance to do
this assignment.
• We are also thankful for the Debre Berhan Ayer Tena Health
Center staffs for helping us, and Debre Berhan University to
cooperate us by giving ethical letter.

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Thank
You
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