Typhoid fever outbreak trends from 2009 to 2013, assessment of knowledge and practices among Health Workers and Residents of Luanshya District, Zambia

Background: Typhoid fever remains one of the causes of morbidity and mortality worldwide. Developing countries are the most affected, due to poor water supply and sanitation delivery services provision. In Zambia, the resurgence of typhoid started in 2008, since then the infection has been in existence and has affected different parts of the country. This study was therefore conducted to determine typhoid fever outbreak trends from 2009 to 2013 and to assess knowledge and practices among health workers and residents in Luanshya district, Zambia.
Methods: Mixed methods were applied, firstly, was the descriptive epidemiology of typhoid fever cases, which occurred in the period of 2009 to 2013. Thereafter, concurrent cross sectional surveys to assess knowledge and practices among health workers and residents of Luanshya district (OPD clients and marketeers). Finally, checklists were used to collect data on epidemic preparedness in participating health centres. Secondary data on Typhoid fever cases was collected using a pre-designed form (2009 to 2013 cases), while interview schedules where used to collect data from health workers, OPD clients, marketeers and epidemic preparedness assessment. Data was entered and validated in Epi data v 3.1 then exported to Stata version 11.0 for analysis.
Findings: Analysis results showed that, most typhoid fever cases were those aged 6 to 19 years besides which female to male ratio of cases was 2:1. Most cases occurred during rainy season (November to March) among which most cases where from the densely populated areas. The study also reveals that 98% of health workers were aware of typhoid fever but lacked updated information on its detection and management. Both, outpatient department clients and
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marketeers had heard of typhoid, however they were not knowledgeable on its signs, symptoms and transmission. Results show that OPD client respondents who used water-borne toilets were 3.2 times more likely to know about typhoid fever, (OR 3.22, 95% CI 1.42-7.33) than those that used pit latrines. Marketeers aged 31-35 years old were 4 times more likely to know about typhoid fever (Odds Ratio 3.7, 95% CI 1.2-11.4: p = < 0.024). In addition, marketeers aged 41-67 years old were 4 times more likely to know about typhoid fever (Odds Ratio 4.5, 95% CI 1.3-16.0: p = < 0.021).Conclusion: This study has given a needed understanding on the distribution of typhoid fever over time in Luanshya district. Community engagement could help strengthen the interventions given the existing of transmission knowledge in the communities interviewed. Further, the study informs policy makers on areas of focus in disease prevention and control, it also opens up questions that need to be answered by doing additional research and with superior study designs