Typhoid fever is an acute illness associated with fever which is caused by two bacteria known as the Salmonella typhi and the Salmonella paratyphi.

The bacteria are deposited in water or food by a human carrier and are then spread to other people in an affected area. Worldwide, typhoid fever affects more than 13 million people annually, with over 500,000 patients dying of the disease.

Data mainly from Africa, Asia and Latin America show that typhoid fever continues to be a public health problem in many developing countries, with schoolchildren aged between five and 15, disproportionately affected. In some endemic areas, children aged under five show incidence rates similar to, or exceeding those of school-age children.

A research conducted in Agogo in the Ashanti Akyem North District of the Ashanti Region this year, as part of a broader research project in Sub-Saharan Africa, by the International Vaccine Institute (IVI), based in Seoul in Korea, estimated an incidence of typhoid among 205 per every 100,000 children who were four to five years old.

At the end of the research, it was concluded that existing epidemiological information on invasive salmonelloses in Sub-Saharan Africa was fragmentary and hindered by heterogeneous study methodology and there was, therefore, the urgent need to collect better data on typhoid infections in Sub-Saharan Africa. The optimal approach was to utilise existing fever surveillance sites and to standardise epidemiologic and laboratory procedures across sites.

It is in line with this recommendation that the IVI, at the Annual General and Scientific Meeting (AGSM) of the International Network for the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) in Pune, India, sought for partnership with the network research sites where active demographic surveillance was ongoing.

Diagnosis of typhoid fever is made when the Salmonella bacteria are detected with a stool culture in a laboratory. It is estimated that approximately, three to five per cent of patients become carriers of the bacteria after an acute illness.

The bacteria multiply in the gallbladder, bile ducts or liver and passes into the bowel. The bacteria could survive for weeks in water or dried excreta.

Chronic carriers may have no symptoms and can be the source of new outbreaks of typhoid fever for many years. Presently, there are two vaccines for typhoid fever which are the oral Ty21a and injectable Vi polysaccharide.

Just like any other fevers, the symptoms of typhoid fever are poor appetite, headaches, generalised aches and pains, and lethargy. Typhoid fever is treated with antibiotics.

In Ghana and many other developing countries, the difficulty associated with diagnosing typhoid fever is that, most often, people who report to health facilities with symptoms of fever are treated for malaria as a first line of treatment.

In November 2007, the Word Health Organisation (WHO) Strategic Advisory Group of Experts (SAGE) on immunisation, endorsed the utilisation of typhoid vaccines in regions where the disease was highly endemic and recommended strengthening of surveillance systems for typhoid fever, including sentinel site surveillance in two to 15-year old populations and the development of reliable and appropriate diagnostics for use in developing countries.

According to Mr Leon Ochia of IVI, the institute which was a leader in the determination of enteric fever disease burden in Asia and currently has ongoing enteric fever surveillance programmes in sub-Saharan Africa, proposes to collaborate with governments and other partners that were engaged in vaccine preventable disease surveillance and reporting, vaccine introduction, and vaccination policy development in Africa.

Data generated from this collaboration according to Mr Ochia, will help define the epidemiology of enteric fever that will in turn drive the systematic deployment of preventive interventions, including immunisation in Sub-Saharan Africa.

Although some hospitals in the country request patients to test for typhoid when the disease is endemic in the area, most hospitals do not, and the Kintampo Health and Demographic Surveillance Site (HDSS) is the only HDSS where statistics for typhoid fever are collected as part of its routine research work.

Two other sites, which are the Dodowa and the Navrongo Health Research Centres, do not collect data on typhoid fever.

According to Dr Kwame Poku Asante of the Kintampo HDSS, the centre collects data on every fever, especially those that lead to the admission of patients, including typhoid and look into the cause of the fever.

The Executive Director of the INDEPTH Network, Dr Osmah Sankoh who also hailed the idea of a collaboration among some of the networks HDSS in Africa, Asia and the Oceana, said these were some of the partnership that the network was looking for.