Modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015
Abstract Background Between January and June, 2015, a large typhoid fever outbreak occurred in Kampala, Uganda, with 10,230 suspected cases. During the outbreak, area surgeons reported a surge in cases of typhoid intestinal perforation (TIP), a complication of typhoid fever. We conducted an investig...
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| Format: | Article |
| Language: | English |
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BMC
2017-09-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | http://link.springer.com/article/10.1186/s12879-017-2720-2 |
| _version_ | 1818200233655402496 |
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| author | Lilian Bulage Ben Masiira Alex R. Ario Joseph K.B Matovu Peter Nsubuga Frank Kaharuza Victoria Nankabirwa Janell Routh Bao-Ping Zhu |
| author_facet | Lilian Bulage Ben Masiira Alex R. Ario Joseph K.B Matovu Peter Nsubuga Frank Kaharuza Victoria Nankabirwa Janell Routh Bao-Ping Zhu |
| author_sort | Lilian Bulage |
| collection | DOAJ |
| description | Abstract Background Between January and June, 2015, a large typhoid fever outbreak occurred in Kampala, Uganda, with 10,230 suspected cases. During the outbreak, area surgeons reported a surge in cases of typhoid intestinal perforation (TIP), a complication of typhoid fever. We conducted an investigation to characterize TIP cases and identify modifiable risk factors for TIP. Methods We defined a TIP case as a physician-diagnosed typhoid patient with non-traumatic terminal ileum perforation. We identified cases by reviewing medical records at all five major hospitals in Kampala from 2013 to 2015. In a matched case-control study, we compared potential risk factors among TIP cases and controls; controls were typhoid patients diagnosed by TUBEX TF, culture, or physician but without TIP, identified from the outbreak line-list and matched to cases by age, sex and residence. Cases and controls were interviewed using a standard questionnaire from 1st -23rd December 2015. We used conditional logistic regression to assess risk factors for TIP and control for confounding. Results Of the 88 TIP cases identified during 2013–2015, 77% (68/88) occurred between January and June, 2015; TIPs sharply increased in January and peaked in March, coincident with the typhoid outbreak. The estimated risk of TIP was 6.6 per 1000 suspected typhoid infections (68/10,230). The case-fatality rate was 10% (7/68). Cases sought care later than controls; Compared with 29% (13/45) of TIP cases and 63% (86/137) of controls who sought treatment within 3 days of onset, 42% (19/45) of cases and 32% (44/137) of controls sought treatment 4–9 days after illness onset (ORadj = 2.2, 95%CI = 0.83–5.8), while 29% (13/45) of cases and 5.1% (7/137) of controls sought treatment ≥10 days after onset (ORadj = 11, 95%CI = 1.9–61). 68% (96/141) of cases and 23% (23/100) of controls had got treatment before being treated at the treatment centre (ORadj = 9.0, 95%CI = 1.1–78). Conclusion Delay in seeking treatment increased the risk of TIPs. For future outbreaks, we recommended aggressive community case-finding, and informational campaigns in affected communities and among local healthcare providers to increase awareness of the need for early and appropriate treatment. |
| first_indexed | 2024-12-12T02:34:24Z |
| format | Article |
| id | doaj.art-efbcf05cb5ed427e825e14b501769ef3 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-12T02:34:24Z |
| publishDate | 2017-09-01 |
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| series | BMC Infectious Diseases |
| spelling | doaj.art-efbcf05cb5ed427e825e14b501769ef32022-12-22T00:41:19ZengBMCBMC Infectious Diseases1471-23342017-09-011711710.1186/s12879-017-2720-2Modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015Lilian Bulage0Ben Masiira1Alex R. Ario2Joseph K.B Matovu3Peter Nsubuga4Frank Kaharuza5Victoria Nankabirwa6Janell Routh7Bao-Ping Zhu8Uganda Public Health Fellowship Program – Field Epidemiology Track, Ministry of Health – Makerere University School of Public HealthUganda Public Health Fellowship Program – Field Epidemiology Track, Ministry of Health – Makerere University School of Public HealthUganda Public Health Fellowship Program – Field Epidemiology Track, Ministry of Health – Makerere University School of Public HealthUganda Public Health Fellowship Program – Field Epidemiology Track, Ministry of Health – Makerere University School of Public HealthAfrican Field Epidemiology NetworkAfrican Field Epidemiology NetworkDepartment of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere UniversityNational Center for Immunizable and Respiratory Diseases ,Centers for Disease Control and PreventionNational Center for Immunizable and Respiratory Diseases ,Centers for Disease Control and PreventionAbstract Background Between January and June, 2015, a large typhoid fever outbreak occurred in Kampala, Uganda, with 10,230 suspected cases. During the outbreak, area surgeons reported a surge in cases of typhoid intestinal perforation (TIP), a complication of typhoid fever. We conducted an investigation to characterize TIP cases and identify modifiable risk factors for TIP. Methods We defined a TIP case as a physician-diagnosed typhoid patient with non-traumatic terminal ileum perforation. We identified cases by reviewing medical records at all five major hospitals in Kampala from 2013 to 2015. In a matched case-control study, we compared potential risk factors among TIP cases and controls; controls were typhoid patients diagnosed by TUBEX TF, culture, or physician but without TIP, identified from the outbreak line-list and matched to cases by age, sex and residence. Cases and controls were interviewed using a standard questionnaire from 1st -23rd December 2015. We used conditional logistic regression to assess risk factors for TIP and control for confounding. Results Of the 88 TIP cases identified during 2013–2015, 77% (68/88) occurred between January and June, 2015; TIPs sharply increased in January and peaked in March, coincident with the typhoid outbreak. The estimated risk of TIP was 6.6 per 1000 suspected typhoid infections (68/10,230). The case-fatality rate was 10% (7/68). Cases sought care later than controls; Compared with 29% (13/45) of TIP cases and 63% (86/137) of controls who sought treatment within 3 days of onset, 42% (19/45) of cases and 32% (44/137) of controls sought treatment 4–9 days after illness onset (ORadj = 2.2, 95%CI = 0.83–5.8), while 29% (13/45) of cases and 5.1% (7/137) of controls sought treatment ≥10 days after onset (ORadj = 11, 95%CI = 1.9–61). 68% (96/141) of cases and 23% (23/100) of controls had got treatment before being treated at the treatment centre (ORadj = 9.0, 95%CI = 1.1–78). Conclusion Delay in seeking treatment increased the risk of TIPs. For future outbreaks, we recommended aggressive community case-finding, and informational campaigns in affected communities and among local healthcare providers to increase awareness of the need for early and appropriate treatment.http://link.springer.com/article/10.1186/s12879-017-2720-2Typhoid fever outbreakIntestinal perforationsUganda |
| spellingShingle | Lilian Bulage Ben Masiira Alex R. Ario Joseph K.B Matovu Peter Nsubuga Frank Kaharuza Victoria Nankabirwa Janell Routh Bao-Ping Zhu Modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015 BMC Infectious Diseases Typhoid fever outbreak Intestinal perforations Uganda |
| title | Modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015 |
| title_full | Modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015 |
| title_fullStr | Modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015 |
| title_full_unstemmed | Modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015 |
| title_short | Modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015 |
| title_sort | modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever kampala uganda 2015 |
| topic | Typhoid fever outbreak Intestinal perforations Uganda |
| url | http://link.springer.com/article/10.1186/s12879-017-2720-2 |
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