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Domestic river water use and risk of typhoid fever: results from a case-control study in Blantyre, Malawi

Gauld, JS; Olgemoeller, F; Nkhata, R; Li, C; Chirambo, A; Morse, T; Gordon, MA; ... Feasey, NA; + view all (2019) Domestic river water use and risk of typhoid fever: results from a case-control study in Blantyre, Malawi. Clinical Infectious Diseases , 70 (7) pp. 1278-1284. 10.1093/cid/ciz405. Green open access

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Abstract

BACKGROUND: Typhoid fever remains a major cause of morbidity and mortality in low and middle-income settings. In the last 10 years, several reports have described the re-emergence of typhoid fever in southern and eastern Africa, associated with multidrug-resistant H58 Salmonella Typhi. Here, we identify risk factors for pediatric typhoid fever in a large epidemic in Blantyre, Malawi. METHODS: A case-control study was conducted between April 2015 and November 2016. Cases were recruited at a large teaching hospital, while controls were recruited from the community, matched by residential ward. Stepwise variable selection and likelihood ratio testing were used to select candidate risk factors for a final logistic regression model. RESULTS: Use of river water for cooking and cleaning was highly associated with risk of typhoid fever (OR 4.6 [CI: 1.6-12.5]). Additional risk factors included protective effects of soap in the household (OR 0.6 [CI: 0.4-0.98]) and more than one water sources used in the previous 3 weeks (OR 3.2 [CI: 1.6-6.2]). Attendance at school or other daycare was also identified as a risk factor (OR 2.7 [CI: 1.4-5.3]) and was associated with the highest attributable risk (51.3%). CONCLUSIONS: These results highlight diverse risk factors for typhoid fever in Malawi, with implications for control in addition to the provision of safe drinking water. There is an urgent need to improve our understanding of transmission pathways of typhoid fever, both to develop tools for detecting S. Typhi in the environment, and inform water, sanitation, and hygiene interventions.

Type: Article
Title: Domestic river water use and risk of typhoid fever: results from a case-control study in Blantyre, Malawi
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/cid/ciz405
Publisher version: https://doi.org/10.1093/cid/ciz405
Language: English
Additional information: © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: 10.1093/cid/ciz405
Keywords: Salmonella typhi, WASH, environment, sanitation, water
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
URI: https://discovery.ucl.ac.uk/id/eprint/10086341
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