Yinka-Ogunleye, Adesola Felicia; (2026) Evaluation of burden estimation and management of acute febrile illnesses to inform typhoid fever surveillance strategy in Nigeria. Masters thesis (M.Phil), UCL (University College London).

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Abstract

Typhoid fever (TF) remains a significant public health concern in sub-Saharan Africa, where its burden is under-recognized due to diagnostic and surveillance challenges. This study aims to enhance TF burden estimation in Nigeria through a community- based study by evaluating acute febrile illness (AFI) management to inform surveillance strategies. I undertook a systematic review of methods of TF burden estimation, and a cross-sectional study in Gwagwalada Area Council using multistage random sampling, interviewing 479 households comprising 1,545 participants. I collected data on AFI episodes, healthcare-seeking behaviour, and socio-demographic factors. Findings from literature review revealed lack of functional TF surveillance in sub-Saharan Africa, late detection and outbreaks, and lack of standardized metrics in primary care research, complicating comparability and generalizability of outputs. I reported a high prevalence (32.9%) of self-reported AFI in Gwagwalada, with children aged 0–15 years accounting for 45.5% of AFI reported. Utilization of healthcare facilities during AFI was suboptimal with 24.6% seeking care in health facilities with the potential for diagnosis and surveillance reporting. Patent medicine vendors were the most utilized care providers (44%), and empirical treatment with antimalarials, antibiotics and parenteral medications was common. The study also found that persons in smaller households (1-3 persons) and persons with health insurance were 79% and 99% times more likely to use health facilities respectively. Residents of rural communities were 84% less like to attend a health facility. Persons who attend health facilities had longer travel duration and incurred higher cost of care. These factors underscored the inequities in healthcare access and utilization. This thesis highlights the need for a thorough evaluation of TF surveillance within the existing national surveillance system and offers critical insights into some of the elements to be targeted in developing a functional TF and AFI surveillance in Nigeria and possibly elsewhere in sub-Saharan Africa.

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