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Typhoid in Tanzania

Like cholera and leptospirosis, typhoid fever is a neglected tropical disease (NTD) caused by the bacterium Salmonella Typhi. In the United States, typhoid fever is rare, with under 400 cases annually, mostly acquired in endemic regions of the world like Asia, Africa, and South America. In fact, people are not routinely vaccinated for typhoid in the United States, except before traveling abroad. Typhoid is extremely transmissible via the fecal-oral route through contaminated water or food, and people living in areas without access to clean water and sanitation facilities are most at risk. Children are at the highest risk of infection and experience the highest rates of morbidity and mortality from typhoid. Typhoid can cause high fever, headaches, abdominal pain, weakness, loss of appetite, and enlarged spleen and liver. Untreated, typhoid can become life threatening.

With 40% of Tanzanian households lacking access to safe drinking water and 60% lacking access to improved sanitation, many Tanzanians in both rural and urban communities are at high risk of infection from typhoid. Tanzania has an incidence of typhoid of over 79 thousand cases a year. The majority of cases occur in children under 15 years old. Typhoid fever is treated with antibiotics, including ciprofloxacin and ceftriaxone. Unfortunately, Salmonella Typhi is increasingly drug resistant. In 2016, multi-drug resistance of 89% was demonstrated in blood-culture studies in Moshi, Tanzania. Blood cultures are necessary to diagnose typhoid, and a full course of antibiotics is needed to treat, making the disease difficult to address in low-resource environments. Prevention through access to clean water, improved sanitation, and proper hygiene practices, especially handwashing, is critical to decreasing the risk of infection, morbidity, and mortality.

Maji Safi Group’s Community Efforts to Prevent Typhoid

Maji Safi Group incorporates typhoid prevention into all its sanitation and hygiene education programs in schools, homes, health care centers, and community venues, such as restaurants, stores, salons, etc. Since typhoid can be transmitted readily through food preparation, Maji Safi Group’s outreach to restaurants with hygiene education is a particularly important component in prevention. In 2022 alone, MSG visited and taught WASH lessons at 16 salons, 29 shops, and 25 restaurants for two days each. WASH lessons included hand washing, water filtering, treatment and storage, food preparation, and toilet facilities. In 2022, Maji Safi Group also distributed 477 handouts related to typhoid prevention.

The Future

The WHO has recommended mass vaccination with the newly developed Typbar-typhoid conjugate vaccine in endemic countries with a high burden of typhoid and high antimicrobial resistance. This new vaccine is more effective than previous typhoid vaccines. It requires only a single dose and can be used safely in children over six months of age, making it appropriate for use in conjunction with regular childhood vaccination programs.

Through education and community programs on the importance of using clean water, improving sanitation, and practicing proper hygiene education, Maji Safi Group is already instrumental in reducing the burden of typhoid in Shirati. If the Typbar-typhoid conjugate vaccine becomes a viable option in the medical landscape of the Mara Region, Maji Safi Group would be able to expand its programmatic impact by working closely with our partners at the District Medical Office (DMO), the Shirati KMT District Hospital, and the health centers and dispensaries we work with to explore ways to make this new option as effective and accessible as possible. When the medical community in the Rorya District conducts mass drug administration (MDA) campaigns, Maji Safi Group typically helps staff the outreach and provides onsite WASH and disease prevention education.

Maji Safi Group also has the capacity to react quickly to disease outbreaks through print media, village visits, radio broadcasts, social media, and a telephone hotline. After having helped government health authorities fight three cholera outbreaks in the Rorya District, an emergency response plan was developed by MSG and the DMO with funding from the LUSH Charity Pot program.

During COVID-19, Maji Safi Group reached millions of people in East Africa through a social media campaign with factual information about preventing the disease and was one of the top 10 public health influencers on social media within East Africa.

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Symptoms and Treatment of Typhoid

Typhoid fever, a significant health concern in regions like Tanzania, manifests through a range of symptoms that can often be confused with other febrile illnesses. Recognizing these symptoms is crucial for timely intervention and treatment, significantly since the disease can be life-threatening if left untreated.

Identifying Typhoid Symptoms

Typhoid fever doesn’t manifest immediately after the infection; it has an incubation period of 6-30 days. The symptoms often develop gradually and can be non-specific initially. Common symptoms include:

  1. High Fever: One of the first signs, typically rising over several days up to 104 degrees Fahrenheit.
  2. Weakness and Fatigue: Patients often experience a feeling of tiredness and weakness.
  3. Stomach Pain: This can be particularly acute in the lower abdomen, with possible bloating.
  4. Headache: A persistent, dull headache can be a common experience.
  5. Loss of Appetite: Individuals may exhibit a significant reduction in appetite or disinterest in food.
  6. Rash: Some patients develop a flat, rose-colored rash known as “rose spots.”
  7. Enlarged Spleen and Liver: In some cases, an enlarged spleen or liver is detectable upon physical examination.

Seeking Timely Medical Attention

Given these symptoms, especially when persistent or severe, it’s imperative to seek medical attention promptly. Early diagnosis often involves blood cultures to detect the presence of S. Typhi bacteria, the causative agent of typhoid.

Modern Treatment Approaches

Once diagnosed, treatment should commence immediately to prevent the illness from advancing to a more severe stage. The cornerstone of typhoid treatment is antibiotic therapy. While drugs like ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole were previously effective, resistance to these has grown significantly.

Today, ciprofloxacin and ceftriaxone are frontline treatments. However, an emerging global challenge is the increase in Salmonella Typhi strains resistant to these antibiotics. In Tanzania, a disturbing rate of multi-drug resistance has been observed, underscoring the urgent need for vigilant antibiotic stewardship.

To combat drug resistance, there’s a growing emphasis on vaccination as a preventive measure, particularly in high-endemic areas. The World Health Organization (WHO) recommends the typhoid conjugate vaccine (TCV) for children over six months of age in these regions. New-generation vaccines like Typbar-TCV are more potent and long-lasting than their predecessors, requiring only one dose, thereby offering a practical preventive health measure.

The Role of Hygiene and Clean Water

Treatment aside, prevention is always better than cure. It’s crucial to highlight the role of hygiene and access to clean water in preventing typhoid. Regular handwashing, safe food preparation practices, and consuming treated water are simple yet effective ways individuals and communities can reduce their risk of typhoid.

Impact of Clean Water Initiatives in Tanzania

In Tanzania, a nation where 40% of households grapple with the scarcity of safe drinking water, the impact of clean water initiatives extends far beyond just quenching thirst. These initiatives are pivotal in reshaping communities, reducing disease prevalence, nurturing the economy, and ultimately, fostering a healthier, more prosperous society. Here, we delve into the multifaceted benefits that clean water programs, such as those implemented by Maji Safi Group, have brought to Tanzanian communities.

Health: Curtailing Disease and Saving Lives

The most immediate and evident impact of clean water is the reduction of water-borne diseases, including typhoid fever, cholera, and leptospirosis. By providing access to clean, uncontaminated water, these initiatives dramatically decrease the incidence of these illnesses, particularly among vulnerable populations such as children under 15, who bear the brunt of morbidity and mortality from conditions like typhoid.

Moreover, clean water enhances general well-being. It means healthier children who can attend school regularly and adults who are fit to work. For instance, by integrating typhoid prevention into its sanitation and hygiene programs, Maji Safi Group has played a crucial role in illness prevention, further underscoring the health benefits of accessible clean water.

Economic Benefits: Fueling Community Development

The economic upliftment stemming from clean water initiatives is profound yet less discussed. When communities are healthy, adults can pursue their livelihoods uninterrupted by illness, and children can attain education without frequent health-related absences. This stability is foundational for economic development, as it fosters a robust workforce and cultivates future generations of skilled professionals.

Furthermore, water projects often create job opportunities within communities, from construction to maintenance roles, facilitating a direct infusion of economic resources into local households.

Women and Children: Changing Lives

In many Tanzanian communities, the task of water collection falls primarily to women and children, often involving long, perilous journeys that consume time which could be used for educational or economic activities. Clean water access within communities liberates them from this duty, empowering women to engage in more productive endeavors and allowing children more time to focus on their education.

Sustainability and Environment: Promoting Harmony with Nature

Clean water projects, when designed mindfully, also contribute to environmental sustainability. They prevent the depletion of local water sources, protect ecosystems, and promote harmony between communities and their environments. Educating communities on sustainable water use ensures that these resources are available for future generations.

Community Empowerment: The Foundation of Self-Sufficiency

Clean water initiatives are often coupled with educational programs that empower communities to maintain and manage these water resources independently. Knowledge of water safety, hygiene practices, and basic maintenance are invaluable for the sustainability of these projects, fostering a sense of ownership and pride within the community.