Typhoid in Tanzania

What is it?

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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