Comparative analysis of risk factors of typhoid fever occurrence in different villages of Astore valley, Gilgit Baltistan Pakistan
DOI:
https://doi.org/10.59736/IJP.22.04.908Keywords:
Microbiology, Salmonella Infections, Salmonella, Sanitation, Typhoid FeverAbstract
Background: Salmonella enterica serotype Typhi and, to a lesser extent, serotypes Paratyphi A, B, and C, cause typhoid fever. Higher prevalence of typhoid is a concern, particularly with remote areas in Astore valley. This study was conducted to investigate the risk factors, vulnerable segments of population, and the efficacy of antibiotics against typhoid pathogen.
Methods: Study was conducted in District Astore from October 2022-august 2023, which encompasses a population exceeding 70,000 individuals residing across more than a hundred communities. Choungrah, Eidgah, Gorikot, Louse, and Harcho were selected as research sites from five distinct villages. This study utilized modern statistical tools to investigate the risk factors associated with typhoid incidence in multiple villages. The research involved both diagnostic and community-based surveys. Microbiological analysis of water samples was conducted using the pour plate technique, while antibiotic susceptibility tests on bacterial colonies were initially performed using disc diffusion methods.
Results: In Choungrah tap water, the bacterial load was 180.10 cfu/ml, while Gorikot tap water had the lowest load 61.33 cfu/ml. Gorikot pipe water had the highest Salmonella species concentration at 11.33 × 10^5 cfu/ml, with Eidgah tap water at 2.33 × 10^5 cfu/ml being the lowest. Ciprofloxacin was most effective antibiotic, while cefixime showed the least efficacy, indicating increased bacterial resistance. Regarding water sources, 70.66% preferred tap water, 16.68% spring water, and 12.66% bottled water. Drainage systems and waste collection techniques were reported insufficient by the majority. Three-quarters consumed street food, with only 5% practicing hand washing before and after meals. 30.33% of males (56.66%) and 18% of females (43.33%) had experienced typhoid fever, while 62% of respondents were aware of illness.
Conclusion: The study reveals a significant prevalence of typhoid fever in the Astore valley, underscoring multiple risk factors including contaminated water sources, poor hygiene practices, and inadequate sanitation.
References
Nsutebu EF, Martins P, Adiogo D. Prevalence of typhoid fever in febrile patients with symptoms clinically compatible with typhoid fever in Cameroon. Trop Med Int Health. 2003 Jun;8(6):575-8.
Mweu E, English M. Typhoid fever in children in Africa. Trop Med Int Health. 2008 Apr; 13(4):532-40.
Buckle GC, Walker CL, Black RE. Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010. J Glob Health. 2012 Jun;2(1):010401.doi:10.7189/jogh.02.010401
Näsström, E. Diagnosis of acute and chronic enteric fever using metabolomics (Doctoral dissertation, Umeå universitet), Lars Åberg, VMC-KBC Umeå, (2017), 88.
Ochiai RL, Wang X, von Seidlein L, Yang J, Bhutta ZA, Bhattacharya SK, Agtini M, Deen JL, Wain J, Kim DR, Ali M, Acosta CJ, Jodar L, Clemens JD. Salmonella paratyphi A rates, Asia. Emerg Infect Dis.2005Nov; 11(11):17646.doi.10.3201/eid1111.050168.
Sahastrabuddhe S, Carbis R, Wierzba TF, Ochiai RL. Increasing rates of Salmonella Paratyphi A and the current status of its vaccine development. Expert Rev Vaccines. 2013 Sep;12(9):1021-31.doi: 10.1586/14760584.2013.825450.
Woods CW, Murdoch DR, Zimmerman MD, Glover WA, Basnyat B, Wolf L, et al. Emergence of Salmonella enterica serotype Paratyphi A as a major cause of enteric fever in Kathmandu, Nepal. Trans R Soc Trop Med Hyg. 2006 Nov; 100(11):1063-7.
Stanaway JD, Reiner RC, Blacker BF, Goldberg EM, Khalil IA, Troeger CE, et al. The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Infect dis. 2019 Apr 1; 19(4):369-81.
Akinyemi KO, Smith SI, Oyefolu AB, Coker AO. Multidrug resistance in Salmonella enterica serovar typhi isolated from patients with typhoid fever complications in Lagos, Nigeria. Public health. 2005 Apr 1; 119(4):321-7.
Steele AD, Hay Burgess DC, Diaz Z, Carey ME, Zaidi AK. Challenges and Opportunities for Typhoid Fever Control: A Call for Coordinated Action. Clin Infect Dis. 2016 Mar 15;62 Suppl 1(Suppl 1):S4-8.
Bajracharya D, Khan MI, Pach III A, Shrestha P, Joshi N, Upreti SR, et al. 25 years after Vi typhoid vaccine efficacy study, typhoid affects significant number of population in Nepal. PloS one. 2014 Jan 6; 9(1):e77974.
Sulaiman K, Sarwari AR. Culture-confirmed typhoid fever and pregnancy. Int J Infect Dis. 2007 Jul; 11(4):337-41.
AKRSP. Horizon of CPEC in: Gilgit Baltistan: A Prospective Study. Aga Khan Rural Support Programme. (2017)
Shehzad H. Typhoid spreading in Gilgit city due to consumption of highly contaminated water: EPA Report.Gigit city.Palmir times.9 june 2020.GB-EPA-WQMS-S(6)2018.
Parry CM, Wijedoru L, Arjyal A, Baker S. The utility of diagnostic tests for enteric fever in endemic locations. Expert Rev Anti Infect Ther. 2011 Jun; 9(6):711-25.
Mian AH, Fatima T, Qayyum S, Ali K, Shah R, Noorullah, et al. A study of bacterial profile and antibiotic susceptibility pattern found in drinking water at district Mansehra, Pakistan. Applied Nanoscience. 2020 Dec;10(12):5435-9.
Adamu MO, Azamu IG, Yakubu AH, Sani AM. Detection and Public Health Risk of Salmonella Species Contaminating Different Water Sources in Keffi, Nigeria. S. Asian J. Res. Microbiol. 2020 May 30; 6(2):39-47.
Tagoe DN, Nyarko H, Arthur SA, Birikorang E. A study of antibiotic susceptibility pattern of bacteria isolates in sachet drinking water sold in the cape coast metropolis of Ghana. Res J Microbiol. 2011 Feb 1;6(2):153-8.
CM S, L K, Puli S, TK V, Acharya A. Sensitivity pattern of bacteria causing respiratory tract infections in a tertiary care centre. Int J Basic Clin Pharmacol 2017 Feb. 1; 2(5):590-5.
Tareen AM. Prevalence of typhoid fever in general population of district Quetta, Balochistan, Pakistan. Journal of Applied and Emerging Sciences. 2016 Feb 26;5(2):70-3.
Nahimana MR, Ngoc CT, Olu O, Nyamusore J, Isiaka A, Ndahindwa V, et al. Knowledge, attitude and practice of hygiene and sanitation in a Burundian refugee camp: implications for control of a Salmonella typhi outbreak. Pan Afr Med J. 2017 Sep 21; 28:54.
Prajapati SK, Tripathi BD. Biomonitoring seasonal variation of urban air polycyclic aromatic hydrocarbons (PAHs) using Ficus benghalensis leaves. Environ Pollut. 2008Feb;151(3):543-8.
Okonko IO, Ogunjobi AA, Adejoye OD, Ogunnusi TA, Olasogba MC. Comparative studies and microbial risk assessment of different water samples used for processing frozen sea-foods in Ijora-olopa, Lagos State, Nigeria. Afr. J of Biotechnol. 2008 Aug 18; 7(16):2902-7.
Umeh, C.N., Okorie, O.I. and Emesiani, G.A., Microbiological Examination of Sachet Water Experimentally Exposed to Sunlight Int. J. Pure Appl. Sci. Technol. 2013;18(1): 36-42.
Gasem MH, Dolmans WM, Keuter MM, Djokomoeljanto RR. Poor food hygiene and housing as risk factors for typhoid fever in Semarang, Indonesia. Trop Med Int Health. 2001 Jun; 6(6):484-90. Doi: 10.1046/j.1365-3156.2001.00734.x.
Ram PK, Naheed A, Brooks WA, Hossain MA, Mintz ED, Breiman RF,et al. Risk factors for typhoid fever in a slum in Dhaka, Bangladesh. Epidemiol Infect. 2007Apr;135(3):458-65.
Ercumen A, Arnold BF, Kumpel E, Burt Z, Ray I, Nelson K, et al. upgrading a piped water supply from intermittent to and continuous delivery association with water borne illness: a matched cohort study in urban India. PLoS medicine. 2015 Oct 27; 12(10):e1001892.
Dewan AM, Corner R, Hashizume M, Ongee ET. Typhoid fever and its association with environmental factors in the Dhaka metropolitan area of Bangladesh: a spatial and time-series approach. PLoS neglected tropical diseases. 2013 Jan 24; 7(1):e1998.
Vollaard AM, Ali S, Van Asten HA, Widjaja S, Visser LG, Surjadi C, Van Dissel JT. Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia. Jama. 2004 Jun 2; 291(21):2607-15.
Ayub U, Khattak AA, Saleem A, Javed F, Siddiqui N, Hussain N, Hayat A. Incidence of typhoid fever in Islamabad, Pakistan. Am-Eurasian J Toxicol Sci. 2015; 7(4):220-3.
Mushanyu J, Nyabadza F, Muchatibaya G, Mafuta P, Nhawu G. Assessing the potential impact of limited public health resources on the spread and control of typhoid. J Math Biol. 2018 Sep; 77(3):647-70. Doi: 10.1007/s00285-018-1219-9.
Buckle GC, Walker CL, Black RE. Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010. J Glob Health. 2012 Jun; 2(1):010401.
Dufour A, Snozzi M, Koster W, Bartram J, Ronchi E, Fewtrell L, editors. Assessing microbial safety of drinking water: Improving approaches and methods. IWA Publishing; 2003 Nov 1.
Azmatullah A, Qamar FN, Thaver D, Zaidi AK, Bhutta ZA. Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever. J Glob Health.2015Dec; 5(2):020407.
AL-Kraety IA, Al-Ammar M. relation of class1integron gene with multi-drug resistance salmonella typi isolates. Pak. J. Biotechnol. Vol. 2017; 14(4):537-41.
Abrar S, Hussain S, Khan RA, Ul Ain N, Haider H, Riaz S. Prevalence of extended-spectrumβlactamaseproducing Enterobacteriaceae: first systematic meta-analysis report from Pakistan. Antimicrob Resist Infect Control. 2018 Feb 20; 7:26.
Peirano G, van der Bij AK, Freeman JL, Poirel L, Nordmann P, Costello M, et al. Characteristics of Escherichia coli sequence type 131 isolates that produce extended-spectrum β-lactamases: Global distribution of the H 30-Rx sublineage. Antimicrobial agents and chemotherapy. 2014 Jul;58(7):3762-7
Phoon HY, Hussin H, Hussain BM, Thong KL. Molecular characterization of extended-spectrum beta lactamase-and carbapenemase-producing Pseudomonas aeruginosa strains from a Malaysian tertiary hospital. Microbial Drug Resistance. 2018 Oct 1; 24(8):1108-16.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Salma Komal, Waqar Younus, Azhar Hussain, Sartaj Ali, Syed Arif Hussain, Ikhlaq Hussain
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.