NURSES PERCEPTION ON THE TREATMENT MEASURES OF TYPHOID FEVER AND THE CAUSES OF DRUG RESISTANCE AT THE BUEA REGIONAL HOSPITAL.

CHAPTER ONE

INTRODUCTION

1.1 Background Of Study

Typhoid fever also simply known as typhoid is a bacterial infection cause by Salmonella typhi (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; 2: 10401.)

The idea of typhoid fever was first talked of by Karl Joseph Eberth. He described a bacillus that he suspected was caused by typhoid in 1884. The pathologist George Theodor August Gaffky (1850-1918), confirmed Eberth’s findings and the organism was given name such as “Eberthella Typhi, Eberth’s bacillus and Gaffky Eberth’s bacillus” (Khan KH. Recent trends in typhoid research—A Review. Int J Biosci 2012; 2: 110–20).

The first effective vaccine for typhoid was developed by Almonth Edward Wright and was introduced for military use in 1896.

Mary Mallon also commonly known as Typhoid Mary, was the most widely known carrier of typhoid fever. She was the first person in the United States to be Identified as the carrier of the pathogen responsible for the disease without experiencing any symptoms related to the condition.

The occurrence of typhoid fever is a major threat globally with annual cases exceeding 20 million and approximately a quarter million deaths (Acharya VI et al., 2017).

On a global scale, at least 16–20million cases of typhoid fever occur annually, resulting in approximately 600,000 deaths (Pang et al., 2015). Genetic diversity within the S. typhi population has been identified by pulsed-field gel electrophoresis (PFGE; Thonget al., 2007), IS200 typing (Threlfall et al., 2017), ribotyping (Altwegg et al., 2015; Nastasi et al.,2007; Pang et al.,2014; Navarro et al., 2016).

The disease is mostly dominant in developed and developing countries, where sanitation is poor mainly in parts of south Asia (Crump and Mints, 2010). The disease is most common in India and children are the most affected, (Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organ 2004; 82: 346–53).

The incidence of the disease decreases in the develop world in the 1940’s as a result of improve sanitation and use of antibiotic to treat the disease (WHO, 2016). According to the most recent estimates between 11 and 21 million cases and 128,000 to 161,000 typhoid related deaths occurs annually worldwide (WHO, 2015).

In the united states, the incident of typhoid fever in 1920 and 2006 where 35,994 and 314 respectively, because of improve sanitation and successful antibiotic treatment, the prevalence has steadily decreased.

Now our days in the United States, most cases of typhoid fever arise in international travellers, the average yearly incidence   of typhoid fever per million travellers is 2.2 (CDC, 2016).

In Africa, the disease is mainly associated with low socio-economic status and poor hygiene, with human beings as the only known natural host and reservoir of the infection.

Estimate for the year 2000 suggest that there are approximately 21.5 million infections    and 2 million deaths from typhoid fever globally each year (Crump et al., 2004; Bhan et al, 2005; Bhutta 2006), (Bhan MK, Bahl R, Bhatnagar S. Typhoid and paratyphoid fever. Lancet 2005; 366: 749–62).

It is thus considered one of the most serious infectious disease threats to public health on a global scale with particular concern over the rapid and widespread emergence of resistance, multiple anti-biotics (Akinyemi et al.,2005; Feng 2000).

Incidence of typhoid of 10 to 100 cases\100,000 persons per year, in most African countries with incidence highest in childhood. East Africa, incidence was estimated at 39\100 persons each year (Crump et al.,2004).

In Cameroon, studies show that there has been an apparent increase in occurrence of typhoid fever reason been that,there is over diagnosis of the illness related to poor performance of the Widal test in laboratories and misinterpretations by prescribers (Nsutebu et al., 2002).

A recent study shows that only 2.5% of febrile patients with signs and symptoms of typhoid fever in Cameroon actually had malaria. Malaria and typhoid fever are among the most endemic disease in the tropic (Nsutebu et al., 2001; Mbuh et al., 2003).

The research will be carried out in December 2019 at the Buea Regional Hospital. The participant will be the nurses at the Buea Regional Hospital.

The objective of this research will be to asses perception on the treatment measures of typhoid fever and the causes of mismanagement, assess their perception on the causes of increase rate of drug resistance; assessing their knowledge on the effect of mismanagement of typhoid fever.

1.2 Problem Statement

During the 1960’s, resistance to 3 or more first line antibiotics including ampicillin, trimethoprim. Sulfa meth oxazole, and chloramphenicol, became more common. S.Typhi began to be reported more frequently. C Britto C D, Dyson 2A, Duchene S, et al., 2018).

However, the welcome Trust and Oxford university established a clinical unit in Ho chi Minh city of Vietnam in conjunction with the Vietnamese government, and a local program of typhoid surveillance involving blood culture and antibiotic susceptibility testing was established.

It quickly became clear the MDR was associated with up to 90% of typhoid cases in Ho Chi Minh City.

Nevertheless, the present threat of MDR encouraged ethically supported trials of ciprofloxacin in the treatment of typhoid and this was reported as being very effective with a low level of clinical relapse. (Wong Uk et al., 2016).

In our local communities and hospital settings, the incident of typhoid fever is higher in children age less than 5 years and they experience a higher rate of complications and hospitalisation. Despite appropriate treatment, some 2-4% of infected children relapse after initial clinical response to treatment, making management of this condition difficult in the part of the nurses.

Others study results show that typhoid fever causes pain, suffering and death that reduce human energy and make individual less able to cope with life.

The disease has a great impact on productivity, social and other aspects of life, it becomes a serious threat to public health, especially in economically poor countries, where the level of hygiene is below standard and sanitary conditions are poor.

1.3 Research Objectives

1.3.1    Main Objective

The main objective of this study is to assess nurse’s perception on the treatment measures of typhoid fever and the causes of drug resistance at the Buea regional hospital.

1.3.2 Specific Objectives

1. To assess nurses knowledge on the concept of typhoid fever.
2. To assess nurses perception on the treatment majors of typhoid fever.
3. To assess nurses knowledge on the causes of drug resistance to the treatment of typhoid fever.

1.4 Research Questions

1. What is the perception of nurses towards the concept of typhoid fever?
2. What perceptions on the treatment measures of typhoid fever?
3. What knowledge do nurses have on the causes of drug resistance towards the treatment of typhoid fever?