Modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015

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dc.contributor.authorBulage, Lilian
dc.contributor.authorMasiira, Ben
dc.contributor.authorArio, Alex R.
dc.contributor.authorMatovu, Joseph K. B.
dc.contributor.authorNsubuga, Peter
dc.contributor.authorKaharuza, Frank
dc.contributor.authorNankabirwa, Victoria
dc.contributor.authorRouth, Janell
dc.contributor.authorZhu, Bao-Ping
dc.date.accessioned2018-07-25T14:46:35Z
dc.date.available2018-07-25T14:46:35Z
dc.date.issued2017
dc.descriptionThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.en_US
dc.description.abstractBackground: Between January and June, 2015, a large typhoid fever outbreak occurred in Kampala, Uganda, with 10,230 suspected cases. During the outbreak, area surgeons reported a surge in cases of typhoid intestinal perforation (TIP), a complication of typhoid fever. We conducted an investigation to characterize TIP cases and identify modifiable risk factors for TIP. Methods: We defined a TIP case as a physician-diagnosed typhoid patient with non-traumatic terminal ileum perforation. We identified cases by reviewing medical records at all five major hospitals in Kampala from 2013 to 2015. In a matched case-control study, we compared potential risk factors among TIP cases and controls; controls were typhoid patients diagnosed by TUBEX TF, culture, or physician but without TIP, identified from the outbreak line-list and matched to cases by age, sex and residence. Cases and controls were interviewed using a standard questionnaire from 1st -23rd December 2015. We used conditional logistic regression to assess risk factors for TIP and control for confounding. Results: Of the 88 TIP cases identified during 2013–2015, 77% (68/88) occurred between January and June, 2015; TIPs sharply increased in January and peaked in March, coincident with the typhoid outbreak. The estimated risk of TIP was 6.6 per 1000 suspected typhoid infections (68/10,230). The case-fatality rate was 10% (7/68). Cases sought care later than controls; Compared with 29% (13/45) of TIP cases and 63% (86/137) of controls who sought treatment within 3 days of onset, 42% (19/45) of cases and 32% (44/137) of controls sought treatment 4–9 days after illness onset (ORadj = 2.2, 95%CI = 0.83–5.8), while 29% (13/45) of cases and 5.1% (7/137) of controls sought treatment ≥10 days after onset (ORadj = 11, 95%CI = 1.9–61). 68% (96/141) of cases and 23% (23/100) of controls had got treatment before being treated at the treatment centre (ORadj = 9.0, 95%CI = 1.1–78). Conclusion: Delay in seeking treatment increased the risk of TIPs. For future outbreaks, we recommended aggressive community case-finding, and informational campaigns in affected communities and among local healthcare providers to increase awareness of the need for early and appropriate treatment.en_US
dc.identifier.citationBulage et al. BMC Infectious Diseases (2017) 17:641. DOI 10.1186/s12879-017-2720-2en_US
dc.identifier.issn1471-2334
dc.identifier.uriDOI 10.1186/s12879-017-2720-2
dc.identifier.urihttps://hdl.handle.net/20.500.11951/303
dc.language.isoenen_US
dc.publisherBioMed Centralen_US
dc.rightsAttribution 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/us/*
dc.subjectTyphoid fever outbreak - Ugandaen_US
dc.subjectIntestinal perforations - Ugandaen_US
dc.titleModifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015en_US
dc.typeArticleen_US
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