Najma Javed, Sajid Abbasi, Muhammad Tahir, Faiza Bashir.
Identifying the risk factors for typhoid fever among the residents of rural Islamabad.
Pak J Med Res Jan ;56(2):48-51.

Background: During August 2015, unusually high typhoid fever cases were reported from rural Islamabad at Federal General Hospital (FGH), Islamabad. Objectives: To determine the risk factors for typhoid fever outbreak and recommend preventive measures. Study design, settings and duration: Outbreak investigation study conducted in Union Councils 19 & 22 of rural Islamabad in the catchment area for Federal General Hospital, from 7th July- 30th August 2015. Subjects and Methods: A questionnaire was used to identify risk factors of typhoid fever. A case was defined as any resident of the rural Islamabad within the mauza Chatta Bakhtawar and Terlai Kalan presenting with high grade fever (>101 F) with one of the following signs/ symptoms; headache, abdominal pain and vomiting with positive typhidot test from 7th July- 30th August 2015. Two age and sex matched controls for each case was selected from the neighborhood. Epi Info 7 was used for analysis. Results: Total of 50 cases and 100 controls were enrolled. Among cases 30 (61%) were females and 20 (39 %) males with M;F ratio of 1:1.5. Mean age was 23.0 years (9.9 ± SD). The most affected age group was 15-25 years (AR 0.19%, n=21). Only one case died (CFR 2%). Use of untreated public water after rains (OR 3.7 CI 1.6- 9.7 p< 0.0002), reconstruction areas and bursting/ leaking of water pipes (OR 4.017 CI 1.6-9.7 p< 0.001) and presence of confirmed typhoid cases at home /close contacts (OR 5.7 CI 2.019-16.18 p< 0.0003) were the significant risk factors found associated with the disease. Whereas using well/ private bore (OR 0.29 CI 0.329-0.653 p< 0.001) and hand washing practices (OR 0.7 CI 0.297-1.9 p< 0.5) had a protective effect. Multivariate analysis showed that use of untreated public water (OR: 3.34, CI: 1.52-7.29, p< 0.002), bursting/ leaking pipes (OR 2.86, CI 0.96-8.48, p< 0.05) were significantly associated with typhoid disease. Conclusion: Contamination of drinking water with sewage during rain and frequent bursting and leaking of the pipes were the most common cause of this outbreak. Key words: Typhoid fever, Islamabad, chlorination, public water.

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