Prevalence and Factors Associated With Typhoid Infection Among Student Nurses at College of Nursing – Ntotroso
Chapter One
Study Objectives
Broad Objective
The study was aimed to assess risk factors contributing to the prevalence of typhoid fever among student nurses attaining Ntotroso General Hospital in Ntotroso of Ghana.
Specific Objectives
- To determine the personal hygienic factors contributing to the prevalence of typhoid fever student nurses who were medically confirmed with typhoid fever attaining Ntotroso General Hospital in Ntotroso.
- To identify sanitary factors in homesteads of respondents contributing to the prevalence of typhoid fever student nurses who were medically confirmed with typhoid fever attending attaining Ntotroso General Hospital in Ntotroso.
- To identify the availability of clean and safe water in the homesteads of student nurses attaining Ntotroso General Hospital that may contribute to the prevalence of typhoid fever.
CHAPTER TWO
LITERATURE REVIEW
Introduction
This chapter presents review of literature according to the study objectives as presented by different authors and researchers in the globe.
Water Related Factors Associated with Typhoid Fever
In developing countries, where safe water and sanitation systems have not been well-established, large-scale typhoid and paratyphoid outbreaks sometimes occur (Polonsky et al., 2012). Walters et al., (2015) reported that during a previous typhoid outbreak in Ntotroso and Bundibugyo districts of Ghana in 2022–2011, which affected 8092 persons, the vehicle of transmission was found to be unclean water.
According to the study conducted by Steven Ndugwa, he reported that the outbreak of typhoid fever in Accra city was likely caused by consuming contaminated water from unprotected ground water sources. He continued by saying that Accra city has more than 200 unprotected ground water sources, most of which serve as unprotected sources of water for economically disadvantaged people in the city (Ndugwa, 2015).
Almost 30% of people living in urban areas and more than 60% of those living in rural areas do not treat their water before drinking (UBOS et al., 2011). Barriers to safer drinking water include the cost associated with establishing a piped treated water system or purchasing water treatment products for household use and the false perception that naturally occurring water sources could be safe (Merkel et al., 2012).
A study by Kibiru Nguri (2011) showed that 39.4% of people did not wash their hands because of unavailability of adequate water and 28% did not wash their hands due to the cost of water, while 23.7% did not wash hands because they had not suffered from typhoid fever before.
According to Dewan (2013), a statistically significant inverse association was found between typhoid incidence and distance to major water bodies.I. Khan et al. (2012) reported that typhoid fever was found to be lower in the households using a safe drinking-water source and also reported that typhoid fever affects younger children living in areas of high population density and lack of access to safe water in Pakistan. Jakopo Zorodzail reported that water sources that had fecal contamination could have also propagated the outbreak in the same study area (Zorodzail et al., 2013). Surface and ground water without guaranteed safe supply for fecal matter could gain access into the water through water borne sewage system, through flush toilets, and pit latrines as found by Pruss-Urstun et al., (2006).
Food hygienic factors associated with Typhoid Fever
Toure reported in their study that weaning food hygiene may be among the most important determinants of diarrheal disease risk in young children, (Toure et al, 2012). According to Kung‟u, up to 70% of all diarrheas are caused by contaminated foods, and microbial counts that may exceed those found in drinking water. Eating food prepared in hotels is therefore a risk factor towards suffering from typhoid fever. (Kung’u et al, 2022).
Analysis by Hussein Gasem in Pakistan showed the following as risk factors for typhoid fever: never or rarely washing hands before eating, eating outdoors food at a street food stall or mobile food vendor, consuming ice cubes in beverage and buying ice cubes from street vendors (Gasem, 2011).
Sanitation factors associated with typhoid Fever
Jakopo Zorodzail in his study found that 80.2% of the residents with temporary houses, 14.4% with semi-permanent houses and 5.4% with permanent houses suggesting that most of the residents were poor and vulnerable to poor housing which could promote poor state of sanitation. Poor sanitation practices are a cause of bacterial, viral, protozoa, and helminthic infections (Jakopo, et al, 2013). Typhoid fever was associated with poor housing and inadequate food and personal hygiene (Gasem, 2011).
According to Khan et al, (20012), typhoid fever affects younger children living in areas of high population density and lack of access to safe water in Pakistan. Breiman also confirmed that young children are at the greatest risk of typhoid fever in densely populated urban areas with poor hygiene and sanitation infrastructure (Breiman et al, 2012).
Unsafe disposal of excreta and solid wastes are significant factors that contribute to contamination of ground water in Accra City as observed by Ndugwa (2015) after an outbreak of typhoid fever. Furthermore, young children are the most likely to be exposed to fecal contamination in the immediate environment surrounding their household as observed by Ngeno et al (2015). A study by Jakopo in Zimbabwe reveals that open defecation, lack of hand washing facility and poor hygiene were the main risk factors for typhoid fever (Jakopo Zorodzail et al, 2013).
CHAPTER THREE
STUDY METHODOLOGY
Introduction
In this chapter, the study was concerned with; study area, study population, research design, study variables, sampling procedure and sample size, research instrument, methods of data collection, data processing and analysis, limitations of the study and solution, ethical considerations and dissemination of the study results.
The Study Area
The study was conducted in Ntotroso General Hospital, in Ntotroso of Ghana.
Study Population
Study population were children and adults (age group7 years old and above) who were medically confirmed typhoid fever by laboratory tests, and were obtained using the inclusion and exclusion criteria explained below and a sample of 138 respondents were chosen to participate in the study.
Study Design
The study was a cross sectional descriptive study which involved interviewing the respondents who were medically confirmed with typhoid fever with questionnaire forms. The questionnaire forms were designed according to the objectives of the study.
CHAPTER FOUR
RESULTS OF THE STUDY
Introduction
In this chapter, the results of the study “Factors Contributing to the Prevalence of Typhoid Fever among Student nurses attaining Ntotroso General Hospital in Ntotroso” are presented in form of tables, graphs and charts, followed by a brief description of the presentation.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS
Introduction
In this chapter conclusions and recommendations are made of the study “Factors Contributing to the Prevalence of Typhoid Fever among Student nurses attaining Ntotroso General Hospital in Ntotroso” based on the significant findings.
Conclusion
Most respondents were males aged 35 years and above and most of them were not married. Most of them attained only primary education and a few secondary educations, and the majority was unemployed but involved in peasant farming as a source of income.
In this study, most respondents have latrines at home but most of them do not control flies densities from their latrines. Most of them also wash hands without soap or totally do not wash hands after visiting the latrine. Furthermore, most of the respondents do not or seldom wash their hands before preparing food and just eat fresh fruits after gathering without washing or pealing.
A significant number of the respondents also eat food from hotels and restaurants, or food sold along roadside. However a good number cover cooked food for use later.
About half of the respondents do not have rubbish pits at home and drink untreated water from boreholes or rain water or water from swamps collected from sources at or less than 30 meters away from any nearby latrine.
There are therefore very significant high risks of eating contaminated food, getting into contact with fecal matter or drinking contaminated water and thus exposure to typhoid fever among the respondents.
Recommendations
Recommendations from the findings of this research;
- Residents should also be sensitized on the importance of having pit latrines at home for proper disposal of fecal matter.
- Residents should be sensitized on control of fly densities from their latrines, through covering of pit latrine holes, use of insecticides, use of VIP latrines, or smoking of pit latrines to avoid flies contaminating food and
- Residents should also be sensitized on the importance of washing hands with soap and clean safe water after visiting the latrine and before preparing or eating
- They should also be sensitized on the importance of washing and pealing fruits before
- Local health and law enforcement authorities should strengthen and enforce food preparation and safety in hotels, restaurants and roadsides a significant number eat food from restaurants or food sold along
- Local law enforcement and health authorities should also enact and enforce laws requiring households in this area to have rubbish pits.
- Lastly, but not least residents should be sensitized on how to treat water at home before drinking using cheap, simple and effective methods like filtration, boiling and using water treatment agents like aqua safe and water guard.
Recommendations for future research;
- It is recommended that another study be done targeting those less than 7 years old other than those who are seven years old and above (target population in this study).
- The study used the questionnaire and key informant Interview schedule as well as a checklist, as data collection tools, therefore future studies should incorporate other methods of data collection such as direct
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