OUTBREAK INVESTIGATION OF TYPHOID FEVER IN VILLAGE KUWARDU, DISTRICT SKARDU, GILGIT-BLATISTAN (G-B), PAKISTAN
Background: On 8th may, 2012, civil dispensary Kuwardu village (5000 population) of district Skardu reported an unusual increase in number of cases with high grade fever, abdominal discomfort and anorexia. A team from health department was deputed to investigate the outbreak with the objectives to identify the associated risk factors and provide recommendations for control.
Methods: A Case was defined as a person living in village Kuwardu with fever >38oc and with one of these symptoms: abdominal discomfort, vomiting, diarrhea and positive Typhidot test (IgM) between 30 April - 27 May, 2012. Cases were enrolled through active case finding. Equal numbers of age and sex matched controls were enrolled from the neighborhood. Descriptive statistics, univariate and multivariate analysis was done. Qualitative assessment of the environment was also done.
Results: A total of 98 cases were identified in which 66% (n= 65) were female. Mean age was 32 years (12-65 years). Age group 21-30 years (n= 32, 32.7%) were the most affected group. Drinking water from the storage tanks (OR=16.6), living in the same house (OR=20.28) were associated with illness. Six water samples were tested and found unfit for human consumption. Multiple logistic regression shows association of household size (>5 person in room of house) (OR 7.46), typhoid patients handling and cooking food (OR=13.43) and drinking water from storage tank (OR 12.62) with disease.
Conclusion: Contamination of drinking water sources with human fecal matter was the most probable cause of this outbreak. Awareness campaign was initiated. The importance of hand-washing practices before cooking and after attending the toilet was highlighted. Developing toilets away from drinking water sources were advocated. Based on our recommendation Public Health Engineering Department has prioritized setting up treated water system and have sent request for funds allocation.
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