Temporal, spatial and household dynamics of Typhoid fever in Kasese district, Uganda
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
Typhoid fever affects 21 million people globally, 1% of whom succumb to the disease. The
social, economic and public health consequences of this disease disproportionately affect
people in Africa and Asia. In order to design context specific prevention strategies, we need
to holistically characterise outbreaks in these settings. In this study, we used retrospective
data (2013–2016) at national and district level to characterise temporal and spatial dynamics
of Typhoid fever outbreaks using time series and spatial analysis. We then selected
cases matched with controls to investigate household socio-economic drivers using a conditional
logistic regression model, and also developed a Typhoid fever outbreak-forecasting
framework. The incidence rate of Typhoid fever at national and district level was ~ 160 and
60 cases per 100,000 persons per year, respectively, predominantly in urban areas. In Kasese
district, Bwera sub-county registered the highest incidence rate, followed by Kisinga,
Kitholhu and Nyakiyumbu sub-counties. The male-female case ratio at district level was at
1.68 and outbreaks occurred between the 20th and 40th week (May and October) each year
following by seven weeks of precipitation. Our forecasting framework predicted outbreaks
better at the district level rather than national. We identified a temporal window associated
with Typhoid fever outbreaks in Kasese district, which is preceded by precipitation, flooding
and displacement of people. We also observed that areas with high incidence of Typhoid
fever also had high environmental contamination with limited water treatment. Taken
together with the forecasting framework, this knowledge can inform the development of specific
control and preparedness strategies at district and national level.
Description
Keywords
Spatial, Household dynamics, Typhoid fever, Kasese district, Uganda
Citation
Mirembe BB, Mazeri S, Callaby R, Nyakarahuka L, Kankya C, Muwonge A (2019) Temporal, spatial and household dynamics of Typhoid fever in Kasese district, Uganda. PLoS ONE 14(4): e0214650. https://doi.org/10.1371/ journal.pone.0214650