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PROJECT TOPIC:  THE ROLE OF NURSES IN MANAGEMENT OF THYPHOID IN WEST AFRICA
Department:  Applied Science
AMOUNT:  10,000
FORMAT:   MS WORD
PAGES:  74
 
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CHAPTER ONE

GENERAL INTRODUCTION

 1.1 Background to the study

One of the principal diseases causing morbidity and mortality in the tropical regions is typhoid fever. Typhoid fever is a serious acute febrile syndrome that is very common in tropical countries. (Nguri, 2011). The mode of transmission of Typhoid fever is through food ingestion. It could also be as a result of contamination of food with infected persons feces which has the presence of Salmonella enteric serovar Typhi (Magnum & Magnum, 2014). There is the movement of the bacteria resulting from perforation into the intestinal. This results in macrophages phagocytizing it. The family of the Genus Salmonella is the Entero bacteria facultative Gram-negative bacilli. It is identified by a biochemical test and antigen structure. Patients infected with Typhoid fever demonstrate the features of high fever, myaliga, headache, stomach pain, sore throat, and diarrheoa. In some instances, the term "enteric fever" collective represent all typhoid and paratyphoid cases (Kanungu, Dutta & Sur, 2008)

In most cases, when Typhoid fever is not attended to early, it may end in the death of the individual. Heyman reports as cited from the Center for Disease Control and Prevention that, globally there are over 17 million cases of Typhoid which results in more than 600,000 deaths yearly. In the developing world, Nguri (2011) reports that, is threat affecting about

12.5 million persons annually. Notwithstanding, in most situations, the effect of the incidence and the  actual  health  effect  of  Typhoid  remains  unexplored  within  the Sub

Saharan region. Marks et al (2010) report that key among the barriers to knowing the effect and incidence of Typhoid within the Sub-Saharan Africa is the issue of lack of diagnostic laboratories. As a result, there are wrong diagnosis as fatal Typhoid Fever is often interpreted as malaria (Evans et al, 2004; Reddy,2010).

1.2   Statement of Research Problem

In West africa, Typhoid Fever ranks among the first twenty causes of outpatient illness. This according to Sorry (2009) as cited by Marks (2010) accounts for 0.92% of hospital admissions. In the literature on Typhoid Fever, little has been documented in West africa. A study conducted by Marks (2010) in West Africa at the Agogo Presbyterian Hospital in the Ashanti Region of West Africa using 1,456 children provides further insights into researching into the diagnosis of Typhoid Fever. In this study, using Blood culture method, it was established that Children<2 years of age had the highest proportion of positive blood cultures (164/1,456). Typhoid fever was low among children <2 years of age (7/1018, 0. 7%). Though the blood culture method was able to record high incidence figure, the authors admit the low sensitivity of standard microbiologic methods which was given as being up to 50%. As a result, the results were prone to under diagnosing moderate bacteremia in Salmonella infections (Gilman et al., 1975; Wain et al., 2001).

There is the need to obtain a more reliable and standardized laboratory diagnoses of Salmonella infections to be able to win the surveillance battle on Typhoid Fever. The diagnosis of Typhoid fever on clinical grounds is difficult sometimes. Blood culture and Management test are the commonest forms of laboratory test for the detection of typhoid fever in almost all clinical settings (Hasan et al., 2013). In developing countries with West africa

 

inclusive, diagnosis is mostly done by Management test. It is a serological test that has moderate sensitivity and specificity (Marks, et al, 2010).This is due to the lack of laboratory capacity for culture experiments. More to this is the associated cost in conducting these experiments. Another rapid serological test has been introduced for an early detection and diagnosis of typhoid fever .The study by Olsen et al (2004) report high sensitivity and good specificity for Typhoid compared to Management test making its application in developing countries very timely. More to its advantage in the same finding was that, it was known to simple to use by clinicians, very reliable when compared to Management test. It additionally provides quick results within 1 hour when it is compared to 48 hours for blood culture and 18 hours for Management test.

However, the usefulness of it has not been explored much as to how sensitive and specific it is when compared to Management test. In Asia, Sherwal et al (2004) has documented that among the relatively small number of studies that have been done in south India and the rest of Asia, was not encouraging. Notwithstanding, Olsen et al (2004) and Andualem et al (2014) posit that there is a continuing debate about Management test utility in the early detection and diagnosis of the disease. In view of this a serodiagnostic test kit with a higher specificity and sensitivity than management test was introduced. In light of this the research questions that arise are

Is Typhoid test simpler and quicker than management test?

 

Is the Typhoid more sensitive and reliable than Management test for the dection and diagnosis of Enteric fever?

1.3   Research Objective

Research Aim or main Objective

This study mainly aims at comparing the results of Management test and Typhoid in the early diagnosis and management of enteric fever cases.

1.3.1 Specific Objectives

The specific objective of this study is;

To compare the specificity and sensitivity of Typhoid and Management serological tests to help in the detection and diagnosis of typhoid fever in the West Africa.

1.4   Research Hypothesis

The following hypothesis test will be conducted

HO: There is no significant difference in the sensitivity and specificity of management and Typhoid serological test in the diagnosis of febrile fever.

H1: There is a statistically significant difference in the specificity and sensitivity of Management serological and Typhoid test.

1.5   Scope of the Study

The study was limited to both its geographical scope and conceptual scope. The geographical scope of the study was the West Africa. The research setting was the West Africa. The study setting was chosen because of the incidence of enteric fever in the Municipal. A prospective cross-sectional design will be used. Conceptually, the study examined, Typhoid acquisition, types and nature of diagnosis, the risk factors to acquisition and patients levels of knowledge on typhoid acquisition and treatment alternatives.

1.6   Significance and justification of the study.

The comparative study of the testing methods for the detection and diagnosis of Typhoid is justified on the counts of the growing Typhoid fever cases in the West africa. The difficulty in early diagnosis of Typhoid is crucial for saving precious lives. A more accurate, affordable and reliable means of diagnosing typhoid early is urgently. This has necessitated the comparative study of the test options so as to reach a decisive point on the test options. The study will provide useful insight into Typhoid test options, their specificity and sensitivity which will be useful to hospital laboratory scientist for improved health care delivery. The findings of this study will add to the body of knowledge on Typhoid test globally and contribute significantly to the limited empirical scholarly works on Typhoid and Typhoid test in West africa in particular. The usefulness of the study findings to policy makers in public health education on environmental health and sanitation is very timely.

1.7   Organization of the study

The entire research work will be presented in five chapters. The first chapter ;chapter one will include the background of the study, the problem statement, leading research questions, study objectives, research hypothesis, justification, contextual and geographical scope and the organization of the study. The chapter two will concern itself with a review of scholarly works on Typhoid diagnosis, Management and Typhoid test. A critical review of the risk factors in acquiring Typhoid will be part of the chapter two. The methodology that will detail the processes and procedures in conducting the study will occupy the chapter three. The results and discussion will be presented in the chapter four of the study. Summary of key findings, conclusions and recommendations for their policy implication will constitute the entire chapter five.

 

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