Association of clinical features of typhoid fever with socioeconomic status in Pakistan

Abstract

Background: Typhoid fever is spread by ingestion of contaminated food or water, which is linked to infrastructure; specifically, sewage and sanitation. In developing countries, infrastructure varies according to socioeconomic status (SES). Balochistan is the least developed province of Pakistan. Aims: To analyse the association between the clinical features of typhoid fever and socioeconomic status. Methods: A quantitative, cross-sectional study was conducted in Quetta, Balochistan, Pakistan. Between May and October 2017, 143 patients presented to tertiary care hospitals and private clinics with a complaint of fever lasting ~3 days, along with a clinical history of headache, malaise, diarrhoea or constipation, abdominal pain, dry cough, and anorexia. All patients had a positive blood culture for Salmonella enterica serotype Typhi. Eighteen patients dropped out of the study, leaving 125. Results: Seventy (56%) participants had low socioeconomic status (SES), 40 (32%) middle SES and 15( 12%) high SES. The strongest predictors of presenting with typhoid fever were patients’ clinical condition when presenting to health facilities, followed by SES. Most respondents had a treatment duration of 1–2 weeks. SES had a high impact on source of drinking water supply. Conclusion: The strongest predictor of reporting typhoid fever was the current clinical condition of the patients, followed closely by SES. The incidence of typhoid fever in the low SES patients was almost the same as in the middle and high SES patients. Patients with low SES were more susceptible to contracting typhoid fever due to poor health status and facilities.