Abstract
Bluegrass is a resettlement farming and mining area 15km from Kadoma city in Zimbabwe. Water sources include boreholes, dam and a shallow well and the sanitation coverage is about 50%.The community experienced one death and an increase in people with signs and symptoms of typhoid fever between 4 -7 October 2013. We conducted an investigation to establish factors associated with contracting typhoid in order to inform control measures. A 1:1 unmatched case control study was conducted using a pretested interviewer administered questionnaire. Water from water sources and that stored at household level were tested for Escherichia coli (E.coli) contamination. Stool specimens were submitted for culture to confirm the outbreak. Data were analyzed using Epi InfoTM (CDC, 2012). Means, proportions, frequencies, odds ratios and their 95% confidence intervals were generated. A total of 42 cases and 42 controls were interviewed. The median age of the cases was 12, 5 years (Q1=11, Q3=14) and for controls was13 years (Q1=10, Q3=15). Fever (n=36, 93%) and abdominal pains (n=36, 93%) were the most common signs and symptoms. Risk factors for contracting typhoid were: having more than 4 members in a household, (OR=12.87: 95%CI 4, 5-41.10), not preparing water before drinking (OR=17.5: 95% CI 4.25-120.4) and open defecation (OR=11.13: 95%CI 3.52-42.4). Storing drinking water in a bucket with a lid (OR=0.04 95% CI 0.009-0.15), having a hand washing facility (OR=0.01 95%CI 0.002-0.06) were protective against contracting typhoid. Water from the shallow well, dam, tap mine 1 and that stored in households were contaminated with E coli. Three stool specimens out of eight were positive for Salmonella typhi. Poor hygiene was the main risk factor for contracting typhoid fever in the community. The outbreak was propagated by person to person transmission as supported by the epidemic curve and epidemiological linkages. Water sources that had fecal contamination could have also propagated the outbreak. Communication for development aimed at improving hygiene standards was conducted. Free treatment to patients and use of water maker for water purification was done.
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