ABSTRACT
Typhoid fever, also known as enteric fever, is caused by Gram-negative bacterium Samonella enterica Serovar Typhi. The disease typhoid fever is mainly associated with low socioeconomic status and poor hygiene with human being. Mores, the signs of typhoid fever most commonly reported are; fever, diarrhea, vomiting, abdominal pain, headache and splenomegaly. The main aim of this study was carried out to assess mother’s knowledge, attitude on prevention of typhoid fever in children 0-5years at Buea Town Community and to determine how knowledge affects their attitude towards their prevention of typhoid fever. The method used as study design was a quantitative descriptive community based cross sectional study and the methods used was a convenient sampling method in which the main tools use was a semi structured questionnaire was administered to 100 participant to assess the knowledge and attitude regarding typhoid fever. Data was analyze using statistical Package for social science version[SPSS] and the information was presented in the form of frequencies ,and percentages on tables ,graphs and chi square to assess the relationship between knowledge of mother and educational status 50.0[x2.9.42,p=0.02]from the results participants had an overall results on good knowledge of [95% Cl.56-61.3] on the prevention of typhoid fever and poor attitude of [40%].There was a significant association between educational level and children[x2:14.9;p=0.001].There was a significant association between attitude and age[x2;20.56:0.000 p=0.4]with children domination of[x2:11.18.3.p=0.4.It can therefore be concluded, the ministry of Public Health should reinforce good polices on hygiene and sanitation offices help control the masses hygiene and sanitation behaviors which can help stop the spread of typhoid. Key words; Typhoid fever, symptom, attitude, knowledge, children.

CHAPTER ONE
GENERAL INTRODUCTION
1.1 Background
Typhoid fever, also known as enteric fever, is caused by the Gram-negative bacterium
Salmonella enterica serovar Typhi. The disease is mainly associated with low socio-economic
status and poor hygiene, with human beings the only known natural host and reservoir of
infections .Estimates for the year 2010 suggest that there are appropriately 21.5 million
infection and 200,000 deaths from typhoid fever globally each year (Crump et al.,2014;Bhan et
al and Bhutta,2006).It is thus considered one of the most serious infection disease threats to
public health on global scale, with particular concern cover the rapid and widespread emergency
to multiple antibiotics (Akinyemi et al,2005;Feng,2010).The global concern over typhoid fever
is reflected in perceptions that typhoid fever is a common and serious disease among children
and adults in Kenya, where highly publicised outbreaks have strengthened this view among the
public health professionals. One consequence is the common use of the Widely test to ‘screen’
febrile children and adults in inpatient and outpatient settings ,as few centres have the capacity
to perform blood or bone marrow culture, the accepted goal standard diagnostic test (Chart et
al. 2010;Willke et al.,2012).The global burden of disease estimates for typhoid were based on
a total of 22 community- based incidence studies with 19 from continents other than Africa and
only three from Africa. On the basis of these data and a prediction rule based on climate and
socio-economic features, continental estimates of disease burden were derived (Crump et al
2014;).These estimates suggested a moderate incidence highest in 100 cases/100,000 person
years in most African countries, with the incidence highest in childhood .In Africa, incidence
estimated at 39/100,000 person years. Recently, increasing amounts of data on the prevalence
of different pathogens found in skin children presenting to health facilities in Africa have been
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reported. These data have considerably raised to profile of non typhoidal salmonella infection
(Graham et al.,2010)
The sign that are most commonly reported are fever followed by diarrhoea, vomiting,
abdominal pain, headache, splenomegaly anorexia and hepatomegaly. There is no obvious
difference in clinical presentation of typhoid between Asia and Africa. We are only aware of
two studies that have explored the performance of clinical case definition for typhoid fever, one
study in Turkey (Vollaardet al 2015).
According to recent WHO estimates the global burden of typhoid is 21million cases per year,
with mortality rate of 1-4%.A vast majority of these episodes occur in developing countries
where typhoid fever is endemic. Quickly emerging and swiftly spreading drugs resistant strains
have deteriorated the situation by inflating the morbidity figures. With changing expenditure
patterns on health, health related behaviours ,hygiene conditions and other social trends, a
change in risk factors or strength of association of risk with typhoid fever can be expected.
Taking this into consideration, efforts are being made in endemic region to detect any change
in know risk factors or identify new modifiable risks factors. Several of the identified risks
factors are similar even across continents.
In Africa, the WHO identified sources of infection identified earlier were certain foods, food
related behaviors and contaminated water. Amongst food items, ice and unbranded ice cream
have been implicated as vehicles of the infectious agent. Food contamimation in turn can occur
through water or by food handlers who may be carriers. Simultaneous increase in consumption
of chilled food and drinks in hot weather of May-June and typhoid incidence has been seen
consistently in Africa.
However, a second peak of typhoid cases has been observed in the month of September-October
after monsoon rains in July-August, which has been primarily associated with the contamination
of drinking water sources with overflowing surface water. Besides these seasonal hikes,
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sporadic typhoid cases are observed round the year that mainly attributed to intermittent mixing
of underground sewerage and drinking water due to damage pipelines. The situation gets still
complicated as the much safer tap water is not available to more than 15-40% of the household
in different districts in Africa. This figure rises to above 60% if data of squatter settlements
alone are seen (unpublished data).
Overcrowding has also been implicated in the transmission of the organism. National census
data show household occupancy of around 6.5persons in different districts of Africa according
to the WHO (2009)Around 60% of population of sub-Saharan Africa lives in urban Squatter
settlements and a large proportion of typhoid cases such as locals. Risk factors identified earlier
in the sub-Saharan Africa did not focus such highly underprivileged localities,as cases studied
were from all over sub-Saharan Africa. Also the time frame for which exposures were
ascertained from cases and controls was different. In this study we identified risks factors more
specific to highly endemic areas within cities so ithat the limited resources could be directed
efficiently. Also our study targets population of 0-5years as this group is at much higher risk of
developing typhoid fever.
1.2 Statement of Problem
Children less than Five years constitute the most vulnerable segment of any population. Their
health status is a sensitive indicator of child’s survival,growth during childhood is widely used
as a marker to assess adequate health,nutrition and development of children (Sabbagh et
al;2010).It is well documented that chronic typhoid fever is associated with serious health
impairments later in the life which has the significant impact on quality of life.Typhoid fever is
still considered as one of the major public health problems in many countries affecting more
than 30% of children under five years of age. Several efforts are being made globally and locally
to reduce the Typhoid fever burden especially in developing nations. The forth millennium
Development Goals (MDG)intends among others to reduce under five years mortality by 2/3rd
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by the year 2015.Sustainable development goals(SDG)goal 3 which states on good health and
wellbeing goal and 6 which talks of clean water and sanitation)This has led to the development
of a more integrated and holistic strategies in a manner as to ensure maximum benefit to the
vulnerable groups especially children. The major intervention in this direction has been that
relating to establishing and promoting exclusive breast-feeding and promoting nutritionally
adequate diets for children less than five years. Although studies in African countries like
Ethiopia, Kenya, Somalia andTanzania have revealed that one of the major reasons of Typhoid
fever have been a knowledge deficit of mothers on prevention of typhoid fever .This study is
therefore, a replicative study aimed at assessing mother’s knowledge attitude towards
prevention of typhoid fever in Buea Town community in Cameroon.
1.3. Research Questions
1) What knowledge do mother’s have in the prevention of typhoid fever?
2) What is the attitude of mothers towards typhoid fever prevention?
3) How does the knowledge they have affect their attitude towards the prevention of
typhoid fever?
1.4 Research Objectives
1.4.1 General Objective
The general objective is to assess mothers knowledge and attitude on prevention of typhoid
fever in children from 0-5years.
1.4.2 Specific objectives
1. To evaluate the level of awareness of mothers of typhoid fever in children 0-5years in
Buea Town community.
2. To assess the attitude of mothers towards typhoid fever in infants 0-5years .
3. To determine if the knowledge affects their attitude towards prevention of typhoid fever.