INTRODUCTION

Background of Studies

Water, sanitation and hygiene (WASH) are critical in the prevention and care for diseases like Diarrhea, cholera and Typhoid fever or Enteric fever which kills about 150,000 people every year.

Typhoid fever is a serious systemic infection caused by gram negative bacteria Salmonella enterica serotype typhi and Salmonella enterica Paratyphoid (Wain et al.,2011). The disease is endemic to low and middle-income countries (LMIC). It is more common in continents of Asia and Africa due to lack of access to save water, hygiene and sanitation(WASH) or save food handling processes (Mogasale et al.,2014). It is transmitted through the fecal oral route from individuals who are currently infected and from asymptomatic carriers of the bacteria (Eng et al.,2015).

However, use of sewage contaminated water for irrigation and domestic use is considered critical in maintaining typhoid endemicity in developing countries(WHO 2003).The estimated global burden of typhoid is 10.9 million cases and 116,800 deaths annually, most of which are in children(Mogosale et al.,2014;Antilon  et al.2017,Standway et al.,2019). Several factors make control of typhoid fever challenging: including its nonspecific clinical presentation, difficult laboratory diagnosis, increasing antimicrobial resistance, and the persistent and asymptomatic shedding of bacteria by convalescent and chronic asymptomatic carriers. Both typhoid and paratyphoid present acutely the same clinical manifestations and incubation period of 5 to 12 days. Symptoms of typhoid fever vary and include low-grade fever, malaise, dry cough, diarrhea, constipation, and abdominal pain  sweating (Acosta et al., 2003).headache, cough, weakness , sore throat, dizziness and muscle pain .other findings include splenomegaly and hepatomegaly and bradycardia. intravascular coagulations. Symptoms typically last 3–4 weeks if untreated, although complication, including  gastrointestinal bleeding ,intestinal perforation, and typhoid encephalopathy (Acosta et al.,2003,Crump et al.,2015). The gold standard for typhoid diagnosis is isolation and identification of Typhi from culture of blood, stool, or bone marrow; however, healthcare facilities in LMIC often lack capacity for performing bacterial culture. Thus, many typhoid cases are diagnosed clinically or with unreliable serologic tests, whereas others remain undiagnosed and inappropriately treated (Dougan et al.,2015 ). Following infection ,patients may shed Typhi in their stool or urine for 1–12months, and up to 5% of patients will become asymptomatic chronic carriers, potentially excreting the bacteria for many years(Acosta et al.,2003). Given the fecal–oral transmission route and persistent shedding by asymptomatic carriers in endemic populations, WASH, serotype and food-handling interventions are critical control measures to interrupt typhoid transmission (Acosta et al., 2003). Water interventions improve the quality, or management of water. Sanitation interventions separate feces from human contact. Hygiene interventions refer to the conditions and practices that remove pathogens from the surfaces of an individual (handwashing, bathing ,etc.)or the home environment (cleaning or disinfection)(Wolfe et al.,2018,WHO/UNICEF 2018). Food-handling interventions (food interventions) refer to the safe production, processing, and storage of foods, with a focus on high-risk foods commonly associated with transmission risk (Acosta et al.,2003,the Himmelfarb health sciences diary 2011 ). Risk factors include poor sanitation and poor hygiene.(Mogasale et al.,2014). Sources of typhoid infection, risk factors for transmission, and protective factors are investigated so that targeted interventions can be implemented .Case control studies, which are relatively quick and inexpensive, are often used during outbreak investigations and in endemic settings(the Himmelfarb health sciences diary). Although unable to determine causality, case–control studies can indicate specific protective or harmful exposures and practices, and facilitate retrospective comparisons of these exposures and practices across outbreaks. By identifying the most commonly identified WASH and food exposures and practices associated with typhoid acquisition and protection, reviews of case–control studies can suggest specific common intervention targets. One or more WASH and food interventions are usually implemented during typhoid outbreaks, and these interventions may also confer protection against other faeco-orally transmitted diseases. However, little is known about which risky and protective WASH and food exposures are most important for typhoid in particular (Yates et al., 2018). These microorganisms colonize the small intestine (cdc.gov 2013), invade the gastrointestinal mucosa and later spread to liver, spleen and bone marrow. The severity of the disease depends on the initial infective dose, virulence and host immune response. To our knowledge, no systematic analysis of the evidence on WASH and prevalence of typhoid fever has been conducted in Bambili so to fill this gap, we will assess the WASH and prevalence of typhoid fever in Bambili..

If left untreated, typhoid fever has a mortality rate 10 to 5% reducing to 1 or 2% with adequate and timely antibiotic treatment

Drinking water contaminated by chemicals or pathogens is a major public health threat in the developing world. Responses to this threat often require water consumers (households or communities) to improve their own management or treatment of water. One approach hypothesized to increase such positive behaviors is increasing knowledge of the risks of unsafe water through the dissemination of water contamination.

Problem Statement

Water pollution is the contamination of water bodies that occur when water pollutants are indirectly or directly discharged into water bodies without adequate treatment to remove the harmful substances.

These water bodies can as well be contaminated by bacteria like Shigella, Escherichia coli, and Salmonella etc.

Typhoid is water borne disease as a result of drinking contaminated, water, food, some locally made drinks with Salmonella typhi. Due to inadequate supply and sometimes lack of save and clean water in student hostels in Bambili, most students have to resort to drinking water from wells and streams. These water sources are largely untreated and might harbour waterborne and vector-borne diseases such as cholera, typhoid fever, diarrhoea, hepatitis and guinea worm

This typhoid is a health problem to students and other persons in Northwest and Bambili. So assessing the water sanitation and hygiene of student hostels in Bambili and the prevalence of typhoid is a call for concern

Research Questions

The following questions will guide the study

• What are the sources of drinking water supply in the study area?
• What are the demographic determinants of typhoid fever in the study area?
• What is the spatial distribution of typhoid fever in the study area?
• What are the strategies that can be adapted to control and prevent typhoid fever in the study area?
• Are there other possible causes of typhoid fever

Hypothesis

Ho – Water hygiene and sanitation has no effect on the prevalence of typhoid fever in student hostels in Bambili

H1- Water sanitation and hygiene has an affect the prevalence of typhoid in student hostels in Bambili

Objectives

Main Objectives

To assess the water hygiene and sanitation of student hostels in Bambili and the prevalence of typhoid fever.

Specific Objectives

. The objectives of the study are

• To identify the sources of water supply in Bambili
• Propose strategies to control and prevent typhoid fever in the study area.
• Educate students on how to manage and treat the available source of water before drinking