title: Risk factors for typhoid in Darjeeling, West Bengal, India: evidence for practical action.
abstract: OBJECTIVE
  To identify risk factors for typhoid and propose prevention measures.
  
  
  METHODS
  Case-control study; we compared hospital-based typhoid cases defined as fever>38 degrees C for >or=3 days with four-fold rise in 'O' antibodies on paired sera (Widal) with community, age and neighbourhood matched controls. We obtained information on drinking water, fruits, vegetables, milk products and sanitation; and calculated matched odds ratios (MOR) and attributable fractions in the population (AFP) for the risk factors or failure to use prevention measures.
  
  
  RESULTS
  The 123 typhoid cases (median age: 25 years, 47% female) and 123 controls did not differ with respect to baseline characteristics. Cases were less likely to store drinking water in narrow-mouthed containers (MOR: 0.4, 95% CI: 0.2-0.7, AFP 29%), tip containers to draw water (MOR: 0.4, 95% CI: 0.2-0.7, AFP 33%) and have home latrines (MOR: 0.5, 95% CI: 0.3-0.8, AFP 23%). Cases were more likely to consume butter (OR: 2.3, 95% CI: 1.3-4.1, AFP 28%), yoghurt (OR: 2.3, 95% CI: 1.4-3.7, AFP 34%) and raw fruits and vegetables, including onions (MOR: 2.1, 95% CI: 1.2-3.9, AFP 34%), cabbages (OR: 2.8, 95% CI: 1.7-4.8, AFP 44%) and unwashed guavas (OR: 1.9, 95% CI: 1.2-3, AFP 25%).
  
  
  CONCLUSIONS
  Typhoid was associated with unsafe water and sanitation practices as well as with consumption of milk products, fruits and vegetables. We propose to chlorinate drinking water at the point of use, wash/cook raw fruits and vegetables and ensure safer preparation/storage of local milk products.
authors.affiliation: National Institute of Epidemiology, Chennai, India.
authors.forename: Puran K
authors.initials: PK
authors.lastname: Sharma
authors.forename: R
authors.initials: R
authors.lastname: Ramakrishnan
authors.forename: Y
authors.initials: Y
authors.lastname: Hutin
authors.forename: P
authors.initials: P
authors.lastname: Manickam
authors.forename: M D
authors.initials: MD
authors.lastname: Gupte
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005516:Food Microbiology; D005638:Fruit / Q000382:microbiology; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D012499:Sanitation; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014435:Typhoid Fever / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000635:transmission; D014675:Vegetables / Q000382:microbiology; D014871:Water Microbiology; D014881:Water Supply; D055815:Young Adult