title: Case fatality rate and length of hospital stay among patients with typhoid intestinal perforation in developing countries: a systematic literature review.
abstract: BACKGROUND
  Typhoid fever remains a major health problem in the developing world. Intestinal perforation is a lethal complication and continues to occur in impoverished areas despite advances in preventive and therapeutic strategies.
  
  
  OBJECTIVE
  To estimate the case fatality rate (CFR) and length of hospital stay among patients with typhoid intestinal perforation in developing countries.
  
  
  METHODS
  Peer-reviewed publications listed in PubMed and Google Scholar.
  
  
  METHODS
  The publications containing data on CFR or length of hospitalization for typhoid fever from low, lower middle and upper middle income countries based on World Bank classification. Limits are English language, human research and publication date from 1st January 1991 to 31st December 2011.
  
  
  METHODS
  Subjects with reported typhoid intestinal perforation.
  
  
  METHODS
  None, standard practice as reported in the publication.
  
  
  METHODS
  Systematic literature review followed by meta-analysis after regional classification on primary data. Descriptive methods were applied on secondary data.
  
  
  RESULTS
  From 42 published reports, a total of 4,626 hospitalized typhoid intestinal perforation cases and 706 deaths were recorded (CFR = 15·4%; 95% CI; 13·0%-17·8%) with a significant regional differences. The overall mean length of hospitalization for intestinal perforation from 23 studies was 18.4 days (N = 2,542; 95% CI; 15.6-21.1).
  
  
  CONCLUSIONS
  Most typhoid intestinal perforation studies featured in this review were from a limited number of countries.
  
  
  CONCLUSIONS
  The CFR estimated in this review is a substantial reduction from the 39.6% reported from a literature review for years 1960 to 1990. Aggressive resuscitation, appropriate antimicrobial coverage, and prompt surgical intervention may have contributed to decrease mortality.
  
  
  CONCLUSIONS
  The quantification of intestinal perforation outcomes and its regional disparities as presented here is valuable in prioritizing and targeting typhoid-preventive interventions to the most affected areas.
authors.affiliation: Policy and Economic Research Centre, Access Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea.
authors.forename: Vittal
authors.initials: V
authors.lastname: Mogasale
authors.affiliation: Clinical Development and Regulatory Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea.
authors.forename: Sachin N
authors.initials: SN
authors.lastname: Desai
authors.affiliation: Epidemiology Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea.
authors.forename: Vijayalaxmi V
authors.initials: VV
authors.lastname: Mogasale
authors.affiliation: Biostatistics and Data Management Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea.
authors.forename: Jin Kyung
authors.initials: JK
authors.lastname: Park
authors.affiliation: International Vaccine Institute, Seoul, South Korea.
authors.forename: R Leon
authors.initials: RL
authors.lastname: Ochiai
authors.affiliation: Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Wierzba
mesh_terms: D003906:Developing Countries / Q000706:statistics & numerical data*; D006801:Humans; D007416:Intestinal Perforation / Q000401:mortality* / Q000628:therapy; D007902:Length of Stay / Q000706:statistics & numerical data*; D014435:Typhoid Fever / Q000401:mortality* / Q000628:therapy
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