title: Typhoid outbreak investigation in Dzivaresekwa, suburb of Harare City, Zimbabwe, 2011.
abstract: BACKGROUND
  Typhoid fever is a systemic infection caused by a Gram negative bacterium, Salmonella typhi. Harare City reported 1078 cases of suspected typhoid fever cases from October 2011 to January 2012. We initiated an investigation to identify possible source of transmission so as to institute control measures.
  
  
  METHODS
  An unmatched 1:1 case-control study was conducted. A questionnaire was administered to study participants to identify risk factors for contracting typhoid. A case was a resident of Dzivaresekwa who presented with signs and symptoms of typhoid between October and December 2011. Water samples were collected for microbiological analysis.
  
  
  RESULTS
  115 cases and 115 controls were enrolled. Drinking water from a well (OR=6.2 95% CI (2.01-18.7)), attending a gathering (OR=11.3 95% CI (4.3-29.95)), boiling drinking water (OR=0.21 95% CI (0.06-0.76)) and burst sewer pipe at home (OR=1.19 95% CI (0.67-2.14)) were factors associated with contracting typhoid. Independent risk factors for contracting typhoid were drinking water from a well (AOR=5.8; 95% CI (1.90-17.78)), and burst sewer pipe at home (AOR=1.20; 95% CI (1.10-2.19)). Faecal coli forms and E. coli were isolated from 8/8 well water samples. Stool, urine and blood specimens were cultured and serotyped for Salmonella typhi and 24 cases were confirmed positive. Shigella, Giardia and E coli were also isolated. Ciprofloxacin, X-pen and Rocephin were used for case management. No complications were reported.
  
  
  CONCLUSIONS
  Contaminated water from unprotected water sources was the probable source of the outbreak. Harare City Engineer must invest in repairing water and sewage reticulation systems in the city.
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Monica
authors.initials: M
authors.lastname: Muti
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Notion
authors.initials: N
authors.lastname: Gombe
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Mufuta
authors.initials: M
authors.lastname: Tshimanga
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Lucia
authors.initials: L
authors.lastname: Takundwa
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Donewell
authors.initials: D
authors.lastname: Bangure
authors.affiliation: Harare City Health Department, Harare, Zimbabwe.
authors.forename: Stanley
authors.initials: S
authors.lastname: Mungofa
authors.affiliation: Harare City Health Department, Harare, Zimbabwe.
authors.forename: Prosper
authors.initials: P
authors.lastname: Chonzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D004926:Escherichia coli / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D012485:Salmonella typhi / Q000302:isolation & purification*; D011795:Surveys and Questionnaires; D014435:Typhoid Fever / Q000188:drug therapy / Q000453:epidemiology*; D014871:Water Microbiology; D014881:Water Supply / Q000592:standards; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Typhoid; Zimbabwe; contaminated water; outbreak investigation