FALSE DIAGNOSIS OF TYPHOID MUST STOP IN NIGERIA!
In Nigeria, if you called in sick and couldn’t make it to work, it was probably because you had Malaria and Typhoid. Did I hear you say Typhoid? You have participated in Fraud!
Let me shock you, the rate of Typhoid fever occurrence in Sub-Saharan Africa based on existing studies is less than 1%, unlike malaria prevalence which currently stands above 60% in Nigeria. Yet, typhoid fever, a disease caused by Salmonella typhi and its paratyphi variant is being diagnosed on a daily basis and treated at an unprecedented rate in Nigeria.
This situation has gotten so bad that almost every patient; male, female, young and old with febrile illness in Nigeria is treated for typhoid. At every turn, what you hear is: ‘I have just been diagnosed and treated for malaria and typhoid’ or ‘since I treated malaria and its not going I must definitely have typhoid. As a matter of fact, patients who believe they have these twin ailments will abandon doctors who refuse to treat the Typhoid component to go see other doctors who are willing to treat.
Perhaps a major cause of this problem is the method used in diagnosing the so called typhoid. It is a widely established fact in medical circles that the serological test (widal agglutination) which is often relied on to make Typhoid diagnosis is unreliable. Several studies (Olopoenia & King (2000), Enabulele & Awunor (2016) etc concluded that Widal test is non specific, poorly standardized, confusing and difficult to interpret.
In other words, Widal test is outdated and has since been abandoned for more reliable tests such as bacteriological culture in other countries.
Nigerian Doctors are aware of this situation, but are probably tired of explaining to patients that they don’t have typhoid, since such patients more often than not will go find another ‘Doctor’ , mostly a quack, to ‘flush out’ the Typhoid from their system with drips, for a tidy sum.
Why should we all be concerned? Because of the dangers inherent in continuing the harmful practice such as:
1) Antibiotics Resistance- consuming antibiotics when not needed breeds resistance and subject patients to unnecessary side-effects.
2) Mis-Diagnosis- and delayed Diagnosis- while ascribing an illness to typhoid, diagnosis of other more dangerous diseases may be missed and mistreated leading to higher morbidity and mortality.
3) Missing malaria resistance- taking antibiotics while recuperating from malaria makes it difficult to detect and differentiate reduced anti-malaria efficacy , drug resistance, or even recrudescence from genuine infection requiring antibiotics treatment
4) Raising cost of treatment/Lowering value of healthcare- an average citizen who is already resistant to common and affordable antibiotics ends up spending more in procuring expensive antibiotics to achieve the same result. This diminishes the value of healthcare provided by physicians who are sometimes pressured to treat this ‘typhoid’
Therefore, my appeal is first to the citizens to desist from self treatment of typhoid fever without undergoing proper tests prescribed by qualified physicians.
As for Typhoid, you should now know that the test that says
1/20,
1/80,
1/160 is no longer useful in diagnosis and you should never take antibiotics on the basis of that test.
It is high time also, that physicians and their various associations insisted on the use of blood or stool culture diagnosis in treating their patients and totally discountenancing Widal test for uniformity of practice.
Subsequently, a specific national policy on the diagnosis and treatment of Typhoid fever and perhaps other infectious diseases should be promoted.
In addition, citizens may also be sensitized on the low prevalence rate of typhoid and the need to see qualified doctors for proper advice, to prevent them from falling prey to quacks who make money from this not-so-common disease.
I conclude by saying ‘’typhoid is now in your court’’
Dr Odunayo Talabi , a Harvard Global Health Fellow is the M.D of Prettyhealth Care Ltd Lagos.
Culled from:
https://www.facebook.com/groups/245052015956885/permalink/653873528408063/
Funny enough, I hate that diagnosis "Malaria and Typhoid"
ReplyDeleteSome will say I don treat the Malaria, na typhoid remain.
One of the challenge remains that we still ask for widal test instead of blood culture.
The next challenge are the proliferation of road side who make all manners of diagnosis. If the patient should come with a test result showing malaria (++) and Significant Titre.....how do now treat the ++ and leaving the significant titre.
We have also drifted to attaching antibiotics to antimalarial as a mode of treatment.......what is that antibiotics for? If not for over diagnosed typhoid.
How do we really draw a line between actual patient management and exploitation.
I think all the health arms should be on deck to watch this. A situation where without the input of a medical doctor,the nurse, pharmacist, laboratory scientist all prescribe without checks is worrisome.
DeleteGood write up ,all this diagnosis test should be enforce in our various hospital,I mean MCS
ReplyDeleteTyphoid is a wide spectrum disease that can equally have healthy carrier state. The populace insist they have typhoid owing to the poor quality of water ,and ignorance of food handlers. The history of typhoid Mary should not be forgotten.y take is part of the problem rests in delay in culture results , 2days of waiting. While the patient takes what? How do u xplain to care givers to wait while they watch their loved ones in pain.(headache, severe abdominal pain , hyperpyrexia not responding to acetaminophen.) They breathe down your neck like angry dragons awaiting a better explanation to the delay. What if the patient can't produce stool the first day?
ReplyDeleteWhat is the duration from bacteremia to perforation? Drugs may only slow progression. What of typhoid psychosis ? Our turn around time for typhoid test should be faster. It gives better backing to our argument that the patient doesn't have typhoid at 1st encounter wt the physician.
ReplyDeleteI don't understand those this mean I shudnt use antibiotics while am being treated of malaria?
ReplyDeleteAntimalaria for malaria, Antibiotics for bacteria infection.
DeleteMalaria is not a bacteria infection.
Some antibiotics such as doxycycline have been proven effective clinically to prevent malaria relapse.
DeleteIs antibiotics not good for treating malaria
ReplyDeleteAntibiotics is not for malaria
DeleteI don talk tire o, I've written a book concerning health myths in Nigeria.... From the comments here, Nigeria has a long way to go
ReplyDeleteI don talk tire o, I've written a book concerning health myths in Nigeria.... From the comments here, Nigeria has a long way to go
ReplyDeleteWell said, but when all the hospitals are in cahoot, the patient not being an expert is at their mercy.
ReplyDeleteI have a great concern about this malaria issue especially in Nigeria. I have always believed that there is something wrong about our understanding of typhoid. How can everyone who visit hospital with a fever that defied malaria treatment be ascribed to typhoid? They are people that from their lifestyle you will conclude that they are very unlikely to have contacted typhoid and yet care givers prefer to query typhoid. I am really sick and tired of the reoccurent problem Nigeria should better look for a fast solution before it becomes a national disaster.
ReplyDeleteI've also been informed that after the whidal a confirmatory test is ment to be done before treatment. This will confirm that it is really typhoid and not some other bacterial infection which is what is now generalised as typhoid.
ReplyDelete