Typhoid Fever in Makassar, Indonesia: A study of selected demographic, socioeconomic and environmental factors, spatial patterns and the disease burden.

Abstract

XVIIth IEA World Congress of Epidemiology 2005, Bangkok, Thailand

Abstract No. 10012

Authors: Ansariadi Ansariadi, Peter Howard, Pat Dale, Neil Snipe

Institution: School of Public Health Hasanuddin University, Indonesia and Griffith University, Australia

Title: Typhoid Fever in Makassar, Indonesia: A study of selected demographic, socioeconomic and environmental factors, spatial patterns and the disease burden.

Background: Typhoid Fever (TF), a major public health problem in the world, is endemic in Makassar, a district in South Sulawesi Province, Indonesia. A comprehensive understanding of TF distribution in the community is required to develop strategic planning for the control and prevention of TF. This study provides a description of the demographic, socioeconomic factors, and spatial distribution of TF cases in Makassar. It analyses the environmental risk factors associated with TF occurrence and the burden of TF in the community. Methods: TF cases that satisfied with TF case definition were identified from 13 hospitals and 1 Community Health Centre in Makassar in 2003, which captured more than 90% of TF cases at health services. The result of the Widal test reported in the medical records with a cut-off point O -1/320 was used to determine the TF cases. 462 TF cases met with this criterion. A correlation analysis was used to examine the correlation between TF and environmental factors such as rainfall and the quantity of clean water available from water companies. A linear regression analysis was used to predict the TF cases based on quantity of clean water available. ArcView GIS was used to investigate the spatial pattern of TF cases. Results: The cumulative incidence of TF was estimated at 40 per 100,000 persons. The 15-19 years age group had the highest cumulative incidence (16/100,000 people) followed by the age group 5-9 and 20-24 at 13/100,000 people. TF cases were distributed evenly across gender. The majority of TF cases came from a mid-level socio-economic background. Though majority of TF cases occurred during the rainy season, there was no correlation between the average monthly rainfall and the number of TF cases per month. With a lag of one month, the quantity of water available was significantly correlated to the number of TF cases (r = -0.612, p<0.05). Regression analysis identified that the quantity of clean water seems to be a good predictor of the occurrence of TF. Typhoid cases were found in 58% of the villages with two villages identified have the highest cumulative incidence. Similarly, the catchment areas of two water stations had a high TF cumulative incidence. The DALY of TF in Makassar was estimated as 96 years (0.1 year per 1,000 persons). Conclusions: TF was prevalent among school aged and young people. The average rainfall was not significantly related to the occurrence of typhoid fever. The quantity of clean water available, however, was significantly related to the TF occurrence and it seems to be a good predictor of the occurrence of TF. Two villages were identified as the highest cumulative incidence.