or more than 18 months, Blantyre has been experiencing a typhoid epidemic. Typhoid fever is caused by a bacterium called Salmonella typhi. This is the cause of the most severe form of the disease. In some rare cases, the disease is caused by bacteria belonging to the same group as Salmonella typhi. These are Salmonella paratyphi A, B and C. These cause a less severe disease.
Over the past 18 months Queen Elizabeth Central Hospital (QECH) in Blantyre has each week admitted several patients with typhoid fever. Patients usually present with nonspecific symptoms of fever, headache, muscle aches and pains. The only way to make a conclusive diagnosis of this disease is to take a blood sample from the patient and culture the blood looking for this bacterium.
Many patients in the community are treated with medicines for treating malaria. In some cases, over the counter antibiotics have been given. Some of the patients recover within the community and if not treated appropriately become carriers of the disease.
What does an epidemic of typhoid fever reveal? It is important to look at the reasons a community develops an epidemic of typhoid fever that thrives. Typhoid fever is usually passed on from one individual to another through contamination.
A typhoid outbreak indicates one of the following:
1. Significant issues with food safety: People presenting with typhoid fever have been exposed to contaminated food. If a carrier of the germ that causes typhoid fever prepares food without paying attention to hand washing and proper washing of utensils, the community that is exposed to such food is at high risk of developing typhoid fever. In Blantyre City we see many places where food is being prepared but the very basic requirements for proper food processing are lacking. Unfortunately, this situation is seen even just outside the grounds of QECH. One wonders where the organs of the State are that are supposed to enforce the minimum requirements for food handling. These include the Malawi Bureau of Standards, Blantyre City Health Department and Tourist Board of Malawi.
2. Water supply issues: Outbreaks of typhoid fever have also been associated with contaminated water supplies. Water supplies can be contaminated by sewer water after water treatment has already happened if the infrastructure breaks as a result of vandalism. Water supplies can also be contaminated at source and the body tasked to provide water to the community is unable to process water to the required standards. Recently the City of Harare in Zimbabwe announced that they were going to stop providing water to the residents of Harare because they did not have the required chemicals for treating water. It is difficult to know whether similar situations apply to the Blantyre Water Board.
3. General sanitation: provision of proper sanitation goes a long way in preventing typhoid epidemics and epidemics of other waterborne diseases like cholera. In many places in Blantyre City including where I work, QECH, we have raw sewage running in drains contaminating Naperi stream and other small water bodies.
Naperi stream is used downstream by communities as water source including drinking. The communities are not warned about the risk this water poses to their health. Only a few households in Blantyre City are connected to the City Sewer system. Most households use septic tanks or pit latrines of various structural dependability. During the rainy season, many of the structures collapse, overflowing into neighbourhoods creating risky situations to the health of the communities. It is not clear in my mind who is ultimately responsible for making sure that these scenarios do not repeat themselves year in year out.
The epidemic is not slowing down at all. The germ unfortunately is showing resistance to many of the antibiotics that are available in Malawi at reasonable cost. As a primary school pupil, my teachers taught us that prevention is better than cure. The city of Harare took a decisive step when they had a typhoid outbreak in 2018. The city banned all roadside cooking and selling of food without exception. This year the city of Harare has taken a decisive step in not providing water they cannot vouch for its safety. What should city of Blantyre authorities do? n