Typhoid fever in sub-Saharan Africa: challenges of diagnosis and management of infections.

Typhoid fever, caused by Salmonella enterica serovar Typhi (S. Typhi), is a disease transmitted by the faecal-oral route. It continues to be a public health problem in many developing countries in sub-Saharan Africa. School-age children, especially those from resource-poor settings with inadequate water and sanitation systems, are disproportionately affected. It is estimated that a total of 400,000 cases occur annually in Africa, an incidence of 50 per 100,000 persons per year. Lack of effective diagnosis often leads to inappropriate treatment and management of these infections. Additionally, the emergence and spread of S. Typhi strains having multiple resistance to nearly all commonly available drugs in most developing countries has been a major challenge to health care systems, reducing the effective treatment options for the disease, increasing treatment costs and increasing the risk of complications and death. Although not much data from sub-Saharan Africa has been published, it seems clear that typhoid is common in Nigeria, Mali, Ethiopia and Kenya. Given the importance of information on disease incidence for targeting control measures, including improved sanitation and water supply, vaccination and assessing impact, priority should be given to strengthening surveillance systems for typhoid fever.