“[PREVALENCE OF TYPHOID FROM 18 TO 25 YEARS IN

BENAZIR BHUTTO HOSPITAL RAWALPINDI]”

[TAYYAB SAJJAD]

[21-arid-26]

DEPARTMENT OF ZOOLOGY FACULTY of SCIENCEs

PIR MEHR ALI SHAH
ARID AGRICULTURE UNIVERSITY RAWALPINDI
PAKISTAN
[2022]
“[PREVALENCE OF TYPHOID FROM 18 TO 25 YEARS IN BENAZIR
BHUTTO HOSPITAL RAWALPINDI]”

by

[TAYYAB SAJJAD]

[21-arid-26]

A Report submitted in partial fulfillment of

the requirement for course of Zoo-711
Research and Report Writing

Master of Science

In

Zoology

DEPARTMENT OF ZOOLOGY
FACULTY OF SCIENCES
PIR MEHR ALI SHAH
ARID AGRICULTURE UNIVERSITY RAWALPINDI
PAKISTAN
[2022]
i
 CERTIFICATION
I hereby undertake that this research is an original one and no part of this Report falls
under plagiarism, If found otherwise at any stage, I will be responsible for the consequences.

Name: [TAYYAB SAJJAD] Signature: ______________

Registration Number:[21-arid-26] Date: ______________

Certified that the contents and form of thesis entitled

“[Prevalence of typhoid from 18 to 25 years in Benazir Bhutto hospital Rawalpindi]”

submitted by “

” has been found satisfactory for requirements of the degree.

Supervisor: Dr. Muhammad Irfan

Co-Supervisor: Dr. Muhammad Irfan

ii
 DEDICATION

A strong and gentle soul who taught me to trust in ALLAH ALMIGHTY for supporting me to
believe in myself. I dedicate this report to my lovely parents for supporting me in all spheres of
my life, to my lovely siblings who always encouraged me to be strong in my academic pursuit
and to my cousin who supported me financially and morally whenever I needed them the most.

iii
 CONTENTS
Page

ABBREVIATIONS V
List of Figures VII

Acknowledgements VIII

Chapter 1 Introduction 2

1.1: Problem Statement 2

1.2: Objectives 2
1.3: Outcomes 2
Chapter 2 Review of literatur 3-5

Chapter 3 Material's and Methods 6

3.1 Study design 6

3.2 Study area 6
3.3 Study population 6
3.4 Study tool 6
Chapter 4 Result and Discussion 7-12

4.2Discussions 12
4.1Demographic study
Conclusion 9

Summary 10

Literature Cited 13-14

QUESTIONNAIRE 15

iv
 ABBREVIATIONS
ST Salmonella Typhi
GNO. Gram negative organism
UN. United Nation
SH. Swrar Headache
CF. Contaminated food

v
 \
LIST OF FIGURE

4.1 Prevalence of typhoid…………………………………………………………..……8

4.2 Gender……. ……………….……………………………………………………..….8

4.3 Age…… …………………………………………………………………….….….....8

4.4 Weakness during typhoid……………………………………………………..………9

4.5 Cough during typhoid…………………………………………………………………9

4.6 Stomach pain condition during typhoid……………………………………………..10

vi
 Acknowledgements

All the praises are for the ALMIGHTY ALLAH, the source of knowledge and
wisdom, who bestowed me with the ability and potential to complete this survey, loving
parents, kind teachers and faithful friends that make me to prosper in life. Glory and praise
to our last Prophet Hazrat MUHAMMAD , who is forever a symbol of
direction and knowledge for whole humanity.
Pir Mehr Ali shah Arid Agriculture University Rawalpindi (PMAS UAAR) under whose
sincere guidance and obliging supervision this work was completed. I would like to express my
special thanks of gratitude to my loving parents my brothers and sister and my class fellows and
friends, especially my teacher Dr. Muhammad Irfan, I am really thankful to them.
I shall be very failing in my duty if I do not putt across my thanks to my supervisory
committee member: Dr. Muhammad Irfan, Professor of Department of Zoology. Pir Mehr Ali
Shah Arid Agriculture University Rawalpindi (PMAS UAAR); for providing valuable suggestion
whenever I need them.
I am especially thankful to my father and my mother who always supported me and my
siblings who always guided me .Their guidance and prayers are the roots for my success. I may
never have words of thanks to them for their great help, moral support, facilitation, kindness,
care, suggestions and guidance during my research work.

vii
 CHAPTER 1

INTRODUCTION

Typhoid fever may be a general malady caused by Salmonella typhi. The microorganism may be a Gram-

negative Bacillus that solely infects humans. within the year 2000, typhoid affected seventeen million

individuals worldwide with roughly 600,000 deaths [1]. However, in Africa, a basic prevalence of 362

cases per one hundred,000 persons is rumored each year. The bacterium are unfold by personnel in

pediatric wards, either on their hands or the dusty linens of infected people. Flies will infect or

contaminate food [5].

The colonization of the system may be a characteristic feature of Salmonella typhi infection. Some

infected people United Nations agency become life-long carriers function the reservoir for Salmonella

typhi. The virulence factors of S. typhi embrace the possession of the Vi substance and therefore the

production of associate toxin (which is typical of Gram negative organisms). Four completely different

clinical symptoms are expressed by enteric bacteria enteric and these embrace typhoid, intestinal flu,

bacteremia associated and symptomless carrier state. enteric bacteria typhi typically invades the surface

of the bowel in humans, however studies have shown their growth and survival within the deeper tissues

of the spleen, liver, and therefore the bone marrow. Signs and symptoms of infectious disease typically

embrace a fulminant onset of a high fever, a headache and nausea. A remains uncommon in Africa [9].

Salmonella typhi will be known within the laboratory by many organic chemistry and serologic tests [10].

Within the event that treatment is begun right time within the contamination, the hurt caused by typhoid is

reversible and restricted. If treatment is started early in the infection, the injury created by typhoid is

reversible and restricted. This leads to a lower fatality rate of but I Chronicles among treated persons

United Nations agency possess associate antibiotic-susceptible strain of S. typhi, creating the end result

and prognosis for patients a positive one [11].

It's thus terribly imperative to review the malady so as to place it underneath check and therefore

curtailing its devastating effects. This study can conclude the prevalence rate of typhoid in metropolis. the

1
end result of the work would increase awareness concerning typhoid, treatment and preventive measures

to limit the prevalence of the malady in metropolis community and therefore the general public. helpful

recommendations were conjointly created on the measures against the unfold of the infection. This study

is restricted to the study of the prevalence of typhoid victimization each Widal and Stool culture take a

look at among the patients of Benazir Bhutto Hospital Rawalpindi.

1.1 Problem statement

To identify the prevalence and effects of typhoid fever. As this disease is affecting and spreading among

the patients. So, this study acknowledged the people, how to protect themselves.

1.2 Objectives

This research has following objectives.

1. The study aimed at determining the prevalence of typhoid

2. Study to determine the effects of typhoid fever

1.3 Outcomes

As this study will give us knowledge about the prevalence of typhoid fever, that how typhoid

fever badly affected the life of people.

2
 CHAPTER 2

REVIEW OF LITERATURE

Ch Herzog Infection 4 (3), 166-173, 1976 Until the last few years, chloramphenicol was

recognized positively as the drug of choice in the treatment of acute typhoid fever. Its

hematotoxicity, as well as the recently observed epidemic and the present endemic occurrence of

S. typhi strains with R-factor-mediated resistance to chloramphenicol in Mexico, India and

South-East Asia, render the clinical evaluation of new antibacterial agents extremely important.

By means of a literature review on controlled.

Jong-Hoon Kim, Vittal Mogasale, Justin Im, Enusa Ramani, Florian Marks the Lancet Global

Health 5 (10), e969, 2017. The Typhoid Fever Surveillance in Africa Program (TSAP), which

was conducted over a 2-year period between 2010 and 2013, provided new incidence figures for

typhoid fever in sub-Saharan Africa. 1 We used these novel data to update estimates of typhoid

fever disease burden in Africa according to a model that was previously developed to estimate

typhoid fever disease burden in low income and middle-income countries.

The search of published studies from January 1, 1990, to December 31, 2013 in PubMed,

Embase, and World Health Organization databases provided 779 publications, of which 12 case-

control studies presented the odds of having typhoid fever for those exposed to unimproved or

unsafe versus improved drinking water sources.

The American journal of tropical medicine and hygiene 99 (3 Suppl), 4, 2018. This article is the

introduction to a 12-paper supplement on global trends in typhoid fever. The Tackling Typhoid

(T2) project was initiated in 2015 to synthesize the existing body of literature on typhoidal

salmonellae and study national and regional typhoid fever trends. In addition to a global

3
systematic review, eight case studies were undertaken to examine typhoid and paratyphoid fever

trends in endemic countries alongside changes in relevant contextual factors.

We conducted a systematic literature review of longitudinal population-based blood culture

confirmed typhoid fever studies from low and middle income countries published from 1st

January 1990 to 31st December 2013.

Journal of global health 2 (1), 2012, Typhoid and paratyphoid fever remain important causes of

morbidity worldwide. Accurate disease burden estimates are needed to guide policy decisions

and prevention and control strategies.

The findings are comparable to the most recent analysis of global typhoid fever morbidity, which

reported crude and adjusted estimates of 10.8 million and 21.7 million typhoid fever episodes

globally in 2000.

Clinical Infectious Diseases 69 (Supplement_6), S435-S448, 2019 Complications from typhoid

fever disease have been estimated to occur in 10%–15% of hospitalized patients, with evidence

of a higher risk in children and when delaying the implementation of effective antimicrobial

treatment.

Tropical and geographical medicine 46 (6), 336-339, 1994 typhoid fever is still a major health

problem in the developing parts of the world, with an estimated annual incidence of 540 per

100,000. Probably one of the most lethal complications of typhoid fever is ileal perforation,

which affects especially young men. We reviewed the literature published after 1960 on typhoid

perforation in different developing countries, with special attention to the incidence and outcome

of typhoid perforation.

4
The Lancet Global Health 5 (10), e969, 2017 The Typhoid Fever Surveillance in Africa Program

(TSAP), which was conducted over a 2-year period between 2010 and 2013, provided new

incidence figures for typhoid fever in sub-Saharan Africa.

5
 CHAPTER 3

MATERIALS AND METHODS

3.1 Study design

As this is the hospital based prosectional study. It is survey based study in the Benazir Bhutto Hospital

Rawalpindi.

3.2 Study Area

This study will be conducted in Benazir Bhutto Hospital Rawalpindi

3.3 Study Population

The population size of the study will be conducted on 30 people.

3.4 Inclusion Criteria

Benazir Bhutto Hospital Rawalpindi is the inclusion criteria of this study.

3.5Exclusion Criteria

Remaining hospitals except Benazir Bhutto Hospital Rawalpindi is the exclusion criteria of this study.

3.6 Data collection

A questionnaire/survey based will be used for data collection (Annex. I).

3.7 Statistical analysis

Numerical data will go under calculation of mean value and standard error. Categorical data will be
processed through frequencies and percentages. Grout analysis will be done by using an appropriate
statistical test.

6
 Chapter 4

Result and Discussion

4.1 Discussion

Typhoid fever is a life-threatening infection caused by the bacterium Salmonella typhi. It is

usually spread through contaminated food or water. An estimated 11–20 million people get sick

from typhoid and between 128 000 and 161 000 people die from it every year.

Salmonella typhi lives only in humans. Persons with typhoid fever carry the bacteria in their

bloodstream and intestinal tract. Symptoms include prolonged high fever, fatigue, headache,

nausea, abdominal pain, and constipation or diarrhea. Some patients may have a rash. Severe

cases may lead to serious complications or even death. Typhoid fever can be confirmed through

blood testing.

Typhoid fever can be treated with antibiotics. As resistance to antibiotics has emerged including

to fluoroquinolones, newer antibiotics such as cephalosporins and azithromycin are used in the

affected regions. Resistance to azithromycin has been reported sporadically but it is not common

as of yet.

Even when the symptoms go away, people may still be carrying typhoid bacteria, meaning they

can spread it to others through their faeces.

Typhoid fever is common in places with poor sanitation and a lack of safe drinking water.

Access to safe water and adequate sanitation, hygiene among food handlers and typhoid

vaccination are all effective in preventing typhoid fever.

This vaccine will be prioritized for countries with the highest burden of typhoid disease. This

will help reduce the frequent use of antibiotics for typhoid treatment, which will slow the

increase in antibiotic resistance in Salmonella Typhi.

7
4.2 Demographic study

4.2.1 Prevalence of typhoid

Prevalance of typhoid
25

20

15 Prevalance of typhoid

10

0
Patient Healthy

4.2.2 Gender

Gender
25

20

15 Gender

10

0
Female Male

4.2.3 Age

8
 Age
40
35
30
25
Age
20
15
10
5
0
18-20 20-25

4.2.4 Weakness

Both male and female have same ratio of weakness.

Weakness
20
18
16
14
12 Weakness
10
8
6
4
2
0
Yes No

4.3.5 Stomach pain

There is no swearing stomach pain during typhoid.

9
 Stomach pain
30

25

20
Stomach pain
15

10

0
Yes No

4.2.6 Coughing

There is no swearing coughing during typhoid.

Coughing
25

20

15 Coughing

10

0
Low Moderate High

10
Conclusion

Typhoid fever remains a major public health problem in Nigeria. The infection however can be

prevented by good sanitation, improving good water supply, the provision of proper sewage

disposal system, as well as the effective use of the available typhoid vaccines. The government

and people of Nigeria should rise up to the challenge of stamping out this ugly trend.

Control of typhoid fever relies on clinical information, diagnosis, and an understanding for the

epidemiology of the disease. Despite the breadth of work done so far, much is not known about

the biology of this human-adapted bacterial pathogen and the complexity of the disease in

endemic areas, especially those in Africa. The main barriers to control are vaccines that are not

immunogenic in very young children and the development of multidrug resistance, which

threatens efficacy of antimicrobial chemotherapy. Clinicians, microbiologists, and

epidemiologists worldwide need to be familiar with shifting trends in enteric fever. This

knowledge is crucial, both to control the disease and to manage cases. Additionally, salmonella

serovars that cause human infection can change over time and location. In areas of Asia,

multidrug-resistant Salmonella enterica serovar Typhi (S Typhi) has been the main cause of

enteric fever, but now S Typhi is being displaced by infections with drug-resistant S enterica

serovar Paratyphi A. New conjugate vaccines are imminent and new treatments have been

promised, but the engagement of local medical and public health institutions in endemic areas is

needed to allow surveillance and to implement control measures.

11
Summary

Typhoid fever happens worldwide, primarily in developing nations whose hygienic conditions

are poor. infectious disease is endemic in Asia, Africa, geographic region, the Caribbean, and

Oceanica, however eightieth of cases return from Asian nation, China, India, Indonesia, Laos,

Nepal, Pakistan, or Vietnam. [24] Inside those countries, infectious disease is commonest in

underdeveloped areas. Infectious disease infects roughly twenty one.6 million folks (incidence of

three.6 per 1,000 population) associated kills an calculable two hundred,000 folks once a year.

[25] In the us, most cases of infectious disease arise in international travelers. the common yearly

incidence of infectious disease per million travelers from 1999-2006 by county or region of

departure was as follows:

Typhoid fever could be a microorganism sickness transmitted by the bodily process of food or

water contaminated with dejection of associate infected person that contain the bacteria

salmonella. The organism enters through the duct tract and spreads through the vascular system

(bacteremia), inflammation the liner of the little and huge bowel (intestinal mucosa). Severe

cases will result in delirium or coma, and should be life threatening [3]. Infected people

sometimes shed the microorganism within the dejection and excretion. Food and water provides

is contaminated thanks to short hand laundry once laxation or excreting. sometimes, cattle might

function a reservoir for paratyphoid fever. In areas with poor sanitation practices, flies might

unfold the sickness from dejection to food, inflicting occurrence of infectious disease. Though

some infected people are within the carrier stage, they're still capable of spreading the diseases to

others [4]. Human infection sometimes happens once the consumption of contaminated foods

and water.

12
 LITERATURE CITED

Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. N Engl J Med

2002;347(22):1770–82. 2. Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM.

Epidemiology, clinical presentation, laboratory diagnosis, antimicrobial resistance, and

antimicrobial management of invasive Salmonella infections. Clin Microbiol Rev

2015;28(4):901–37.

Oh HM, Masayu Z, Chew SK. Typhoid fever in hospitalized children in Singapore. J Infect

1997;34(3):237–42

 Ahmed, Z.U., A.M. Siddiqui and O. Hassan, 1994. Emergence of drug resistant enteric fever in

Bangladesh. J. Pak. Armed Forces Med. J., 44: 14-16.

 Anonymous, 2002. Report wants action against gender inequality and illiteracy. Daily Dawn,

Dec. 9, 2002.

Anonymous, 2002. Earth day: School children stress need for clean environment. The News

International, April 24, 2002.

Crump J, Youssef FG, Luby SP, Wasfy MO, Rangel JM, Taalat M, Oun SA and Mahoney FJ.

(2004). Estimating the incidence of typhoid fever and other febrile illnesses in developing

countries. Emerging infectious diseases, 9(5), 539.

Humphrey T. (2004).Salmonella, stress responses and food safety. Nature Reviews

Microbiology, 2, 504-509.

13
Mastroeni P and Maskell D. (2005). Epidemiological and Clinical aspects of human typhoid

fever. Salmonella infections: Clinical, Immunological and Molecular Aspects, University Press,

Cambridge, 1-10.

Chin J. (2000). Control of communicable disease manual. American Public Health Association,

17.

Philippa MA, Shanahan J, Mary V, Thomson CJ and Sebastian GB. (2003). Molecular analysis

of and identification of antibiotic resistance genes in clinical isolates of Salmonella typhi from

India. American Society for Microbiology, 36, 1595.

AA Khattak, M Venkatesan, MF Nadeem, HS Satti… - Malaria journal, 2013 - Springer

Marks F, Adu-Sarkodie Y, Hunger F, Sarpong N, Ekuban S, Agyekum A, et al. Typhoid fever

among children, Ghana. Emerging infectious diseases. 2010;16(11):1796–1797.

Sinha A, Sazawal S, Kumar R, Sood S, Reddaiah VP, Singh B, et al. Typhoid fever in children

aged less than 5 years. Lancet. 1999;354(9180):734–737.

Levine MM, Ferreccio C, Cryz S, Ortiz E. Comparison of enteric-coated capsules and liquid

formulation of Ty21a typhoid vaccine in randomised controlled field trial. Lancet.

1990;336(8720):891–4.

14
 QUESTIONNAIRE

1. What is your gender?

2. What is your age?
3. Have you feel weakness?
4. Have you experienced coughing?
5. Do you have stomach pain?
6. Do you ever experienced typhoid?

15