REPUBLIC OF CAMEROON

REPUBLIQUE DU CAMEROUN
Peace-Work-Fatherland
Paix-Travail-Patrie
MINISTRY OF HIGHER EDUCATION
MINISTERE DE L’ENSEIGNEMENT
SUPERIEUR

HIGHER INSTITUTE FOR

BUSINESS AND MANAGEMENT
SCIENCES

HIBUMS POLYTECHNIC-
BAFOUSSAM ANNEX
(AFFILIATED TO THE UNIVERSITY OF BAMENDA)
ASSESSMENT OF ROLE OF NURSES IN THE
MANAGEMENT AND PREVENTION OF TYPHOID FEVER
IN CMA DJELENG (WEST REGION)
 A RESEARCH PROJECT SUBMITTED TO THE DEPARTMENT OF NURSING IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF A
HIGHER NATIONAL DIPLOMA (HND) IN NURSING
BY
FOMBAT EZINA ABON
(HIBUMS Polytechnic)
Supervisor:

Mat. N°:

Session 2021/2022

CERTIFICATION
This is to certify that the research work titled “ASSESSMENT OF ROLE OF NURSES

IN MANAGEMENT AND PREVENTION OF TYPHOID FEVER” was

carried out at CMA Djeleng by FOMBAT EZINA ABON, under the supervision of MADAM
CONSTANCE JIPUGHU N. submitted to the department of nursing at HIBUMS polytechnic
in partial fulfillment of the requirements for the Award of Higher National Diploma (HND) in
Nursing.

Sign: _________________________ Date _____________

(Student)

Sign: _________________________ Date______________

(Supervisor)

Sign: _________________________ Date______________

Head of Department
DEDICATION

This piece of work is dedicated to

my family.

ACKNOWLEDGEMENT

 My special gratitude and recognition goes to my supervisor Madam Constance Jipughu

N. for her guidance, advice and inspiration towards the success of this work.
 I am very thankful to all my teachers in Higher Institute for Business and Management
Sciences Bafoussam for inspiring me for a postgraduate studies and for their
encouragement during my postgraduate studies.
 To the administrators of HIBUMS,
This work I say to
is dedicated thank
my you for the
mother work they are doing to see
Madame
that they enrich us the students
FOMBAT ROSALINE NDEH
 To God be the Glory, for the strength he gave me to withstand all the obstacles this past 3
year
 To the administrators of HIBUMS, I say thank you for the work they are doing to see
that they enrich us the students .
  I also want to acknowledge my parents Mr FOMBAT MARCUS and Madam
ROSALINE NDEH who made everything possible for me to go through my studies
right from the start till now.
 To the staff of my school I say thank you for your efforts, to the staff of CMA
DJELENG endless thanks for their collaboration with me to see that I complete my
work.

ABSTRACT
Typhoid fever is a gastrointestinal infection cause by Salmonella enteric typhi
bacteria. It is transmitted from person to person through fecal oral route where an
infected or asymptomatic individual with poor hand or body hygiene passes the
infection to another person when handling food and water. As observe in many
hospital most often nurses pay less attention to educate patient on prevention of
typhoid fever whereas their premodial role is to teach these patients on how to
prevent both in the hospital and at home, hence patient go for traditional medicine
in the prevention and management of typhoid fever . This study sought to bring
out the role of the nurses in the management of typhoid fever among nurses
working in CMA Djeleng, its had as objectives to; assess how the nurses manage
patient suffering from typhoid fever, and to identify the challenges face by the
nurses in the management of typhoid fever and the treatment of typhoid fever.
The study was a descriptive cross-section design in which every nurses is given a
questionnaire and guided at a distance on how to answer it. The estimated sample
sizes of 20 nurses were choosen through convenient random sampling. The
instrument for data collection was a structured questionnaire. This study was
carried out at CMA Djeleng .Looking at the various result obtained majority of the
nurses had knowledge on the management and prevention of typhoid fever. The
study recommends that there should be continuous education programs for the
staff, and for the government supply sufficient equipment and employ more nurses
in other to be able to managed patients with typhoid.

TABLE OF CONTENT
DEDICATION................................................................................................................................ii
ACKNOWLEDGEMENT..............................................................................................................iii
ABSTRACT……….……..………………………………………………………………………
TABLE OF CONTENT..................................................................................................................iv
LIST OF ABBREVIATION........................................................................................................vi
LIST OF TABLES........................................................................................................................vii
LIST OF FIGURES......................................................................................................................viii
ABSTRACT...................................................................................................................................ix
CHAPTER ONE..............................................................................................................................1
INTRODUCTION...........................................................................................................................1
1.2 Statement of Problem...............................................................................................................3
1.3 Significance of the study...........................................................................................................3
1.4 Research question......................................................................................................................4
1.5 Objectives..................................................................................................................................4
1.5.1 Specific objectives................................................................................................................4ii
1.6 Limitation……………………………………………………………………………………5
1.7 Research scope...........................................................................................................................5
1.8 Limitation……………………………………………………………………………………5

1.9 Definition of terms.....................................................................................................................5

CHAPTER TWO.............................................................................................................................7
REVIEW OF RELATED LITERATURE.....................................................................................7
2.1 Introduction................................................................................................................................7
THE LIFE CYCLE OF TYPHOID FEVER..................................................................................10
2.3 Pathophysiology......................................................................................................................11
2.4 Clinical manifestation..............................................................................................................12
2.5 Assessment and diagnostic finding..........................................................................................12
2.6 Prevention................................................................................................................................13
2.7 Medical management...............................................................................................................14
2.8 Pharmacological management.................................................................................................15
2.9 Nursing management...............................................................................................................16
CHAPTER THREE.......................................................................................................................19
MATERIALS AND METHODS..................................................................................................19
3 .0 Study Design...........................................................................................................................19
3.1 Study site.................................................................................................................................19
3.2 Study population......................................................................................................................19
3.2.1 Sampling technique………………………………………………………………………...19
3.2.2 Inclusion criteria...................................................................................................................19
3.2.3 Exclusion criteria..................................................................................................................19
3.3 Study duration..........................................................................................................................20
3.4 Data collection tools………………………………………………………………………...20
3.5 Instrument of validation……………………………………………………………………..20
3.6 Data collection technique…………………………………………………………………...20
3.7 Ethical consideration...............................................................................................................22
3.8 Data analysis...........................................................................................................................22
3.9 Limitation of the study.............................................................................................................23
 LIST OF ABBREVIATION
EXHIST: Experiential Higher Institute of Science and Technology
NA: Nurse Assistant
SRN: State Registered Nurse
HND: Higher National Diploma
HPD: Higher Professional Diploma
SPSS: Statistical package for social sciences
WHO: World Health Organization
CMA: Centre Medical D’Arrondissement
CT scan: Computed topography
PCR: Polymerase chain reaction
MRI: Magnetic resonance imaging
BMA: Bone marrow aspirate
PPI: Proton pump inhibitors
IV: Intravenous
UPEC
CPN
9
10
 ASSESSMENT OF ROLE OF NURSES IN THE MANAGEMENT AND
PREVENTION OF TYPHOID FEVER .

CHAPTER ONE

INTRODUCTION

Typhoid fever is a bacterial infection that can be life threatening infection caused
by the bacterium Salmonella typhi. (W.H.O, 2018). Typhoid is usually acquired
through ingestion of contaminated water or food , and is a common illness in area
where sanitation is poor(WHO 2018). Typhoid is a communicable disease marked
especially by fever diarrhea , headache and intestinal inflammation and is caused by
bacterium Salmonella typhi (world heath organization 2019). The major symptoms
of the diseases include malaise, fever, vomiting, splenomegaly and hepatomegaly
(Nsutebu et al 2003).
Typhoid fever is a gastrointestinal infection cause by Salmonella enteric typhi
bacteria. It is transmitted from person to person through fecal oral route where an
infected or asymptomatic individual with poor hand or body hygiene passes the
infection to another person when handling food and water.
Karl Joseph Eberth was the first to describe the bacillus that was suspected to cause
typhoid in 1980. Four years later, Gorge Gaffky was a pathologist that confirmed this
link, naming the bacillus Eberthella tyhi, which is today known as Salmonella entries
(Aug 22,2018 Christopher klein) . The incubation period is 7 to 14 days .(American
Academy of pediatrics by Kimberlin, D.W,et al eds)
Tracking down the culprit behind an outbreak of typhoid fever in 1900, New York was a
break through which stated that free carrier can spread sickness. The best known carrier
was “Typhoid Mary”. Mary Mallon was an Irish cook in Oyster Bay, New York 1960

11
who was known to have infected 53 people, 5 of whom died. Later return with a false
name but detained and quarantined after typhoid outbreak. She died of pneumonia after
some years in quarantined. (Kimberlin et al DW 2018)
11-20 million cases of typhoid fever worldwide were estimated in 2017.
Children and adolescence are the most vulnerable group affected by typhoid fever. They
account for about 16100 of all typhoid fever death worldwide. (World Health
Organization 31 january 2019).

In Africa typhoid fever is an invasive bacterial infection cause by Salmonella enterica

serovar Typhi 10million and 3million death arise each year.(Mogasale V,Maskery
B,Ochiai RL et al) .In Cameroon particularly, it was estimated to 9million and more than
110000 deaths in 2019.(www.Preprint.org 21 June 2020) . Children and adult
particularly are at risk because they do not practice good hand hygiene as well as prepare
food and meat adequately. If their condition is left untreated, it may progress rapidly to
convulsion, pneumonia, seizures, intestinal perforation, typhoid encephalopathy and
death. The manifestation may be mild with low great fever due to passive immunity.
Those without acquired immunity have severe complication like dehydration. Early
diagnosis and treatment of typhoid fever reduces diseases and prevent death. It can be
prevented by practicing good hand hygiene, cook food and meat thoroughly and a good
source of portable water. Vaccination can also be used to prevent this disease. In the
laboratory, typhoid fever is diagnosed using different techniques example widal test,
stool and blood culture. Typhoid fever can be manage and treated with the use of
antibiotic, chemotherapy and diet(essential of clinical infectious disease second edition
by William F. Wright 2013).

1.1BACKGROUND

12
 Typhoid fever is a life threatening infection caused by the bacterium salmonella
tyhi (WHO,2019).The name S. Typhi is derived from the ancient Greek word
typhos,an ethereal smoke or cloud that was believed to cause disease and
madness(projectchampionz.com.ng). It is most common in children (Wain et al, 2015)
and among young adults 5 and 19years ( WHO,2021). Typhoid usually spread
through contaminated food or water. Once the bacteria are eaten or drunk, they
multiply and spread into the bloodstream( WHO, 2019). It is relatively common in
countries with poor water supply and sanitation. Infants, children, and adolescents
experience the greatest burden of illness (crump, luby and mintz, 2014 ) . Outbreak of
typhoid fever are also frequently reported from Sub Saharan Africa and countries in
southeast Asia where major deaths and disability occur (Yap,kien-pong; et al 2012)
The risk of death may be as high as 20% without treatment (WHO, 2015). With
treatment ,it is between 1 and 4%(Wain et al.,2015;WHO,2019) Salmonella typhi
lives only in humans. Persons with typhoid fever carry the bacteria in their
bloodstream and intestinal tract. Typhoid infection produces febrile illness 6-30 day
after exposure (CDC 2013. Anna 2014), Characterized by prolong high
fever ,headache ,fatique, and malaise being the classic symptoms with nausea,
abdominal pain ,and constipation or diarrhea. There is improved living conditions and
the introduction of antibiotics results in a drastic reduction of typhoid fever
incidence and deaths (WHO,2019) .
There are many species of Salmonella which include:
 Salmonella typhi (Salmonella entrerica serovar typhi)
 Salmonella bongarii
 Salmonella paratyphi
 Salmonella enteriditis
 Salmonella typhimuriu
CHALLENGES FACED IN THE MANAGEMENT AND PREVENTION OF
TYPHOID FEVER

13
 The biggest challenge faced by nurses in endemic countries in Africa is inadequate
financing for tyhoid fever preventive measures or treatment service. As a result, there are
communities or population that cannot asses, the preventive measures or treatment when
needed.

The emergence and spread of S. typhi strains having multiple resistance to nearly all
commonly available drugs in developing countries has been a major challenge to health
care system ,reducing the effective treatment option for the disease increasing treatment
cost and risk of complication and death.( clinical infectious diseases A.Duncan Steele
2016)

Furthermore, the quideline and training for treatment of enteric fever cases in Africa are
sorely needed to help reduced the inappropriate use of antimicrobial treatment
(www.ncbi.nlm.nih.gov Anita K.M.Zaidi,1 mar 2016)

They equally face the challenges with the inhyginic condition of some countries
especially with children and adult are at risk because the do not practice good hand
hygiene,food and adequate meat prepared if this condition is not treated it may lead to
complications (www.ncbi.nlm.nih.gov 2016)

1.2 Statement of Problem

The management of typhoid fever is one of the fundamental roles of nursing

practice which is most often neglected by nurses or given less attention to the
practice. As observe in many hospital in Africa in general and Cameroon in
particular, most often nurses pay less attention to educate patient on prevention of
typhoid fever whereas their premodial role is to teach these patients on how to
prevent both in the hospital and at home , hence patient go for traditional medicine

14
in the prevention and management of typhoid fever. . This study sought to bring
out the role of the nurses in the management and prevention of typhoid fever
among the nurses working in C.M.A Njeleng
1.2Significance of the study
 To the researcher it’s in partial fulfilment for the award of the Higher National
Diploma
 To the researcher the study has improved on the knowledge of the
researcher and provides a basis for future research and references to other
researchers.
 This study was undertaken mainly to understand the underlying roles
that contribute in the management of typhoid fever among patients

 The finding of this study will help improve student’s knowledge on the
role of the nurse in the management of typhoid fever and other diseases
and the essential principle, as well as pave a way for further studies on
the role of the nurse in the management of typhoid fever as a medical
condition.

1.4Research question

1 What is typhoid fever?

2 How is typhoid fever prevented and manage?
3 what are the challenges faced by the nurses in the management and
prevention of typhoid fever?
Hypothesis

15
 Nurses in Njeleng do not have adequate knowledge on the management and
prevention of typhoid fever.
RESEARCH OBJECTIVES
General objectives

To assess the role of the nurse in the management and prevention of typhoid
fever at CMA
1.5.1 specific objectives

 To assess the knowledge of nurses on typhoid fever.

 To assess the nurses knowledge on the prevention and management of
typhoid fever.
 To assess their knowledge on the different ways of management and
prevention of typhoid patients in C.M.A.
1.6 Research scope

The scope of study embodies nurses of all qualification working in CMA

DJELENG
1.7 limitation.
This study is limited only to nurses at medical and paediatric units , of C.M.A Djeleng and
does not involve all nurses of West Region hence can not be generalized
Lanquage also acted as aitation because the questionnaires were explained to the nurses
hence, time consuming
1.8 OPERATIONAL DEFINITIONS
Nurse. A person who is qualified in the arts and science of nursing and meets certain prescribed
standard of education and clinical competence (Baillieres midwifery dictionary 10 th edition
2010).

16
Nursing. This is a profession within the health care sector focused on the care of
individuals, families, and communities so they may attain, maintain, or recover
optimal health.(Willis L 2019, professional guide to diseases. Lippincott Williams
7th edition) .

Management. Is a collaborative process that facilitates recommended treatment

plan to essure the appropriate medical care is provided to disabled, ill or injured
individual.(shiyinghe.com, 27 Aug 2020)

Typhoid fever. Typhoid is a life threatening infection caused by the bacterium S.

typhi (WHO,2019) which is transmitted by water, milk or other foods, especially
shellfish, that have been contaminated.

Encephalopathy. This is brain dysfunction or damage of the brain temporarily or

perminently. ( Eli S Neiman www.medscape.com 9 oct 2019)

Attenuated. A bacteriological process or a vaccine created by reducing the

virulence of a pathogen, but still keeping it viable (Wikipedia Badgett, marty
R;Auer, Alexandra; Carmichael, Leland E.;parrish, ColinR.; Bull James J. oct
2002. A journal of virology).

Vaccination. This are injection given in order to stimulate the immune system
against microbes, thereby preventing disease(
https://www.hhs.gov/healthcare/about-the-law/read-the-law/index.html.Accessed
9march,2017 ).

Vaccine. A vaccine is a biological preparation that provides active acquired

immunity to a particular infectious disease(Rubin L, Levin M, Ljungman P, et al
2013)

17
Convulsion. Convulsion is an episode in which you experience rigidity and
uncontrolled muscle spasms along with altered consciousness. ( Ann Pietrangelo
march 22, 2019)

Pneumonia. Pneumonia is an infection of one or both of the lungs caused by

bacteria, virus, or fungi. It is a serious infection in which the air sac fill with
pus and other liquid. ( Johns Hopkins medicine 2019)

Acquired immunity. This is immunity that develops over lifetime or after

exposure to a suitable agent or vaccination . ( Erica Hersh Dec 9,2019, Miller,
Elizabeth 2015 )

Passive immunity. This is the transfer of immune system components, primarily

antibodies (immunoglobulins),into a person . (essential human virology, 2016)

18
 CHAPTER TWO

REVIEW OF RELATED LITERATURE

2.1 Introduction

Typhoid fever (enteric fever). A notifiable infectious disease caused by

salmonella typhi which is transmitted by water milk or other foods especially
shellfish, that have been contaminated .There is high fever, a red rash, untreated
fever may progress to delirium and sometime intestinal hemorrhage (Aug 19,2019
John L Brusch,MD). Recovers usually begins during the fourth week of the
disease. A person who has had typhoid fever gain immunity from it but may
become a carrier. Although perfectly well, the person harbors the bacteria and
passes them out in the feces. The typhoid bacillus often lodges in the gallbladder of
carriers (Bailliere nurses dictionary 26th edition).

An infectious feverish disease caused by the bacterium Salmonella typhi

[salmonella enterica serovar typhi] and less commonly by salmonella paratyphi.
Acute generalized infection of the reticulo endothelial system, intestinal typhoid
tissues and the gallbladder. The infection always come from another human, either
an ill person or a carrier of the bacterium. The bacterium passed on with and foods
can withstand both drying and refrigeration.

Typhoid fever, which remains a global health problem, is common in

developing countries where there is over population and poor sanitary conditions .
Typically if detected early it can be successfully managed with antibiotics but if
untreated these illness can be fatal .

19
 The name salmonella typhi is derived from the ancient Greek typhos an
ethereal smoke or cloud that was believed to cause disease or madness.

Typhoid fever, also known as enteric fever, is a potential fatal multisystem illness
caused primarily by Salmonella enterica, Serotyphi and to a lesser extent,
Salmonella enterica serotyphi paratyphi A, B and C (Newton AE 2014,CDC health
information for internal travel 2014 the yellow book) . Typhoid fever has a wide
variety of presentation that range from an overwhelming multisystem illness to
relative minor cases of diarrhea with low grade fever ( 2019 willis L.et al
Lippincott William and wilkins).

World Health Organization (WHO) in 2018 reported that 35% to 75% of adult in
developing countries and 18% of adult from industrialized countries are suffering
from typhoid fever

In Sub Sahara Africa, typhoid fever is the leading caused of death due to
poor hygiene and sanitation. In Cameron in general about 9 million people are
suffering from typhoid fever and about 110000 people die each year 2019.

2.2 Etiology\ Causes.

Typhoid fever is commonly acquired through an ingestion of food or water
contaminated by the urine or feces of infected carriers or through person to person
contat, from beverages that has been touch by an infected person. While a
typhoidal Salmonella have no non-human vector
(https://www.betterhealth.vic.gov.au/health/paratyphoid 6 may 2020) .

20
 Contaminated food. Paratyphi is more commonly transmitted in food from
street vendors; it is belived that some such foods provide a friendly
environment for the microbe.
 Migration. Paratyphi is more common among newcomers to urban areas.
Probably because they tend to be immunologically naïve to it; also, traveller get
little or no protection against against paratyphi from the current typhoid
vaccines all of which target typhi(WHO, 2017).
 Decrease stomach PH. Typhoid salmonella are able to survive a stomach PH
as low as 1.5, antacids, histamine2 receptors antagonist(H2 blockers), proton
pump inhibitors(PPI), gastrectomy and achlorhydria decrease stomach acidity
and facilitate S. typhi infection.
 Poor hygiene. As the middle class in south Asia grows, some hospital there
grows, some hospitals there are seeing a large number of typhoid fever cases
among relatively well-off university students who live in group household
with poor hygiene.
 Cause by the bacterium salmonella typhi.
 Ingestion of contaminated food or water.
 Contact with an acute case of typhoid fever.
 Water is contaminated where inadequate sewerage system and poor
sanitation.
 Contact with chronic asymptomatic carrier.
 Salmonella enteriditis and S. typhimurium are other salmonella bacteria
cause food poisoning and diarrhea.
 Eating food or drinking beverages that handled by a person carrying the
bacteria.

21
22
THE LIFE CYCLE OF TYPHOID FEVER
Ingestion of contaminated food or water.

Salmonella bacteria.
Invade small intestine and enter the bloodstream.

Carried by white blood cell in the liver, spleen, and bone marrow

Multiply and re-enter the bloodstream.

Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of
the bowel and multiply in high number.

Then pass into the intestinal tract and can be identified for diagnosis in
culture from the stool test in the laboratory(introduction to clinical infectious 2019
1st edition).

23
Figure 1: The life cycle of typhoid fever.

2.3 Pathophysiology
Pathogenic salmonella ingested in food survive passage through the gastric
acid barrier and invade the mucosa of the small and large intestine and produce
toxin. Invasion of epithelial cell stimulate the release of pre-inflammatory
cytokines which induce an inflammatory reaction. The acute inflammatory
response cause diarrhea and may lead to ulceration and destruction of the mucosa.
The bacteria can disseminate from the intestine to cause systemic disease (Atlas of
infectious diseases pathology by Bryan H. Schmitt).
All pathogenic salmonella species, when present in the gut are engulfed by
phagocytic cells, which they pass them through the mucosa and present them to the
macrophage in the lamina propria. Salmonella typhi and paratyphi enter the
24
host’s system primarily through the distal ileum. They have specialized fimbriae
that adhere to the epithelium over cluster of typhoid tissue in the ileum (peyer
patches), the main relay point for macrophages traveling from the gut into typholic
system.

2.4 Clinical manifestation

Gastrointestinal symptoms. Over the course of the first week of illness, the
notorious gastrointestinal manifestation of the disease develop; these include
diffuse abdominal tenderness, and in some cases, right upper quadrant pain.
Abdominal distention. The abdomen becomes distended, and soft splenomegaly is
common; on the third week, abdominal distention is severe. and Pea soup diarrhea.
Some patient experience foul, green –yellow, liquid diarrhea(WHO, 2020).
 Sustained fever
 Malaise.
 Abdominal pain.
 Constipation or diarrhea.
 Severe headache.
 Hepatomegaly
 Splenomegaly(www.nhs.uk )

2.5 Assessment and diagnostic finding.

The diagnosis of typhoid fever is primarily clinical.
 Culture. The criterion standard of typhoid fever has long been culture
isolation of the organization culture are widely considered 100% specific.
 Radiography. Radiography of the kidneys, ureter, and bladder is useful if
bowel perforation is suspected.

25
  CT scan and MRI. These studies may be warranted to investigate for
abscesses in the liver or bones, among other sites.
 Bone marrow aspiration. The most sensitive method of isolating S. typhi
is BMA culture. (Bone Morrow Aspiration);
 Histologic finding. The hallmark histologic finding in typhoid fever is
infiltration of tissue by microphages that contain bacteria, erythrocytes and
degenerated lymphocytes.
Diagnosis of typhoid fever is made by:
 Blood, bone marrow, or stool culture test.
 Widal test.
 Slide agglutination (Hardreaders et al H 8TH edition) .

2.6 Prevention.
Two main typhoid fever prevention strategies
1 Vaccination
There are three type of typhoid vaccines licensed for used: The Newer
generation injectable typhoid conjugated vaccine, consisting of the vi antigen
linked to tetanus toxoid protein for children from 6month up to 45years of age.
The unconjugated vi polysaccharide VIPs injectable vaccine based on purified
antigen for people over 25years of age. The live attenuated tyzla oral vaccine in
capsule formulation for people over 6years of age (Catham-stephens K,Medella
F, Hughesm, appiah GD, Aubert RD Caidi et al January 2019).
First type of vaccine
 Contains killed salmonella typhi bacteria
 Administered by a shot.
Second type of vaccine.

26
  Contains a live but weaken strain of the S. typhi fever.
 Taken by mouth
 Be vaccinated against typhoid while travelling to a country where
typhoid is common.
 Typhoid vaccines lose their effectiveness after several years so check
with your doctors to see if it is time for a booster vaccination
(www.who.int) .
2 Avoid risky food and drinks
 By bottled drinking water or bring it to a rolling boil for one minute
before drinking it.
 Ask for drink without ice, unless the ice is made from bottled or boiled
water. Avoid popsicles and flavored ices.
 Eat food that have been thoroughly cooked and that is still hot.
 When eating raw fruit and vegetable that can be peeled, peel yourself.
Don’t eat the peelings.
 Avoid food and beverages from street vendors(Newton AE 2014,CDC
2014).

2.7 Medical management.

Treatment for typhoid fever should not be delayed for confirmatory test since
prompt treatment drastically reduces the risk of complication and fatalities (CDC
health information for internal travel 2014 the yellow book).
Medical care. If a patient present with unexplained symptoms describe above
within 60days of returning from a typhoid fever endemic area or following
consumption of food prepared by an individual who is known to carry typhoid,
broad spectrum empiric antibiotics should be started immediately.

27
Surgical care. Surgery is usually indicated in cases of intestinal perforation; if
antibiotic treatment fails to eradicate the hepatomegaly carriage, the gallbladder
should be respected. Small bowel resection is indicated for patient is multiple
perforations.
Diet. Fluid and electrolytes should be monitored and replaced diligently; oral
nutrition with a soft digestible diet is preferable in the absence of abdominal
distention or ileus.
Activity. No specific limitation on activity are indicated for patient with typhoid
fever; as with most systemic disease, rest is helpful, but mobility should be
maintained if tolerable. The patient should be encouraged to stay home from work
until recovery(Nurses and midwives council Ghana 1995).

2.8 Pharmacological management

Antibiotics. Until susceptibilities are determined, antibiotic should be empiric, for
which there are various recommendation. Antibiotics such as ampicillin,
chloramphenicol, thiobactin, Amoxceline, and fluoroquinolones (ciprofloxacine,
gemifloxacin, levofloxacin, mexifloxacin, and ofloxacin) used to treat typhoid
fever. Also cephalosporin like
ceftriaxone(https://www.who.int/csr/don/27Dec2018 ).

Corticosteroids. (Dexamethasone, bethamethasone, prednisone, triamicinolone,

and methylprednisolone) may decrease the likelihood of mortality in severe
typhoid fever cases complicated by delirium, stupor, coma, or shock if bacterial
meningitis has been definitely rule out by cerebrospinal fluid studies
Treatment in severe cases is electrolyte replacement (to provide electrolyte, such as
sodium, potassium and chloride ions, lost through vomiting and diarrhea) and

28
rehydration. Routine antimicrobial therapy is not recommended for mild or
moderate cases in healthy individuals. This is because antimicrobial may select for
resistant strains, which subsequently can lead to the drug becoming ineffective.
However, health risk group such as infants, the elderly and immune compromised
patient may need to receive antimicrobial therapy. Antimicrobial are also
administered if the infection spread from intestine to other body parts. Because of
the global increase of the of antimicrobial resistance. Treatment guideline should
be reviewed on regular basis taking into account the resistance pattern of the
bacteria based on the local surveillance system(Oxford Advanced Learners
Dictionary of Current English, Oxford-London 14th editon).
The two most common complication in untreated typhoid fever are: Internal
bleeding in the digestive system. Splitting (perforation) of a section of the digestive
system or bowel, which spread the infection to the nearby tissue
Other possible complication include: Myocarditis, mycolic aneurysm, pneumonia,
pancreatic, meningitis, delirium, hallucination, paranoid psychosis, and dead.

2.9 Nursing management

Nursing management of patient with typhoid fever includes the following:
History: Assess the patient history of travels if any; a severe, nonspecific febrile
illness in a patient who has been exposed to typhoidal salmonella should always
raise the diagnostic possibility of typhoid fever.
Physical examination: The clinical presentation of typhoid fever varies from a
mild illness with low grade fever, headache, fatigue, malaise, loss of appetite,
cough, constipation, and skin rash or rose spots too in some cases, a fatal
complication such as intestinal perforations, gastrointestinal hemorrhage,
encephalitis and cranial neuritis.

29
Nursing diagnosis.
 Risk for fluid volume deficit related to vomiting and diarrhea.
 Imbalance nutrition less than body requirement related to less intake of
food due to nausea, and vomiting related to excessive output
 Acute pain related to inflammation of the small intestine.
 Activity intolerance related to mandatory bed rest.
 Hyperthermia related to increase in metabolic rate

Nusing care planning and goals

.
 To maintain a normal fluid volume
 To improve intake of nutritional requirement.
 To reduce or diminish pain.
 To main a normal body temperature.
Nursing intervention
Encourage increase in fluid intake. Monitor the status of hydration as
needed. Monitor the fluid intake daily; encourage an increase in fluid intake; and
collaborate with other medical team for IV fluid administration.
Improve nutritional intake monitor the amount of caloric intake; monitor
weight loss; provide a comfortable environment during meals, and encourage an
increase in protein and vitamin C intake to meet nutritional need.
Reduce or diminish body pain. Assess the level of pain, location, duration,
intensity and characteristics; provide worm compress on areas with pain, and
administered analgesic as prescribe.

30
Improve body temperature. Monitor patient temperature degree and pattern and
patterns; observe for chills. Provide tepid sponge bath and avoid the use of ice
water and alcohols; and administered antipyretics as prescribe (P.R Jeffries et al
J.Battin 2011)

2.10 Review of drug.

Multidrug resistant (MDR) typhoid fever is define as an infectious disease cause
by Salmonella enterica serova typhi strains (S. typhi), which are resistant to the
first line recommended drugs for treatment such as chloramphenicol, ampicillin,
and trimetho-prim-sulfamethoxozole.
Cefixime is recommended by the International Academy of the philipines (IAP) for
uncomplicated typhoid fever. Ceftriaxone is recommended for complicated typhoid
fever. First and second line drugs and the third generation cephalosporin (Choe
KW,Kim SM, Oh MD. Et al 1990).

31
 CHAPTER THREE

MATERIALS AND METHODS

3 .0 Study Design
This is a cross-sectional descriptive study design was used to assess nurses
knowledge on THE ROLE OF NURSES IN THE MANAGEMENT AND
PREVENTION OF TYPHOID FEVER .

3.1 Description of Study site.

The CMA of DJELENG is located in the West Region of Cameroon
department of Mifi arrondissement of Bafoussam 2 in the Djeleng l district.
CMA of DJELENG formerly called great endemics was built in the 1960s after
independence, which dealt with diseases such as: tuberculosis, leprosy, STIs,
Vaccinations in the west region. In june 2005, erectedas a CSI, by a nurse
and then in CMA in 2006 under the management of a chief doctor by
ministerial decree No. 1628/MINSANTE of 19 January 2006.
The activities of the hospital

DJELENG CMA carries out preventive and curative activities

It offers the following services:
 Reception
 Physiotherapy
 Biomedical analysis laboratory
 Men’s and women’s medicine
 Pediatrics
 Prenatal consultation
 Maternity

32
  Small surgery
 Operating room
 Community pharmacy
 Medical imaging
 UPEC
Administrative structure
 The CMA of DJELENG consists of 04 building ; the 1 st building contains :
the rceeption, the community pharmacy, the commissary, the on –call
pharmacy, the vaccination, the doctors’ office, the CPN , physiotherapy and
the office of the general supervisor.
 The 2nd building contains the office of the head doctor the laboratory,
maternity
 . The 3rd building is the pediatric, operation room and surgery .
 The 4th building is the medical ward and UPEC.
Organization chart of the hospital and patients circuit
 A chief medical officer
 Doctors
 A general supervisor
 Service majors
 Staffs
 Security guards
 cleaners

3.2 Study population

All nurses working at C.M.A Djeleng and who have at least one year of
experience as nurses were involved in this study. 3.2.1 SAMPLING
TECHNIQUE

33
 A convenient sampling technique was used to select participants for the
study.20 nurses of all qualification were selected at random to represent the
entire nurses body at C.M.A Djeleng
3.2.1 Inclusion criteria.
All nurses present at the time of data collection at C.M.A Djeleng.
3.2.2 Exclusion criteria
All nurses working at C.M.A excluding those on annual or maternity leave,
and those who were unwilling to fill the questionnaire were excluded .
3.3 Study duration
This study was carried out from December 2021 to March 2022.
3.4 DATA COLLECTION TOOLS
A well structured questionnaire in both English and French lanquage will
be handed to each respondant ,the internet, books, journals, pens, papers, and
pencils for data recording and analysis.

3.5 INSTRUMENT OF VALIDATION

A structured questionnaire was submitted at HIBUMS Polytechnic to the
researcher s supervisor, which was corrected by the supervisor and
comfirmed for data collection.
3.6 DATA COLLECTION TECHNIQUE
Data used in this study was collected through the administration of
questionnaires for immediate or later collection depending on the
participants. At the C.M. Djeleng any nurse that met the inclusion criteria
was made to understand the topic and the modalities to answer the
questionnaire then a verbal consent was obtained from the nurses from
which a questionnaire was served for nurses (respondant) to give their

34
 opinions . After about the investigator went round the hospital collecting
the questionnaires while thanking the respondantfor their participation.

3.8 Ethical consideration

An authorization obtained from the school together with a hand written
application was submitted to the director of C.M.A Djeleng, ethical clearance
was obtained from the director or general supervisor of the hospital and a
verbal consent was obtained from all the nurses willing to participate in the
study.

3.9 DATA ANALYSIS

Data was entered into a computer and analyzed using Microsoft Excel 2013.
The collected data was analyzed and represented on diagrams such as pie
charts and bar charts.
3.10 COMMUNICATION OF RESULTS
At the end of this study a supervised presentation/defence was carried out in
which the examiners will amend and approve of the study for use. Aproved copies
will be deposited to:
 Members of jury
 Supervisor
 HIBUMS Polytechnic, for exploitation by junior students.
 At C.M.A Djeleng for exploitation by health personnels.
3.8 Limitation of the study
 This study reports on nurses in registered and enrolled nurses. Therefore
may not be a true representative of general population.

35
  There was also limitation in language as some participants could not
understand what was written on the questionaires and so have to explain
to them in detail and it was time consuming especially as most of them
where francophones and there was some language barrier.

APPENDIX 2

QUESTIONNAIRE
I am FOMBAT EZINA ABON, a final year students at Higher Institude for
business And Management Science (HIBUMS) Polytechnic Bafoussam Annex
specifically in the field of nursing. I am out to access the role of nurses in the
management of typhoid fever . This is in partial fulfilment of the Higher National
Diploma in nursing . Please carefully read the questions below and give your
opinion by ticking the correct letter. Your participation is very important. The
information you will gives me, will be highly confidential.

36
 CHAPTER FOUR
ANALYSIS AND PRESENTATION OF RESULTS.
4.1 Demographic Data
Table 3 shows the demographic data of respondents
Regarding the ages 7(35.00%) of sample nurses were between the ages 20-29years,
6(30.00%) had ages 30-39years, 5(25.00%) had ages 40-49years and 2(10.00%) were
between the ages 50 and above.
This study also shows that majority 17(85.00%), were female and 3(15.00%) were
male.
According to the level of qualifications 4(20.00%) of nursing assistant, 5(25.00%)
of state registered nurses, 10 (50.00%) of higher national diploma, 1(5.00%) degree
holder and nobody for HPD.
In relation to their years of working experience it shows that 11(55.00%) had
working experience of 0-5years, 6(30.00%) worked for 5-10years, 2(10.00%) 11-15years,
while nobody had more than 15years of working experience.
The study also shows that 5(25.00%) worked in the medical ward, 6(30.00%)
work in the pediatric unit, 4(20.00%) in the maternity and 5(25.00%) worked in other
units. As illustrated on the table below
Table 1: Demographic distribution of nurses working in CMA DJELENG
Participants age Frequency Percentage (%)
ranges
20-29years 7 35.00%
30-39years 6 30.00%
40-49years 5 25.00%
50and above years 2 10.00%
Total 20 100
Gender

37
 Female 17 85.00%
Male 3 15.00%
Total 20 100
Qualification
Nurse assistance 4 20.00%
State register nurse 5 25.00%
National diploma 10 50.00%
Degree holders 1 5.00%
Total 20 100
Work experience
0-5years
11 55.00%
5-10years 6 30.00%

11-15years
2 15.00%
15years and above 0 0.00%

Total 20 100

Working units Frequency Percentage (%)

Medical ward 5 25.00%
Pediatric unit 6 30.00%
Maternity 4 20.00%
Other units 5 25.00%
Total 20 100

38
 SECTION B
Table 4 shows nurses knowledge on typhoid fever.
Regarding their knowledge on definition of typhoid 15(75.00%),
16(80.00%), 17(85.00%) had correct answers on the definition, source and routes
respectively . While 5, 4, 3 respodents did not have adequate knowledge
respectively as shown on the table below.
Table 3: Nurses Knowledge On Typhoid Fever
Question Good Frequency for Percentage Frequency for Percentage
numbers Response right answers (%) wrong answers (%)

6 Typhoid is an 15 75 5 25
infectious
diseases
caused by
bacterium S.
typhi

7 Ingestion of 16 80 4 20
unwashed
food and
unsafe
drinking water

8 Fecal oral 17 85 3 15
route

SECTION C:
Table 5 EVALUATING NURSES KNOWLEDGE ON PREVENTION AND
MANAGEMENT OF TYPHOID FEVER.
Concerning the management and prevention of 15(75.00%), Signs and
symptoms 16(80.00%), 17(85.00%) knew the management, 18(90.00%) always

39
 educate their patients before discharging them, 19(95.00%) education program
reduced the incident rate of typhoid, 17(85.00%), Say nurses are not exposed to
infection and those that have inadequate knowledge were
5(25.00%),4(20.00%),3(15.00%),2(10.00%),1(5.00%),3(15.00%) respectively as
presented on the table below.
Question Good Response Freque Percentage(%) Inadequate Frequenn Percentages
ncy answers cy

9 Heath talk on proper 15 75.00% Proper 5 25.00%

hygiene and safe perinea
drinking water hygiene
10 Headache,diarrhea,co 16 80.00% Bloody 4 20.00%
nstipation stool
11 Ciprofloxacin, 17 85.00% Quinine 3 15.00%
ceftriaxone
12 Yes 18 90.00% No 2 10.00%
13 Yes 19 95.00% No 1 5.00%
14 No 17 85.00% Yes 3 15.00%

SECTION D
Table 5: CHALLENGES FACED IN THE MANAGEMENT OF TYPHOID
FEVER .
Regarding the challenges and difficulties faced in the management of
typhoid, 4(20.00%) inadequate personnels,6(30.00%) inadequate drug
management,3(15.00%) time constraint, 7(35.00%) drug resistance . As illustrated
on the pie chart above.

40
 CHAPTER 5
5.0 DISCUSSION, CONCLUSION AND RECCOMMENDATION
5.1 DISCUSSION
5.1.1 NURSES KNOWLEDGE ON THE DEFINITION
Nurses knowledge on the definition 15 being 75.00% knew the definition
of typhoid which is in line with (WHO,2018) which defines typhoid as an
infectious diseases caused by bacterium S.typhi and 5(25.00%) could not give the
adequate definition of typhoid.
5.1.2 NURSES KNOWLEDGE ON THE MANAGEMENT OF TYPHOID
From the study , results reveal that a majority of the nurses 85.00% knew
the management of typhoid Ciprofloxacine,Amoxceline,Cephalosporin as in
(https://www.who.int). while minority 15.00% had partial knowledge on the
management.
5.1.3 THE NURSES KNOWLEDGE ON THE CHALLENGES
With regards to the challenges faced majority 35.00% had knowledge in
the management of typhoid fever (clinical infectious diseases A.Duncan Steele
2016 drug resistance while minority 3(15.00%) had partial knowledge on the
challenges.
5.2 CONCLUSION
From the analysis minority of the nurses had knowledge on the definition
while minority of them had knowledge on the route of transmission this is due to
low level of education.
In relation to the analysis majority knew the various drugs used to managed
typhoid while minority did not have much knowledge on the signs and symptoms
of typhoid fever.This could be due of long working experience.

41
 Concerning their knowledge on the challenges the majority of the nurses
knew the challenges and minority did not know the challenges this could be
because of inadequate equipment or insurficient personnels to managed the
patients.
In conclusion the researcher can say majority knew the definition and the
routes of transmission and a shallow knowledge signs and symptoms and a
relative knowleddge on the challenges.
5.3 RECOMMENDATIONS
 For the government to equipe all hospitals with sufficient equipement .
 To the health institute to train good nurses who will be able to managed
patients suffering fromtyphoid fever.
 For the hospital to collaborate and managed patients suffering from
typhoid fever.
 For the nurses to make patient safety,educating them on proper hygiene
and comfort through proper management of typhoid fever.
 For nurses to maintain enough care during management.
 The study recommends continuous education program for the staffs

SECTION ONE: DEMOGRAPHIC INFORMATION

1) Age? A) 20-29years B)30-39years C)40-49years D)50 and above
2) Sex? A ) Male B) Female

42
3) Qualification? A) NA B ) SRN C )HND D )HPD E ) Degree +
4) Working experience? A ) 0-5years B ) 5-10years C )11-15years
D )15 and above
5) Which unit do you work in? A ) Medical ward B ) pediatric unit
C ) Maternity D ) And others

SECTION TWO : Assessing knowledge on typhoid fever.

6) What is typhoid fever? A) Typhoid is a viral infection B) Typhoid is an infectious
disease caused by salmonella typhi C ) It is a pathology that affects only the
adolescent D ) None of the above
7)Typhoid is transmitted through-? A ) Injestion of unwashed food and unsafe drinking
water. B ) Good hygiene C ) Typhoid does not exist D ) All of the above
8)What is the route of transmission? A ) Airbone B) Sexually transmitted C)
Fecal oral D ) None of the above
SECTION THREE ASSESSMENT ON HOW NURSES AND MIDWIFE MANAGE AND
PREVENT TYPHOID FEVER IN CMA DJELENG
9) How is typhoid fever prevented? A) Encourage and reassure B )
Health talk on proper hygiene and safe drinking water C ) proper
perinea hygiene D ) None of the above
10)What are the signs and symptoms of typhoid? A ) Headache, Diarrhea,
Constipation B ) Coughing with blood C ) Bloody stool D ) Dyspnea
11) What medication is best used for the management of typhoid fever? A)
Paracetamol B) Ciprofloxacin, Ceftriaxone C ) Quinine D ) Bactrim
12)Do you often educate the patient upon discharge?
A ) NO B) YES
13) Education programs can reduced the incidence rate of typhoid
A ) YES B ) NO

43
14)Does the management of patients with typhoid fever exposed you to infection risk?
A )NO B ) YES

SECTION four: IDENTIFYING THE CHARLENGES FACE BY THE

NURSES AND MIDWIFE IN THE MANAGEMENT OF TYPHIOD FEVER.

15) what are the challenges and difficulties you faced tick as many as possible?
A) Inadequate personnel B ) Inadequate drug management C ) Time
constraint D) Drug resistance

44