Social and Economic Burden Associated With Typhoid Fever in Kathmandu and Surrounding Areas: A Qualitative Study

Abstract

Typhoid fever is a significant contributor to infectious disease mortality and morbidity in low- and middle-income countries, particularly in South Asia. With increasing antimicrobial resistance, commonly used treatments are less effective and risks increase for complications and hospitalizations. During an episode of typhoid fever, households experience multiple social and economic costs that are often undocumented. In the current study, qualitative interview data from Kathmandu and surrounding areas provide important insights into the challenges that affect those who contract typhoid fever and their caregivers, families, and communities, as well as insight into prevention and treatment options for health providers and outreach workers. When considering typhoid fever cases confirmed by blood culture, our data reveal delays in healthcare access, financial and time costs burden on households, and the need to increase health literacy. These data also illustrate the impact of limited laboratory diagnostic equipment and tools on healthcare providers’ abilities to distinguish typhoid fever from other febrile conditions and treatment challenges associated with antimicrobial resistance. In light of these findings, there is an urgent need to identify and implement effective preventive measures including vaccination policies and programs focused on at-risk populations and endemic regions such as Nepal.

Salmonella Typhi Colonization Provokes Extensive Transcriptional Changes Aimed at Evading Host Mucosal Immune Defense During Early Infection of Human Intestinal Tissue

“…Typhoid fever is frequently fatal when untreated in pediatric or immunocompromised populations [ 9 , 31 , 51 , 79 ]. It affects an estimated 11.9 to 26.9 million people annually [ 6 , 49 , 50 ], with estimated financial burdens equaling roughly a third of the gross national income for patients in undeveloped areas of Southeast Asia [ 35 ]. Current treatments depend on antibiotics; however, STY is rapidly developing antibiotic resistance, thereby increasing both the risk and severity of infection.…”

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“…A recent study from Nepal also found that enteric fever patients were concerned about the recurrence of the disease and used supplements and special diets to prevent this. 35 The concerns and awareness regarding relapse or recurrence suggest that it perhaps is more common in the community than the 5–10% hospital-based estimate. 5 …”

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“…Salmonella typhi is the causative agent of typhoid fever, a serious disease condition with an annual global burden of approximately 16 million cases, leading to 600,000 fatalities [12]. S typhi typically live in animal and human intestines and humans become infected by the consumption of contaminated water or food [12]. S. typhi was reported by 30% of the studies under review as shown in Table 2.…”