Assessment of Laboratory Diagnostic Tests and Antimicrobial Treatment of Typhoid at the University of Nairobi Health Services

Abstract

Typhoid is a systemic disease caused by Salmonella enterica serovar typhi. It causes significant morbidity and mortality especially in developing countries with estimated 12 to 33 million cases and 200,000 to 600,000 deaths annually. Proper diagnosis of the disease will enable clinicians to initiate the right treatment thereby contributing to the well being of the patient and minimizing the development of antimicrobial resistance. It will also give epidemiologists accurate data on the local prevalence of typhoid. Main Objective: Assessment of laboratory diagnostic tests and antimicrobial treatment of Typhoid at the University of Nairobi Health services. Study Design: Retrospective study Study Site: University of Nairobi health services, off State House road, Nairobi. Study Population: All patients sent to the University of Nairobi health services laboratory for typhoid diagnostic tests from January 2010 to Dec 2010. Methodology: The laboratory and medical records of 384 randomly selected patients were analyzed. Information of laboratory tests done and antimicrobial treatment given was abstracted from laboratory records and patients files. This information was documented on serialized data collection forms. Results: The Widal test was the most commonly used in the diagnosis of typhoid at 95.55%. Stool culture was 3.40%, blood culture 0.5% and Salmonella stool antigen 0.1 %. Antimicrobial treatment was given at all levels of Widal titres from 0 negative H negative to 01:160 H 1:160 (78.87%) and at 0 1:320 H 1:320 (21.12%). Quinolones (especially ciprofloxacin) were the mostly used antibiotics (52.11 %) then cephalosporins (28.16%) and penicillins (19.71 %) Conclusion: The high utilization of widal test coupled with the poor interpretation of the results and the low use of cultures can lead to inappropriate antimicrobial treatment and worsening of multidrug resistant Salmonella enterica serovar Typhi . Recommendations: Urgent designing and implementation of a policy targeting health care providers within the University of Nairobi Health Services on rational utilization of laboratory diagnostic tests of typhoid and antimicrobial treatment.