In Nigeria, if you called in sick and couldn’t make it to work, it was probably because you had malaria and typhoid. Did I hear you say typhoid? You have participated in fraud! Let me shock you, the rate of typhoid fever occurrence in Sub-Saharan Africa based on existing studies is less than one percent, unlike malaria prevalence which currently stands above 60% in Nigeria.
Yet, typhoid fever, a disease caused by Salmonella typhi and its paratyphi variant is being diagnosed on a daily basis and treated at an unprecedented rate in Nigeria.

This situation has gotten so bad that almost every patient; male, female, young and old with febrile illness in Nigeria is treated for typhoid. At every turn, what you hear is: ‘I have just been diagnosed and treated for malaria and typhoid’ or ‘since I treated malaria and it’s not going I must definitely have typhoid’. As a matter of fact, patients who believe they have these twin ailments will abandon doctors who refuse to treat the typhoid component to go see other doctors who are willing to treat.

Perhaps a major cause of this problem is the method used in diagnosing the so-called typhoid. It is a widely established fact in medical circles that the serological test (widal agglutination) which is often relied on to make typhoid diagnosis is unreliable. Widal test is outdated and has since been abandoned for more reliable tests such as bacteriological culture in other countries

Nigerian doctors are aware of this situation, but are probably tired of explaining to patients that they don’t have typhoid, since such patients more often than not will go find another ‘doctor’ , mostly a quack, to ‘flush out’ the typhoid from their system with drips, for a tidy sum.

Why should we all be concerned? Because of the dangers inherent in continuing the harmful practice such as:
(a) Antibiotics resistance– consuming antibiotics when not needed breeds resistance and subject patients to unnecessary side-effects;
(b) Misdiagnosis and delayed diagnosis– while ascribing an illness to typhoid, diagnosis of other more dangerous diseases may be missed and mistreated leading to higher morbidity and mortality;
(c) Missing malaria resistance– taking antibiotics while recuperating from malaria makes it difficult to detect and differentiate reduced anti-malaria efficacy , drug resistance, or even recrudescence from genuine infection requiring antibiotics treatment; and
(d) Raising cost of treatment/lowering value of healthcare– an average citizen who is already resistant to common and affordable antibiotics ends up spending more in procuring expensive antibiotics to achieve the same result. This diminishes the value of healthcare provided by physicians who are sometimes pressured to treat this ‘typhoid’

Therefore, my appeal is first to the citizens to desist from self treatment of typhoid fever without undergoing proper tests prescribed by qualified physicians. As for typhoid, you should now know that the test that says 1/20,1/80,1/160 is no longer useful in diagnosis and you should never take antibiotics on the basis of that test.

It is high time also, that physicians and their various associations insist on the use of blood or stool culture diagnosis in treating their patients and totally discountenancing Widal test for uniformity of practice.

Lastly, I appeal to the Federal Ministry of Health to start an immediate campaign to change this trend. It is my suggestion that relevant research be launched to determine the true incidence and prevalence of typhoid fever in Nigeria. Subsequently, a specific national policy on the diagnosis and treatment of typhoid fever and perhaps other infectious diseases should be promoted. In addition, citizens may also be sensitized on the low prevalence rate of typhoid and the need to see qualified doctors for proper advice, to prevent them from falling prey to quacks who make money from this not-so-common disease.

Dr Odunayo Talabi

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