Typhoid fever affects 21 million people globally, 1% of whom succumb to
the disease. The social, economic and public health consequences of this
disease disproportionately affect people in Africa and Asia. In order to
design context specific prevention strategies, we need to holistically
characterise outbreaks in these settings. Here we used retrospective data
(2013-2016) at national and district level to characterize temporal and
spatial dynamics of typhoid fever outbreaks using time series and spatial
analysis. We then selected cases matched with controls to investigate
household socio-economic drivers using a conditional logistic regression
model, in addition to develop a typhoid outbreak-forecasting framework.
The incidence rate of typhoid fever at national and district level was ~
160 and 60 cases per 100,000 persons per year, respectively, predominantly
in urban areas. Bwera sub-county registered the highest incidence rate,
followed by Kisinga, Kitholhu and Nyakiyumbu sub-counties. The male-female
case ratio at district level was at 1.68 and outbreaks occurred between
the 20th and 40th week (May and October) each year preceded by seven weeks
of precipitation. Our forecasting framework predicts outbreaks better at
the district rather than at the national level. We have identified a
temporal window associated with typhoid fever outbreaks in Kasese
district, which is preceded by precipitation, flooding and displacement of
people. We also observed that high typhoid incidence areas also had high
environmental contamination with limited water treatment. Taken together
with the forecasting framework, this knowledge can inform the development
of specific control and preparedness strategies at district and national
levels. NATIONAL_DATASET.csv - Ministry of
Health surveillance database (2013-2015) with corresponding weather used
in the retrospective study HOSPITAL
DATASET.csv - Health records of Typhoid fever patients from
the three hospitals in Kasese district
HOUSEHOLD DATASET.csv - Database
from the Case-Control study FORECAST
DATASET.csv - Ministry of Health Surveillance Database
(2016-2017) used for validation of the forecast framework
HOUSEHOLD DATASET.RData
TYPHOID_ANALYSIS_RCODE.html TYPHOID_ANALYSIS_RCODE.Rmd KASESE_WEATHER_FORCASTING.csv