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Open Access 01-09-2020 | Typhoid Fever | Surgery in Low and Middle Income Countries

Morbidity and Mortality of Typhoid Intestinal Perforation Among Children in Sub-Saharan Africa 1995–2019: A Scoping Review

Authors: Megan Birkhold, Yacaria Coulibaly, Oumar Coulibaly, Philadelphie Dembélé, Daniel S. Kim, Samba Sow, Kathleen M. Neuzil

Published in: World Journal of Surgery | Issue 9/2020

Abstract

Background

Typhoid fever incidence and complications, including intestinal perforation, have declined significantly in high-income countries, with mortality rates <1%. However, an estimated 10.9 million cases still occur annually, most in low- and middle-income countries. With the availability of a new typhoid conjugate vaccine licensed for children and recommended by the World Health Organization, understanding severe complications, including associated mortality rates, is essential to inform country-level decisions on introduction of this vaccine. This scoping review summarizes over 20 years of the literature on typhoid intestinal perforation in sub-Saharan Africa.

Methods

We searched EMBASE, PubMed, Medline, and Cochrane databases for studies reporting mortality rates due to typhoid intestinal perforation in children, under 18 years old, in sub-Saharan Africa published from January 1995 through June 2019.

Results

Twenty-four papers from six countries were included. Reported mortality rates ranged from 4.6–75%, with 16 of the 24 studies between 11 and 30%. Thirteen papers included postoperative morbidity rates, ranging from 16–100%. The most documented complications included surgical site infections, intra-abdominal abscesses, and enterocutaneous fistulas. High mortality rates can be attributed to late presentation to tertiary centers, sepsis and electrolyte abnormalities requiring preoperative resuscitation, prolonged perforation-to-surgery interval, and lack of access to critical care or an intensive care unit postoperatively.

Conclusions

Current estimates of mortality related to typhoid intestinal perforation among children in sub-Saharan Africa remain unacceptably high. Prevention of typhoid fever is essential to reduce mortality, with the ultimate goal of a comprehensive approach that utilizes vaccination, improvements in water, sanitation, and hygiene, and greater access to surgical care.

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Title: Morbidity and Mortality of Typhoid Intestinal Perforation Among Children in Sub-Saharan Africa 1995–2019: A Scoping Review
Authors: Megan Birkhold
Yacaria Coulibaly
Oumar Coulibaly
Philadelphie Dembélé
Daniel S. Kim
Samba Sow
Kathleen M. Neuzil
Publication date: 01-09-2020
Publisher: Springer International Publishing
Keyword: Typhoid Fever
Published in: World Journal of Surgery / Issue 9/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05567-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Morbidity and Mortality of Typhoid Intestinal Perforation Among Children in Sub-Saharan Africa 1995–2019: A Scoping Review

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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