Typhoid test to worry about

If you have been diagnosed with typhoid fever and then subjected to treatment with common antibiotics, yet your illness doesn’t show signs of improvement, you must—among other things—ask yourself this key question today: Was an accurate test done to prove if really I have typhoid?

Most health facilities in Tanzania and other developing countries still rely on Widal test to diagnose typhoid fever, but scientists are questioning its reliability.

It is suggested that if you have high fever and abdominal pain, then, your doctor suggests a Widal test—and it turns out positive—there is still room for doubt, if your medic relied on a mere rapid test to confirm the typhoid. Most times, you need an additional test to be pretty sure of what you are suffering from.

“Unfortunately, in some developing countries […] Widal test appears to be the only laboratory means for diagnosing typhoid fever among suspected patients,’’ says a research review titled: Widal agglutination test − 100 years later: still plagued by controversy, published in in the British Medical Journal (BMJ).

Dr Elisha Osati, a medical specialist at Muhimbili National Hospital(MNH), says, “At times people end up requesting for antibiotics from their doctors simply because a Widal test turned out positive when they went for the test, but only to realise later that the antibiotics weren’t necessary.”

“There must be enough reasons first; to conclude that the patient actually has typhoid,’’ emphasises Dr Osati.

“Widal test is not conclusive. To confirm the disease, a medic has to go the extra mile. What we call titration has to be done. One other step is to do a culture and sensitivity test. But there are many health facilities that are still unable to perform the culture and sensitivity test. This is where problems begin,’’ he points out.

“My advice to patients is that they should always talk to their doctors and be sure of how they are being diagnosed with typhoid. They shouldn’t simply ask for or accept antibiotics. Inappropriate use of antibiotics fuels antibiotic resistance,’’ cautions Dr Osati.

“We strongly advise that such facilities refer patients to where this test can be done. Do they refer? That’s something to question now,’’ insists Osati, who is the president of the Medical Association of Tanzania (MAT).

The government has since issued a circular No:HC.49/421/01/52, indicating that Widal test is not done appropriately at health facilities across the country but the practice has not changed for the better—even in recent years.

You have NHIF card? Choose wisely

The National Health Insurance Fund (NHIF) covers Widal test as part of your treatment package, but on condition. Your health facility must not lie.

“We [at NHIF] are bound to engage with facilities that follow standards of practice. If we assure ourselves that a certain health facility does not diagnose typhoid correctly as dictated by treatment guidelines, we are keen not to engage with it,’’ says Dr Edwin Chitage, a Quality Assurance Officer at NHIF.

The Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) says it will not tolerate health facilities with diagnostic laboratories that can’t use the Widal test correctly.

Ms Neema Haliye, the ministry’s Acting Registrar of Private Health Laboratories Board (PHLB) says health facilities must ensure that when a Widal test is done in their labs, and it turns positive, they should carry out further tests to confirm.

“[…]We are receiving complaints from NHIF that some health facilities submit claims for Widal tests that are questionable,’’ says Ms Haliye, who is also a medical laboratory scientist at the MoHCDGEC. “Usually, a health facility that meets the standards of offering this test has to submit an application to us, and we give it authorisation, but we haven’t actually gone on the ground in all health facilities to trace if they are following the procedures correctly or not,’’ she admits.

How common is typhoid in Tanzania?

Typhoid fever, a life-threatening infection caused by a bacterium known as Salmonella Typhi, is a common problem in Tanzania, studies show and doctors say most people are aware of the disease but not necessarily-knowing how to prevent it.

“Almost all patients who visit hospitals[…] at least know the word “typhoid” to the extent that a patient may not even narrate his/her history[of illness] to the doctor instead he/she will ask to be tested for it[typhoid],’’ says Dr Wilson Lugano, a medical officer who has practiced at various medical facilities in the country.

Globally, the World Health Organisation (WHO) says that every year, an estimated 11–20 million people suffer from the disease and between 128,000 and 161,000 people die from it.

Confused with other illnesses

Typhoid, according to medical experts, has become challenging to detect in patients because its symptoms resemble those of other diseases such as malaria, which also cause fever.

The Widal test, widely used labs at health facilities, has played a major role in the diagnosis of typhoid fever but recent research reveals there are several pitfalls in how it is used and how results are interpreted.

People must begin questioning

In recent months, the Deputy Minister of Health Community Development, Gender, Elderly and Children, Dr Faustine Ndugulile has warned the public against the tendency of medics at health facilities “unnecessarily” diagnosing patients with typhoid.

“Quite often, we witness cases of patients at our health facilities being told they are suffering from typhoid without sufficient evidence to prove the diagnosis,’’ said Dr Ndugulile on July 10, 2018 during an interview on eatv.tv.

“It is high time patients begin questioning whenever they are given results of their typhoid tests in half an hour at certain health facilities […] mostly, in ideal practice, the results must be out after 48 hours,’’ said Dr Ndugulile, who is also a specialist in public health.

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