The article explores the environmental and non environmental factors that
contributes to a recent increase in typhoid fever cases in Fiji. The typhoid fever is caused by the bacterium Salmonella enterica serotype Typhi growing within the intestines and blood. With an estimated disease burden of 20.6 million cases in low- and middle-income countries in 2010, typhoid fever remains an enteric disease of public health concern in Fiji (de Alwis et al. 2018). There are many risk factors for transmitting Salmonella Typhi in Fiji and they are only partially understood. For instance, inadequate hand washing practices, poor sanitation, lack of access to safe water, and the dumping of untreated waste/sewage.
Moreover, during the cyclone season between the months of November to April, extensive rainfall and flooding can dramatically increase the risk of foodborne and waterborne diseases. Therefore, in order to understand the causal factors, the authors used the presence of Vi-specific antibodies as a biomarker for typhoid fever exposure and used geospatial and statistical approaches to identify environment-associated risk factors in the general population of Fiji.
The authors first used a survey method where information for 44 variables was collected during the cross-sectional survey, they then selected 13 survey variables for this typhoid fever risk factor analysis on the basis of potential environmental risk factors of interest and potential confounding covariates. These variables included age, education, self-reported typhoid fever vaccination status, type of toilet at home, and type of sewage system.
The authors later used the multilevel mixed-effect logistic regression by including environmental and individual-related covariates as fixed effect and a random intercept in order to identify the risk factors. 16 environmental covariates were test and if the analysis showed at least moderate evidence of an association with seropositivity (p<0.5), these covariates were then used in multivariable analysis as a continuous variable. Therefore from the test result, 4 environmental variables showed significant association to the increase cause in typhoid fever, which were annual rainfall, rainfall during the wettest month, work location, and rainfall during cyclone season.
Moreover, the authors then conducted a hotspot analysis using information gathered from the Global and Anselin local Moran I test to identify statistically significant spatial clusters. High-seroprevalence communities (hotspots) were detected only in Viti Levu, whereas typhoid fever appeared to be more homogeneously distributed in Vanua Levu, suggesting a different transmission pattern on the two islands. Therefore, the study demonstrated a spatially heterogeneous exposure to typhoid fever.
Overall, I would give this study a score of 8 out of 10. The reason is because I
believe the authors chose the correct approaches in trying to identify the underlying causes of the typhoid fever outbreaks in recent years in Fiji. The hotspot analysis gives readers strong understanding in seeing whether there are spatial clusters within parts of Fiji. Additionally, the multivariable regression analysis successfully identify the variables contributing to Typhoid fever, which is very helpful for local authorities to uses this information to address a practical solution. However, the authors themselves had identify some knowledge gap within this study, such as the uncertainty around whether the Vi antigen is the absolute proxy for Salmonella Typhi infection. Additionally, the cluster analysis was hindered by an uneven distribution of the surveyed communities. Therefore,
improvements could be made to this study.
Source:
de Alwis, R., Watson, C., Nikolay, B., Lowry, J. H., Thieu, N. T. V., Van, T. T., …Cano, J. (2018). Role of Environmental Factors in Shaping Spatial Distribution of Salmonella enterica Serovar Typhi, Fiji. Emerging Infectious Diseases , 24 (2), 284+. Retrieved from http://link.galegroup.com.ezproxy.library.ubc.ca/apps/doc/A533000198/HRCA?u =ubcolumbia&sid=HRCA&xid=8629fe44