Household and Environmental Typhoid Fever Transmission in Bandar Lampung City, Indonesia: A Case-Control Study.

Introduction: Typhoid fever is an endemic disease that causes substantial morbidity and mortality in low and middle-income countries. A case-control study was conducted to understand the risk factors for typhoid fever. Methods: The study applied the case-control method to compare past exposure between participants who had typhoid fever (cases) and participants who did not have typhoid fever (controls) after obtaining ethical approval (No. 244/KEPK-TJK/III/2023). We identified and surveyed patients with typhoid fever confirmed by blood culture. Control subjects were randomly selected neighbors of cases with no history of typhoid fever. Both cases and controls were interviewed at home. During the visit, a structured observation of their living environment was performed. Multivariable analysis was applied using logistic regression and odds ratio to evaluate the relationship between exposure and risk of typhoid fever. Data collected was entered into Statistical Package for Social Science (SPSS) after being checked for completeness, edited, and coded. Results: The study found that typhoid fever was significantly associated with not washing hands with soap (Adjusted Odds Ratio = 6.08; 95% CI 2.43 - 15.21), eating unwashed raw vegetables (Adjusted Odds Ratio = 4.63; 95% CI 1.62 - 11.73); eating mobile food (Adjusted Odds Ratio = 10.89; 95% CI 4.08 - 29.05); eating street food (Adjusted Odds Ratio = 3.28; 95% CI 1.27 - 8.45); no access to safe drinking water (Adjusted Odds Ratio = 6.08; 95% CI 2.11 - 17.52); no access to healthy latrines (Adjusted Odds Ratio = 3.59; 95% CI 1.47 - 8.78). Conclusions: The study found that typhoid fever was associated with inadequate food and personal hygiene, and poor housing.