Burden of febrile illness complications and determinants of typhoid fever complications in the Ashanti region of Ghana

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Abstract Background and Aim Typhoid fever remains a significant global public health concern and ranked among the top ten causes of outpatient illnesses in Ghana from 2020 to 2022. Identifying the risk factors associated with its complications is crucial for reducing mortality. This study aimed to assess the prevalence, types, and risk factors of complications in febrile patients, with a specific focus on typhoid fever in the Ashanti region of Ghana. Method Clinical data from 238 patients with positive blood cultures, obtained from the surveillance for Severe Typhoid in Africa program between May 2016 and September 2019 were analysed. Statistical reduction techniques were used to identify key variables, and logistic regression identified factors independently associated with typhoid complications. Results The overall prevalence of complications amongst the febrile patients was 55% (131/238). S. Typhi and non- S. Typhi infections resulted in 38.9% (28/72) and 62% (103/166) complications, respectively. In general, notable complications associated with febrile illnesses included sepsis (23.5%, 56/238), severe anaemia (19.3%, 46/238), gastrointestinal bleeding (3.8%, 9/238), and intestinal perforation (2.5%, 6/238). Typhoid fever contributed to 18.1% (13/72) of sepsis, 8.3% (6/72) of gastrointestinal bleeding, and 5.6% (4/72) each for severe anaemia and intestinal perforation. Mortality rates were 1.4% (1/72) in S. Typhi patients and 2.4% (4/166) in non- S. Typhi patients. Complications were independently associated with a longer duration of illness before hospital visit (AOR 8.6, 95%CI 1.2-64.7, p=0.035) and rural residence (AOR 0.1, 95%CI 0, 0.7, p=0.024). Conclusion The study highlights a significant burden of complications among febrile patients in Ghana, with typhoid fever as a major concern. Delayed healthcare-seeking behaviour significantly increased the risk of typhoid complications, while the rural residence appeared to be protective. These findings underscore the need for timely diagnosis, prompt treatment, and health education, especially in urban areas. Strengthening preventive strategies, including vaccination, remains essential to reducing typhoid-related complications and mortality.

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