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Progress in management of typhoid perforation
A Y Ukwenya1, A Ahmed, E S Garba
1Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. yahayaukwenya@rocketmail.com
Annals of African Medicine
|November 9, 2011
Summary
The case fatality rate for typhoid perforation has decreased significantly worldwide due to advances in surgical care. However, disparities in outcomes persist, particularly in West Africa, highlighting the need for improved quality of care and prevention strategies for enteric fever.
Area of Science:
- Medical research
- Surgical outcomes
- Infectious disease epidemiology
Background:
- Typhoid perforation (TP) remains a significant cause of mortality globally.
- The case fatality rate (CFR) for TP has shown a variable decline over the past decades.
Purpose of the Study:
- To review the historical progress in the management of typhoid perforation from 1960 to 2010.
- To highlight current principles, controversies, and advances in TP treatment.
- To analyze factors influencing variations in CFR for TP.
Main Methods:
- Systematic review of publications on typhoid and perforation from 1960 to 2010.
- Searches conducted primarily via Medline and Ovid databases.
- Estimation of median CFR by decade from reported studies.
Main Results:
- Median CFR for TP declined from over 50% in 1960 to single digits in some countries by the last decade.
- West Africa showed a higher median CFR of 16%.
- Variations in CFR are linked to perforation-operation interval and quality of care.
Conclusions:
- Significant improvements in TP management have led to better patient recovery rates.
- Prevention of enteric fever in endemic areas remains a critical priority.
- Addressing disparities in care quality is essential to further reduce TP mortality.
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