​Africa needs clean water to cut the high typhoid rate


Africa can be proud of many remarkable achievements in recent decades. Giving 427-million more people access to improved drinking water since 1990 — an average of 47 000 people every day across sub-Saharan Africa — ranks among the most impressive and most important.

Safe drinking water and good sanitation bring huge benefits. They cut the death toll from disease, lift the long-term burden of ill-health and release many hours spent fetching water every day for more productive activity. African economies have lost an estimated $19.3-million in recent years because of poor sanitation.

It is to highlight this importance that the United Nations marks World Water Day every year on March 22. The aim is to celebrate progress made and to encourage countries to redouble efforts to ensure every family reaps the reward of a safe and reliable water supply.

Despite real progress, there is, still a long way to go until this goal is reached in Africa. Nearly one in two of the 783-million people without access to clean water globally live in the sub-Saharan region. And a recent study into typhoid, one of the diseases most closely connected with contaminated water, has underlined the heavy price that individuals and communities continue to pay.

The direct link between typhoid and contaminated water and food is not new. It was identified as the source of the mass epidemics that caused such misery in the rapidly expanding cities of Europe and North America nearly 150 years ago.

But there remain worrying gaps in our knowledge about the disease and our ability to prevent it. There are still nearly 22-million typhoid cases globally every year, leading to over 200 000 preventable deaths — many of them children.

It had been thought, for example, that the highest rates of the disease were in south Asia. But a recent study, the Typhoid Fever Surveillance in Africa Programme (TSAP), found that in some areas of Africa the threat from typhoid was just as severe.

To date, TSAP is the most comprehensive, standardised analysis of salmonella infections in sub-Saharan Africa. Researchers for the study, funded by the Bill & Melinda Gates Foundation and carried out by local partners, tested for typhoid in blood samples in 10 African countries from Senegal to South Africa.

The study found that typhoid was twice or three times as common as previously thought, with its incidence, in some areas, at or even above rates in south Asia. It also confirmed that children aged two to 14 carry the greatest burden of the disease.

Findings also called into question the belief that typhoid occurs largely in urban areas with tightly packed populations. The study found that there could be a higher rate of the disease in the countryside.

The data demands a more intense approach to tackling typhoid across sub-Saharan Africa that can be applied in rural as well as urban settings. The priority must be to extend access to safe drinking water as quickly as possible.

But this is going to require significant resources and many years. In the meantime, we need an increased emphasis on preventive measures and improved treatments while this longer-term ambition is realised.

Prevention must include the development of effective new vaccines to provide protection for those groups most at risk, especially children. By giving long-lasting immunity, not only can we protect individuals from the symptoms of typhoid itself, but we can also prevent them from becoming unsuspecting carriers of the disease without symptoms — a major cause of infections and epidemics. With more people vaccinated, fewer people get sick, and when fewer people get sick there is less of a chance of contaminating water and food sources. The vicious cycle of typhoid can be broken.

We also need to see new treatments developed to help overcome drug-resistant bacteria so we have effective lines of defence for people who do get sick. Additional research is required to better understand which groups and areas suffer most from the severest forms of typhoid with the most devastating effects so we can focus our efforts more precisely.

Typhoid is a disease that takes far too many young lives and deters economic and social development. We are making significant progress in honing in on typhoid in Africa, and with improved data and better tools to protect communities, we can help the continent fight the scourge of this terrible disease.

Anita Zaidi is the director of the enteric and diarrhoeal diseases programme at the Bill & Melinda Gates Foundation. Follow her on Twitter at @AnitaEDD.

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