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The Resurrection of Typhomalarial Fever in South Sudan

By: Gabriel Garang Pioth

March 12, 2013 (SSNA) -- It has become a common phenomenon across South Sudan for a patient who has malaria-typhoid like symptoms and went for blood test in their local pathology laboratory to be told ‘you have malaria-typhoid’. The term typhomalarial fever or malaria-typhoid fever has it is called in South Sudan was first coined by the United State Army in the mid-19th century. After thorough investigations into the authenticity of this new disease, nothing of such disease was found and the term just remains in the medical dictionary since then.   

When the word malaria-typhoid is mentioned again in the 21st century, it makes people wonder whether the South Sudan medical professionals are still backwards or are they coning the poor people? It wouldn’t be a surprise to find unscrupulous medical professionals who want to capitalise on the fear of malaria and typhoid fever in South Sudan to get quick bucks. So how would you make sure you are not wrongly diagnosed next time you visit your local pathology laboratory?

First, the prevalence, agents and mode of transmission of these two diseases are somewhat different. Typhoid fever is common in countries where sanitation and majority of the population are poor whereas malaria is mostly endemic in the tropics and sub-tropical areas. This means that the malaria incidences at this time of the year would be common in swampy areas and along the river Nile or other major rivers in South Sudan. While Typhoid Fever is caused by salmonella (S.) species, malaria is caused by plasmodium species (protozoan). The mode of transmission of salmonella species is through the consumption of faecal contaminated food or water by an individual. Conversely, the malaria parasite (plasmodium species) enters the person’s blood system via the female anopheles mosquito bite, blood transfusion, organs transplant or sharing of needle/syringe contaminated with blood from infected person.

Secondly, both diseases have different signs and symptoms. The signs and symptoms of typhoid fever include high fever, chills, cough, watery diarrhoea, bradycardia, malaise and low blood pressure. It often occurs in overcrowded, flooded and unhygienic areas where sanitation system is compromised. On the other hands, symptoms of malaria include high fever, chills, sweats, headaches, nausea and vomiting, body aches and general malaise. The symptoms of malaria occur in three stages: (i) cold stage (shivering chill); (ii) hot stage (fever, headaches, vomiting) and (iii) sweating stage (sweats and malaise/tiredness). Malaria and typhoid fever only share high fever, generalised aches and malaise. These are the things you should ask yourself if you got them next time you are told ‘you have malaria-typhoid’.

The third point of difference between the two diseases lies in the laboratory test. The gold standard test for Malaria parasite is thick and thin blood film, which is relatively simple, quick and cheaper to perform. It takes less than 20 minutes from taking a drop of blood from a finger prick (puncture) onto the slide and staining it with Giemsa stain to the viewing of the stained slide under the microscope to find out the diagnosis. In contrast, the widely use test for salmonella species in sub-Saharan Africa is a Widal agglutination test. This laboratory technique lacks: (i) reproducibility (you cannot obtain almost the same results if you repeat it next time or perform it in another lab); (ii) precision and sensitivity due to cross-reactivity of Widal agglutinins with other bacterial antigens and (iii) established reference range that fit the population being tested. The fact that the laboratory scientists in South Sudan get the results of typhoid fever in a single day in their small laboratories says two things: either they have advanced testing equipment or use presumptive diagnosis. There are incidences in which a person has been continuously diagnosed with malaria-typhoid while the signs and symptoms indicate the patient may have anaemia which he/she might have acquired from chronic malaria.

The current and accurate laboratory techniques for isolating Salmonella enterica serotype (S. typhi) in blood, urine or stool cultures is expensive and normally take about 3 to 4 days to get the results. It also requires advanced training and equipment which are beyond the capacity of majority of local laboratories in South Sudan.

Lastly, the rate at which the patients are being diagnosed (and its concomitant administration of wrong medications) with malaria-typhoid fever in South Sudan leaves a lot to be admired. Also the community seemed to have resigned into the belief that there is a malaria-typhoid fever outbreak or endemic in South Sudan. Since there are no rapid and accurate alternatives around, this trend is likely to cause more misdiagnosis and deplete enormous resources from the poor families for unforeseeable future. In addition, it will lead to the emergence of new strains of salmonella enterica serotype typhi, which areresistant to common antibiotics.

It is therefore up to the individuals to check their background and status before accepting the diagnosis. The Republic of South Sudan Ministry of Health should also ensure that there are proper and enforceable quality assurance practices in all laboratories across South Sudan states. There should also be criminal and financial penalties or loss of accreditation for the laboratories that give wrong and misleading laboratory results to the patients.

The author is a South Sudanese who reside in Australia. He can be contacted by email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

World AIDS Day 2011 Celebration in South Sudan

By Dr. Lul P. Riek

December 3, 2011 (SSNA) -- On 1st December, 2011, the people of South Sudan will join millions of people around the world to observe World AIDS Day. Like no other illness, AIDS is the most single destructive epidemic in the recent human history because it has killed more than 25 million people and an estimated 34 million people are living with HIV. The available information indicates that 4,900 people die every single day from HIV/AIDS in which 90 percent of them are from sub-Saharan Africa and 7,100 people are infected with the AIDS virus globally every day. No other illness has faster infection rate than HIV/AIDS.

This year theme is “Getting to Zero” which means Zero new HIV infections, Zero Discrimination and Zero AIDS related deaths. The first step in getting to zero, however, is for all sexually active people in South Sudan to know their HIV status. The HIV test is voluntary, free and confidential, and is being offered in more than 106 VCT centers across ten states. It is a tough decision to make. But it is a decision that must be taken by all of us if we have to get to Zero new infection. A person may feel perfectly healthy for several years after becoming infected with HIV, and may be at risk for passing on the virus to others especially their loved ones. The only way to know for sure if an individual is infected with HIV is to be tested.

Despite the ongoing effort in the country to boost HIV/AIDS awareness and knowledge, many people still wonder why we should celebrate this day; instead we should be looming in despair, crying and mourning. The purpose of world AIDS day celebration is to educate the public on HIV/AIDS related issues by providing the communities with accurate up-to-date information, advocate for more services such as prevention, care, treatment and support for the people living with HIV/AIDS. This day is an excellent opportunity to remember and honor people who have died from HIV/AIDS. Besides, it is a day to draw an urgent attention to reduce stigma and discrimination that surround the epidemic and to show compassion, respect and dignity for those who are living with the disease. The Ministry of Health estimates that more than 300,000 (Three Hundred Thousand) people in the country are living with Human Immunodeficiency Virus (HIV) and 3.8 millions are at risk of contracting the virus every single day. In which one in ten of those people living with HIV is unaware of his or her status.

The second step to getting to zero is ensuring that all HIV-infected individuals receive timely linkage to medical care. Currently, South Sudan has 21 centers that are providing professional services to more than 15,000 HIV/AIDS patients. The third step is to show compassion, dignity, respect and equal right to those who are living with HIV/AIDS.

Getting to Zero to avoid new infections for newly independent South Sudan is just too much to ask in my opinion but possible if we are all committed. Because all kind of risk factors for the rapid and quick spread of HIV are here in big number, lack of awareness and knowledge (result from South Sudan Household Survey 2010) show that only 9 percent of South Sudanese women age 15-49 years are knowledgeable about three ways of preventing transmission of HIV.

The other problem facing South Sudan is a massive influx of female sex workers to South Sudan from the African countries hardest hit by HIV infection where some of them living openly with virus in their own countries, multiple concurrent sexual partners practice, poverty, illiteracy, high levels of stigma, discrimination, and denial regarding HIV/AIDS. There remains institutionalized powerlessness among women and girls that obviate safer sex practices in most parts of South Sudan. Cultural insubordination of women is a factor in prohibiting women to practice safe sex because most men do not usually engage in protected sex with condoms. Additionally, cultural norms such as tribal marking practices, polygamy and widow inheritance are also ingredients for rapid spread of the disease.

In Juba, the capital of South Sudan, there is no recreations centers; alcohol and sex are the main pastimes. The concern is that extensive consumption of alcohol and practice of unsafe sex may lead to high-risk behavior and the spread of HIV/AIDS. A trend reversal requires that three daunting medical challenges be dealt with immediately; these are (a) expansion of programs for the control and prevention of new HIV infections by increasing awareness among people at highest risk; (b) implementation of guidelines and criteria for standard clinical management of HIV/AIDS, and (c) scale-up of biomedical research.

This World AIDS Day reminds us that HIV/AIDS epidemic may be even more devastating than the civil war which had claimed 2.5 million lives. Now is not the time to mang-mang. Now is not the time to point fingers and look left or right to find someone to blame. It is the time to act immediately, decisively and we must act together with share responsibility. Our message is loud, simple and clear. Prevention is our most powerful weapon against the epidemic. All South Sudanese people should take steps to ensure that they do not become infected, that they do not infect others and that they know their status.

For young people, both girls and boys, the future of this country belongs to them; they must take responsibility of their sexual behaviors and should not expose themselves to unnecessary risks. Always be reminded that our fathers and mothers when to war not because there was no enough sex nor alcohol in South Sudan. We went to war because there was no development going on in South Sudan, because our children were not going to schools, because of lack of medical services, lack of clean and safe water, absent of road networks, injustice and discrimination by our own former government in Khartoum, lack of infrastructures and many more. Let’s make no mistake about it; our failure to prevent the spread of the epidemic could turn SPLM vision of creating a prosperous, peaceful, secular South Sudan into mission impossible.

It appears that many people are still reluctant to be tested because of the fear of discrimination and stigma associated with HIV. Obviously, many people would die from AIDS; it would exacerbate existing poverty, which in turn leaves individuals vulnerable to the adverse affects of the disease.

As such government alone cannot stop the spread of HIV infection or even doctors or nurses, let us all heed the call, everyone should take the lead in the fight against HIV/AIDS. Each individual needs to take a moment to think about the issue of AIDS crisis seriously, we need to talk openly about it and share the concern with our families, friends, collogues, and with our communities. Together we can protect our country from HIV/AIDS.

NB: The author is a Director General for Community and Public Health in the Ministry of Health. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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