Prevalence and Determinants of Typhoid Fever Among Patients Attending General Hospital Lokoja, Kogi State

Typhoid fever caused by Salmonella enterica serovar Typhi remains endemic in Nigeria, perpetuated by inadequate water supply, poor sanitation, and reliance on unreliable serological tests. This cross-sectional study determined the prevalence and key determinants of typhoid fever among patients presenting to General Hospital Lokoja, Kogi State, in the North Central geopolitical zone of Nigeria. A total of 200 febrile patients were enrolled between January and June 2024. Blood culture using BACTEC automated system was employed as the gold standard diagnostic method alongside the Widal slide agglutination test for comparative purposes. Sociodemographic and environmental data were collected using structured questionnaires. Blood culture confirmed typhoid in 12.5 percent of cases, while the Widal test yielded a 41 percent positivity rate. Concordance between both methods was only 58 percent, reflecting the poor specificity of the Widal test. Drinking water from open sources and absence of household toilets were the strongest epidemiological determinants. Multi-drug resistance was documented in 32 percent of confirmed Salmonella typhi isolates, including resistance to chloramphenicol, ampicillin, and cotrimoxazole. The study advocates for reduction in Widal test dependency, expanded blood culture services, typhoid conjugate vaccination campaigns, and prioritized WASH interventions in Kogi State. Keywords: typhoid fever, Salmonella typhi, Lokoja, Widal test, blood culture.