The Democratic Republic of Congo (DRC) is the epicentre of typhoid fever, a survey shows.

According to the Severe Typhoid in Africa programme, which offers new typhoid fever burden estimates from six high burden countries on the continent — DRC, Madagascar, Burkina Faso, Ethiopia, Ghana and Nigeria — the country is exhibiting a high incidence rate with 315 cases per 100,000 individuals.

Four countries recorded more than 100 cases for every 100,000 person-to-years of observation, which is considered a high burden. In DRC, children between 2-14 years of age were shown to be at highest risk across all 25 study sites.

The number of suspected typhoid intestinal perforations was notably high, particularly in DRC and Ghana, suggesting that a substantial proportion of typhoid infections go undetected and untreated.

Read: Drug-resistant typhoid cases rise, say scientists 

Without prompt treatment, severe complications such as intestinal perforation or neurological issues may develop, leading to lasting consequences, and even death.

There is a high burden of typhoid fever in Sub-Saharan Africa, according to the study in The Lancet Global Health, with an estimated 12.5 million to 16.3 million cases of typhoid every year with 140,000 deaths.

“This burden combined with the threat of typhoid strains resistant to antibiotic treatment calls for stronger prevention strategies, including the use and implementation of typhoid conjugate vaccines in endemic settings along with improvements in access to safe water, sanitation, and hygiene,” said the study.

However, with generic symptoms such as fever, fatigue, and abdominal pain, and the need for blood culture sampling to make a definitive diagnosis, it is difficult for governments to capture the true burden of typhoid in their countries.

Typhoid fever is a public health problem in low-and middle-income countries with unsafe drinking water supplies and the quality of life is poor.