The global burden of typhoid fever was estimated at 17 million cases with 178,000 deaths in 2015 with more cases being reported in South Asia, South East Asia, and Sub-Saharan Africa. ¹ Whereas typhoid fever appears to be less common or under ascertained in Africa compared to Asia, more recent studies confirm that typhoid fever incidence is high in some parts of Africa. ²

The prevalence of the fever in Uganda was reported to be 7.6% during the February, 2015 disease outbreak that started from Kampala City ³ and by the month of December 2015, the cases were reported by nearly all districts in Uganda with central region reporting the highest numbers followed by Northern, Western and Eastern respectively. In Mbale specifically, the prevalence of typhoid fever was reported at 1.3%. ⁴

The recommended diagnosis for typhoid fever in Uganda is by use of culture, rapid antibody tests, Polymerase Chain Reaction (PCR) and relative leukopenia tests and not Widal’s test ⁵ ; and the antibiotics used for treatment include Ciprofloxacin, Chloramphenicol, Ceftriaxone, and or Amoxicillin depending on the fever’s severity. ⁵ Private health facilities in Mbale city are still depending on the Widal’s test that is no longer recommended to diagnose typhoid fever which isn’t the case in public health facilities. The test is not recommended because of its low positive predictive value (60%) and low negative predictive value (75.2%). ⁶ The non-compliance to the diagnostic guidelines of diagnosing typhoid fever is causing inappropriate drug prescription and multidrug resistance development against antibiotics like ampicillin, chloramphenicol and ciprofloxacin. ⁷

Since accurate diagnosis is crucial to the management of typhoid fever, ⁷ the research aimed at determining the predictive values of Widal’s test against culture and the antimicrobial sensitivity profile of S. typhi isolates from patients attending private health facilities in Mbale city, Uganda; and give information about how typhoid fever is being managed in private health facilities, act as a basis for developing or re-enforcing policies on typhoid fever management, and also act as a reference to other researchers adventuring in the same field of study.

This study revealed the Widal’s test had a positive predictive value (PPV) of 6.8% implying that, there was a 6.8% probability that the participant with a positive Widal’s test result truly had typhoid fever. ^{8 , 9} This finding was similar to most of the studies reviewed whose PPV was below 60% with exception of Minjibir (2020) whose PPV was 68.2%. ^{6 , 10 – 15} Therefore, the Widal’s test is not dependable for the diagnosis of typhoid fever. ¹⁴ This study revealed that the Widal’s test had a negative predictive value (NPV) of 100%. This implied that, there was a likelihood that the participant with negative Widal’s test results truly didn’t have typhoid fever. ^{8 , 9} This finding was similar to most of the studies reviewed whose NPV was above 90% with exception of Mengist (2017) and Mawazo (2019) who obtained 75.2% and 89.7% respectively. ^{6 , 10 – 15} Therefore, the Widal’s test result can serve as a good indicator of the absence of typhoid fever. ¹¹ This study revealed that the Widal’s test had a sensitivity of 100%. This indicated that, the Widal’s test has the ability to rule out the presence of typhoid fever and this surpasses that of Widal’s test acceptable of 70%. ¹⁶ This finding was similar to most of studies with exception of Yousif (2018) whose value was 26.5%. ^{6 , 10 – 15} This study also revealed that the Widal’s test has a specificity of 76%. This indicated that Widal’s test has the ability to identify positive cases although with a high false positive rate of 93.2% (41/44). This was so probably because typhoid fever is uncommon among the participants hence giving a large proportion of false positive test results and this explains partly why this study’s positive predictive value was low (6.8%). ¹⁷ This finding was similar to most of the studies reviewed whose value was above 70% specificity with exception of Deksissa and Gebremedhin (2019), Mawazo (2019) and Muthoni (2016) whose values were 44.4%, 18.3% and 47.7% respectively. ^{6 , 10 – 15} As described by many scholars, false diagnosis of typhoid fever can lead to an inappropriate treatment which eventually leads to antibiotic resistance development, a serious threat to the global public health which if not addressed in time, may lead to mortality. ^{18 , 19} This study described the antibiotic sensitivity profile of S. typhi. Chloramphenicol was 67% (2/3) resistant, a finding was similar to Wasihum et al (2015) and Deksissa and Gebremedhi (2019) who reported 76.1% and 20% resistance respectively. ^{11 , 20} Augmentin was 67% (2/3) resistant, a finding similar to Wasihum et al (2015) and; Deksissa and Gebremedhi (2019) also reported 2.6% and 100% resistance. ^{11 , 21} This study’s finding was however contrary to Chaudhary et al (2016) who reported Augmentin as 94.3% sensitive. ¹⁰ This study also revealed that Ciprofloxacin was 100% (3/3) sensitive which finding was contrary to Wasihum et al (2015) who reported (76.1%). ²¹ This study’s finding of Ceftriaxone being 67% (2/3) intermediate was contrary to Deksissa and Gebremedhi (2019) who reported 100% sensitivity. ¹¹

In comparison with culture, the gold standard, Widal’s test is highly sensitive (100%) with a low specificity of 76% and PPV (6.8%) and NPV (100%). It should therefore be followed up with a more specific confirmatory test. S. typhi was highly sensitive to both Ciprofloxacin and Imipenem; and resistant Chloramphenicol and Augmentin.

The data that support the findings of this study are available on request from the corresponding author, [SG]. The data are not publicly available because they contain information that could compromise the privacy of research participants. In the event that the reader needs access to the said data, they could do so by writing an email to the corresponding author, [SG] detailing justification for the primary data source request.