DRC: MSF team helps control typhoid outbreak in Popokabaka

People’s living conditions in Popokabaka mean that outbreaks of waterborne diseases are common. There is limited access to clean drinking water and most homes lack sanitary facilities.

“In this area, people drink water from the river, where we also bathe and clean the dishes,” says Chadrac. “How do you expect us to avoid the disease?”

To reduce people’s risk of catching the disease as they go about their daily life, MSF health promoters have held awareness-raising sessions in schools, health facilities, and within the community. MSF teams have also tracked the course of the disease throughout the area in order to respond quickly and effectively.

"In addition to support for care and sensitization [of the community], we conducted epidemiological surveillance of the entire zone in order to adapt our response to the evolving situation," says Mavunda. "This work quickly revealed that the number of cases was much higher than initially estimated. Every day, the hospital was receiving patients with typhoid fever referred from peripheral health centers. In total, it is estimated that more than 3,700 people have been affected since the beginning of the year."

Surgery for patients with complications

Endemic in sub-Saharan Africa, typhoid can cause serious complications in 10 to 15 percent of patients, including digestive hemorrhage, intestinal perforation, and peritonitis—all of which require surgery.  

"Given the number of complicated cases in the area, we directly integrated a surgical component into our response," says Mavunda. "We've dealt with a lot of cases of peritonitis, which is a serious infection that can easily lead to death. Acute peritonitis sometimes requires multiple operations on the same patient. Before MSF launched its response, 29 in-hospital deaths had been reported, almost all of them post-operative. Providing surgical support and post-operative care was therefore fundamental.”

Eleven-year-old Tharcisse developed complications from typhoid and has already had four visits to the operating theater.

"The first three operations were performed last May and June," says his father, also named Tharcisse. "After the first two, the situation had not improved. I was about to take him to Kinshasa to be treated there, but when I heard that the MSF team had arrived, I decided to wait. And it was the MSF team that organized the rest of the operations.”

Three-year-old Mabweni also had to be operated on a second time after he was admitted to Popokabaka hospital experiencing complications from typhoid.

"He had his first operation on July 4,” says his father, Julva. “Three days later, there were other complications and he had to go through another operation. This has been done and we are waiting for him to recover to go home.”

From mid-July to mid-September, 2,180 patients were treated and 20 surgical operations were performed with MSF’s support. In addition to treating typhoid fever, the MSF team also operated on 11 people for surgical emergencies and treated more than 3,500 patients suffering from simple and severe malaria.

Cases of typhoid fever are now decreasing, allowing the MSF team to respond to emergencies elsewhere in the country, but staff at health facilities across the region will need to be vigilant in the coming weeks. Water, hygiene, and sanitation – the main factors in the spread of typhoid fever – are still far below what is needed in the Popokabaka area, and the onset of the rainy season could lead to an increase in cases. Before heading elsewhere, the MSF emergency team donated medicines, medical, and surgical equipment to Popokabaka hospital to strengthen care, but a more structural response is needed to improve people’s living conditions and tackle the disease at its source.

MSF’s emergency team supported the Ministry of Health in treating patients with typhoid fever at Popokabaka hospital and seven other health facilities in and around Popokabaka city from mid-July to mid-September 2021.