Introduction: In early October 2015, the health facility in Mahama, a refugee camp for Burundians, began to record an increase in the incidence of a disease characterized by fever, chills and abdominal pain. The investigation of the outbreak confirmed Salmonella Typhi as the cause. A case-control study was conducted to identify risk factors for the disease. Methods: A retrospective matched case-control study was conducted between January and February 2016. Data were obtained through a survey of matched cases and controls, based on an epidemiological case definition and environmental assessment. Odd ratios were calculated to determine the risk factors associated with typhoid fever. Results: Overall, 260 cases and 770 controls were enrolled in the study. Findings from the multivariable logistic regression identified that having a family member who had been infected with S. Typhi in the last 3 months (OR 2.7; p < 0.001), poor awareness of typhoid fever (OR 1.6; p = 0.011), inconsistent hand washing after use of the latrine (OR 1.8; p = 0.003), eating food prepared at home (OR 2.8; p < 0.001) or at community market (OR 11.4; p = 0.005) were risk factors for typhoid fever transmission. Environmental assessments established the local sorghum beer and yoghurt were contaminated with yeast, aerobic flora, coliforms or Staphylococcus. Conclusion: These findings highlight the need of reinforcement of hygiene promotion, food safety regulations, hygiene education for beverage and food handlers in community market and intensification of environmental interventions to break the transmission of S.Typhi in Mahama. © Jose Nyamusore et al.

Refugee camps Case-control study Burundi Typhoid fever Salmonella typhi risk factors Epidemiology

food contamination beer Salmonella enterica serovar Typhi yoghurt hand disinfection yeast food processing bacterial transmission Staphylococcus laboratory diagnosis home transmission food safety Salmonella typhi environmental sanitation water analysis analysis sorghum aerobic bacterium bacterial flora Rwanda coliform bacterium Toilet Facilities clinical feature human middle aged typhoid fever controlled study Logistic Models nonhuman procedures epidemiological data Young Adult hygiene Humans hand washing sanitation Adolescent Infant, Newborn male environmental factor female preschool child Infant risk factor Risk Factors Child, Preschool newborn refugee camp Refugee Camps symptom standards Incidence isolation and purification epidemic Article Retrospective Studies Disease Outbreaks major clinical study adult health education market Case-Control Studies statistical model retrospective study case control study attitude to health Child