الفهرس 
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Abstract
Typhoid fever is a global health problem that is estimated to cause 21 million illnesses and 200,000 deaths annually worldwide (Crump et al., 2004). Ingestion of contaminated drinking water and food is the most common route of disease transmission. Although typhoid fever is common in many regions of the world, the actual burden of the disease is poorly defined in most endemic countries. The widespread prevalence of multidrug-resistant typhoid fever also influences the true impact of the disease in these regions (Gasem et al., 2001). With the advent of new vaccines for typhoid fever the incidence of T F outbreaks will be decreased. There is a need for timely and accurate assessment of the disease burden in typhoid-endemic countries to guide decisions about the allocation of scarce resources for disease control and prevention programs (Linfy et al., 2001). This study aims to determine the factors affecting the occurrence of typhoid fever of all age groups. SUBJECTS AND METHOD A descriptive study design is used to fulfill the aim of the study.Two types of subjects were used in the current study:1. A purposive sample of 200 confirmed TF cases were selected from the patient’s list at the Fever Hospital, private clinics, 2 private hospitals, from both sex and age groups. Then the sample was divided into adult cases and child cases:The adult cases consisted of 142 adult. 1.Child cases (18 years and below) consisted of 58 cases 2. Also, 200 subjects were selected as controls:One hundred fifty adults were randomly recruited from the community as controls.Also, 50 children were randomly selected from the community as controls.The researcher was keeping recruiting the cases till reaching the required number (from February – October 2011, two days/week),This study took place in the fever hospital which is located south of Kafer El Zyat. It is on the agriculture rode to Cairo-Alexandria. This city is famous by agriculture and industry. The total population number is 412378 persons and there are 37 villages related to Kafer El Zyat.Tool of data collection: A structured interview Questionnaire was developed by the researcher that contained two parts was used to collect the necessary data. The questionnaire was formed of two parts:A. Personal factors: Such as 1.sociodemographic data of subjects, 2. past medical history, 3. personal hygienic practices; 4. assessment of subject’s knowledge about Typhoid fever was also done.B-Environmental factors: : as source of water used for drinking,washing vegetables and cooking. Also, they were asked about type of housing, persons per household, ventilation of the house, carriage system. II. Biophsilogical measurement for water analysis: Sixteen random samples of water from Nile River, the tap and the canals were taken from the same areas where the positive Typhoid cases were found. The water samples were collected in sterile containers to be analyzed at Cairo Research Institute.The results of the study shows comparison between child typhoid cases and control children regarding personal hygienic practices,environmental factors, knowledge about typhoid and past medical history. Also, the finding reports the same factors for confirmed TF adult cases and the control group. Factors in children groups Personal Factors of children groups:The majority of children in both groups were living in rural areas,more than one third of children cases and control group (37.9%, & 38% respectively) are in primary schools. there is no significant difference between child cases & controls regarding socio demographic data(p>0.05).Also, there is no significant difference between child case & controls regarding past medical history (p>0.05). However, 5.2% of child cases and 4% of controls had previous infection of typhoid.The majority of child cases and controls (79.3% and 80.0% successively) have no knowledge about TF. However, there are no statistical significance differences between both groups in all the knowledge items Regarding personal hygienic practices, 72.4% of the cases are drinking and eating outside house compared to 30% of the controls. Like wise, all the children’s personal hygienic practices are statistically significantly different with better practices of the control group as for hand washing, use soap for hand washing, washing raw vegetables before eating or boiling milk before drinking with statistical significant difference in all items of personal hygienic practices.Concerning to environment factors the results presents that the majority of cases and controls have tap water in the house (79.1% 84%respectively). While 20.9% of cases have pump compared with 16% of the control group. The differences between the two groups are not statistically significant. Factors in Adult groups Regarding comparison between adult cases and controls personal factors, the results shows that less than half of the typhoid cases (40.1%)and 34.7 of the adult control group are house wives. Also, 21.1% and 15.3% of the typhoid cases and controls are farmers. Also, more than one third of the cases (35.9%) are illiterate compared with 27.3% of the control group. However there are no statistical significant differences between the two groups.Also, the comparison between adult typhoid cases & controls regarding past medical history shows no statistical significant differences between the two groups. However, previous infection by typhoid was reported by 20.4% of the cases and 15.3% of control group are infected by typhoid before.In addition, the result clarifies the comparison between adult cases & controls regarding knowledge about typhoid fever. It shows a significantly higher knowledge than that of the cases in most items of knowledge about TF.As for the comparison between adult cases & controls regarding hygienic personal practice, the result shows statistical significant difference in their practices where 58.5% of adult cases compared to 44% of controls eat and drink outside house, Also, 47.2% of the cases reported that they don’t wash their hands regularly compared to 34% ofthe control group. And, 62.7% of the cases compared to 48.7% of the control do not use soap for hand washing. Also, the majority of the cases do not boil milk before drinking. Like wise, 21.8% of the cases compared to 34.7% of the control use water and vinegar for washing raw vegetables, with statistical significant difference between the two groups. The Multivariate regression analysis of personal hygienic practices among the studied children that lead to TF shows that the only important risk factor is drinking milk before boiling and eating unwashed raw vegetables (OR=1.39 & 1.27, respectively) P-value (<0.05). The Multivariate regression analysis of personal hygienic practices among the studied adults that lead to TF shows that the only important risk factors is drinking milk before boiling & eating unwashed raw vegetables (OR=1.39 & 1.27, respectively) P-value (<0.05).Based on the finding of the study, the following important recommendations are proposed:
• Raise community awareness about transmission of typhoid
• Children and adults should be carefully screened and educatedabout personal hygiene.
• Food handlers should be educated about the importance of personalhygiene prior to handling food or utensils and equipment.