Comparative Diagnosis of Typhoid Fever using Typhidot and Widal Methods with Culture At The Korle Bu Teaching Hospital in the Greater Accra Region, Ghana.

Abstract

Typhoid fever remains a persistent public health challenge in many low- and middle income countries, including Ghana. Accurate and timely diagnosis is crucial for effective case management and prevention of antimicrobial resistance. Although stool culture is considered the gold standard, limited laboratory capacity has necessitated reliance on rapid serological methods such as Widal and Typhidot tests, whose diagnostic accuracy remains uncertain in the Ghanaian context. The current study compared the diagnostic performance of Typhidot and Widal tests with stool culture for the detection of typhoid fever at Korle-Bu Teaching Hospital, Accra. Furthermore, this study examined the relationships between socio-demographic factors, clinical symptoms, personal hygiene practices, antibiotic use, and typhoid infection. A crosssectional study was conducted among 234 suspected typhoid patients. Blood and stool samples were tested using Widal, Typhidot, and stool culture methods. Sensitivity, specificity, predictive values, and agreement were calculated. In addition, logistic regression was used to examine the associations between infection and risk factors. The prevalence of typhoid fever varied widely by method: Typhidot (50.4%), Widal (35.9%), and stool culture (5.1%). Typhidot detected all culture-positive cases, showing 100% sensitivity and 52.3% specificity, while Widal recorded 83.3% sensitivity and 32.4% specificity. Both tests had poor PPVs (approximately 10.2% and 6.3% respectively) but high NPVs (>97%). Agreement between Typhidot and Widal was moderate (κ = 0.47, p < 0.001). Socio-demographic variables (age, sex, marital status, and insurance status) and most clinical symptoms showed no significant associations with infection. However, a prior history of typhoid was associated with a higher positivity rate (AOR = 2.06, p = 0.008). Typhidot outperformed Widal in terms of sensitivity; however, both tests exhibited low specificity and predictive values compared to stool culture, thereby limiting their reliability as standalone diagnostic tools. Strengthening culture-based diagnostics and promoting rational antibiotic use are crucial for enhancing case management and reducing antibiotic resistance.