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CHAPTER ONE
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1.0 INTRODUCTION
Typhoid and malaria co-infection is a major public health problem in many developing countries of the world (Mbuh, et al., 2003). Typhoid fever is an acute life threatening febrile illness caused by the bacterium Salmonella enterica.
The bacillus is transmitted by water, milk or solid food contaminated  by faeces of typhoid victims or of carriers, that is healthy persons who harbors typhoid bacilli   without presenting symptoms,  It has been, estimated that there are about 22 million cases of typhoid fever and 200,000 related deaths occurrence world wide each year (Crump et al., 2004).
Malaria is caused by protozoan parasite of the genus plasmodium and phylum Apicomplexa. In humans it is caused by Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae and Plasmodium ovale. Moreover Plasmodium falciparum is the most important cause of this disease and is responsible for about 80% of malaria infection and 90% of deaths in sub-sahara African (Mendis et al., 2001) malaria caused about 400-900 million cases of fever and approximately one to three million deaths annually (Breman, 2001).
This represents at least one death every 30 seconds. Vast majority of cases occurs in children under the age of 5years and more so with pregnant woman (Green wood et al., 2005). Malaria and typhoid fevers remain a threat to many people in sub-sahara Africa for several reasons which include increase in HIV and AIDS spreads, increase resistance of Malaria parasite to wide range antimicrobial agent and lack of potable water (Alnwhich, 2001).
This disease has been associated with major negative economic impact   in regions where it is widely spread such as high cost of health care, working days lost due to sickness, days lost in education, decreased productivity  due to brain damage from cerebral malaria loss of investment and tourism etc (Greenwood et al., 2005).
An association between Malaria and enteric fever was first describe in the medical literature in the 19th century and was named typhomalaria fever by the United States Army (Smith, 1982). The relationship between the two diseases has been substantiated by studies from Africa, India and elsewhere (Ohanu et al., 2003).
Although malaria and typhoid are caused by different and distinct organism, a protozoan and a gram-negative bacillus and transmitted via different mechanism, both disease share rather similar symptoms (Uneke, 2008). Thus it is very common to see patients undergoing both typhoid and malaria treatment even when their diagnosis has not been confirmed (Mbuh et al., 2003).
Typhoid is an infectious disease caused by bacteria of salmonella group, Salmonella- typhi and Salmonella paratyphi A, B or C. The organism are gram-negative flagellated, non- encapsulated, non – sporulating  and facultative anaerobic bacillus in that it does not produce gas from glucose and form little or no water.
It has only one phase antigen and posses a capsular antigen called xi (Brooks et al., 2001). Salmonella Typhi causes typhoid (enteric) fever, the bacteria pass from the small intestine into blood through the lymphatic system, the recticulo endothelial system becomes infected as well as the gall bladder the organism invade the intestine causing inflammation and ulceration (Brooks et al., 2001).
The bacterium that causes typhoid fever may be spread through poor hygiene habit and public sanitation condition and sometime also by flying insects feeding on faeces. Public education campaign encouraging people to wash their hands after defecating and before handling food are important component according to the US centers for disease control and prevention (Ellis et al., 2006).
The chlorination of drinking water has led to dramatic decrees in the transmission of typhoid fever in the USA. Â A person may become an asymptomatic carrier of typhoid fever, suffering no symptoms, but capable of infecting others according to (Ellis et al., 2006).
Approximately 5% of people who contract typhoid continue to carry the disease after they recover, the most famous asymptomatic carrier was Mary Mallon commonly known as Typhoid Mary a young cook who was responsible for infecting at least 53 people with typhoid three of whom died.
From the disease Mallon was the first  apparently perfectly  healthy person known to be responsible for a typhoid (Epidemic) in the early 20th century, Mary carriers of typhoid were locked into an isolation ward never to be released  to prevent further typhoid cases, these people often deteriorated mentally, driven by the conditions they lived in.
Malaria is primarily a vector – borne parasitic disease caused by Plasmodium protozoan parasite and transmitted to men, through the bite of infected female anopheles mosquito the most serious forms of disease is caused by Plasmodium falciparum while the other species P vivax, P ovale and P malariae induce milder disease in humans.
However, the fifth specie   P knoelest is a Zoonosis that causes malaria in monkeys, but can also infect humans (Crump et al., 2004). Blood transfusion is also believed to be a dread vehicle for the transmission of many parasitic diseases including malaria (Epidi et al., 2008).
The co-infection of malaria parasite and salmonella specie is common especially in the tropic where malaria is endemic. The common detection of high antibody titre of these salmonella serotypes in malaria patients has made some people to believe that malaria infection can progress to typhoid or that malaria always co-infects with typhoid paratyphoid in all patients.
Hence, some people treat malaria and typhoid concurrently once they have high antibody titre for Salmonella serotypes, even without adequate laboratory diagnosis for malaria and vice versa (Crump et al., 2004).
 1.1 PREVENTION
Vaccination, sanitation and personal hygiene are the critical measures that can be taken to prevent typhoid. Typhoid does not affect animals and therefore transmission is only from human to human. Typhoid can only spread in environment where human faeces or urine are able to come into contact with food or drinking water, careful food preparation and washing of hands are crucial to prevent typhoid.
There are two vaccines licensed for use in the prevention of typhoid which are (1) the live, oral vaccine (solid as vivotif Berna) and (2) the injectable typhoid polysaccharide vaccine sold as typhine vi by Sanofi Pasteur and typheris by Glaxosmith Kline). Both are 50oC to 80oC protective and are recommended for travelers to areas where typhoid is endemic. (Brooks et al., 2001).
Significant progress has been made in the control and eradication of malaria through increased funding, expanded malaria control programme and a great decreased in the number of cases and deaths due to malaria. This control involves the use of mosquito nets that are treated with insecticides as well as clearing all the bushed and stagnant water where mosquito breeds in (Crump et al., Â 2004).
Clinical Findings: Salmonella typhi and Para typhi are primarily infective for animals that constitute the reservoir for human infection e.g. poultry, pigs, rodents, cattle, pets.
The organism enter via the oral route usually with contaminated food or drink. Salmonella which cause, the Enteric fevers (Typhoid fever). The ingested Salmonella reach the small intestine, from which they enter the lymphatic’s and then the blood streams.
They are carried by the blood to many organs including the intestine of organism, in intestine lymphoid tissue are excreted in stools after incubation period of 10-14 days, fever, malaise, headache constipation occurs, the fever rises to a high plateau, and the spleen and liver becomes enlarged the complications of enteric fever were, intestinal hemorrhage and perforation, and the mortality rate was 10-15%.
Immunity children, persons with SS and AS sickle cell trait are susceptible than normal individuals that is, those with AA hemoglobin.
1.2Â JUSTIFICATION
Due to high prevalence of typhoid and malaria fervers in young children especially, this project work is therefore aimed at determining the rate of co-infection of typhoid and malaria parasite in an area where both seemed to be endemic and have generated a lot of public health concern using slide agglutination test to determine or detecting typhoid fever and the use of thick and thin films for malaria test.
1.3 AIM AND OBJECTIVES
The aim of this study is the determination of the rate of co-infection in typhoid and malaria fevers among children.
The specific objectives of this research work is
To analyse blood samples for the presence of malaria parasite and typhi among children attending Barau Dikko and Garden City Hospital.
To ascertain the prevalence of typhoid and malaria parasite among children attending Garden city hospital and Barau Dikko specialist hospital within Kaduna metropolis.
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