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Volume 31, Number 10—October 2025
Research
Comparative Epidemiology of Salmonella Paratyphi A and Salmonella Typhi Causing Enteric Fever, Bangladesh, 2018–2020
Sadia Isfat Ara Rahman1
, Md Golam Firoj1, Se Eun Park1, Farhana Khanam1, Suneth Agampodi1, Kassa Haile1, Edilawit Mesfin, Faisal Ahmmed, Md Taufiqul Islam, Ashraful Islam Khan, Fahima Chowdhury, Afroza Akter, Martin Bundi Mwebia, Justin Im, Natasha Y. Rickett, Cecilia Kathure Mbae, Asma Binte Aziz, Beatrice Ongadi, Moses Mwangi, Benjamin Ngugi, Meseret Gebre Behute, Kelvin Kering, Suman Kanungo, Xinxue Liu, Deok Ryun Kim, Andrew J. Pollard, K Zaman2, Samuel Kariuki2, Firdausi Qadri2, and John D. Clemens2
, Md Golam Firoj1, Se Eun Park1, Farhana Khanam1, Suneth Agampodi1, Kassa Haile1, Edilawit Mesfin, Faisal Ahmmed, Md Taufiqul Islam, Ashraful Islam Khan, Fahima Chowdhury, Afroza Akter, Martin Bundi Mwebia, Justin Im, Natasha Y. Rickett, Cecilia Kathure Mbae, Asma Binte Aziz, Beatrice Ongadi, Moses Mwangi, Benjamin Ngugi, Meseret Gebre Behute, Kelvin Kering, Suman Kanungo, Xinxue Liu, Deok Ryun Kim, Andrew J. Pollard, K Zaman2, Samuel Kariuki2, Firdausi Qadri2, and John D. Clemens2
Table 3
Associations between sociodemographic and WaSH characteristics and the occurrence of Salmonella Typhi disease in the closed cohort in epidemiologic study of Salmonella Paratyphi A and Salmonella Typhi, Bangladesh, 2018–2020*
| Characteristic | Participants | PY | No. cases | IR (95% CI) | Crude HR | p value | Adjusted HR† | p value |
|---|---|---|---|---|---|---|---|---|
| Religion | ||||||||
| Muslim | 102,187 | 159,289 | 323 | 203 (182–226) | Referent | NA | Referent | NA |
| Others |
1,029 |
1,501 |
0 |
0 (0–164) |
0 (0–∞) |
>0.999 |
0 (0–∞) |
>0.999 |
| Monthly expenditure | ||||||||
| < Median | 51,644 | 78,813 | 149 | 189 (160–221) | Referent | NA | Referent | NA |
| > Median |
51,572 |
81,976 |
174 |
212 (182–246) |
1.15 (0.91–1.45) |
0.234 |
1.18 (0.94–1.49) |
0.160 |
| Toilet facility: private | ||||||||
| Yes | 43,869 | 72,368 | 105 | 145 (119–175) | Referent | NA | Referent | NA |
| No |
59,347 |
88,422 |
218 |
247 (215–281) |
1.67 (1.31–2.13) |
<0.001 |
1.55 (1.22–1.98) |
<0.001 |
| Adult toilet: flush toilet | ||||||||
| Yes | 5,002 | 8,055 | 18 | 223 (137–346) | Referent | NA | Referent | NA |
| No |
98,214 |
152,735 |
305 |
200 (178–223) |
0.89 (0.54–1.45) |
0.630 |
0.85 (0.52–1.4) |
0.533 |
| Child toilet: flush toilet | ||||||||
| Yes | 410 | 689 | 1 | 145 (13–677) | Referent | NA | Referent | NA |
| No |
102,806 |
160,101 |
322 |
201 (180–224) |
1.44 (0.2–10.32) |
0.717 |
2.23 (0.31–16.05) |
0.425 |
| Source of drinking water: private tap, well or pump; water vendor | ||||||||
| Yes | 32,110 | 52,266 | 78 | 149 (119–185) | Referent | NA | Referent | NA |
| No |
71,106 |
108,524 |
245 |
226 (199–255) |
1.53 (1.17–1.99) |
0.002 |
1.4 (1.07–1.82) |
0.013 |
| Treated cleaning water | ||||||||
| Yes | 314 | 499 | 1 | 200 (18–934) | Referent | NA | Referent | NA |
| No |
102,902 |
160,291 |
322 |
201 (180–224) |
1 (0.14–7.14) |
0.999 |
1.01 (0.14–7.23) |
0.992 |
| Hand wash before taking meal | ||||||||
| Yes | 71,253 | 112,173 | 220 | 196 (171–223) | Referent | NA | Referent | NA |
| No |
31,963 |
48,616 |
103 |
212 (174–256) |
1.07 (0.83–1.38) |
0.594 |
1.05 (0.82–1.35) |
0.707 |
| Hand wash after defecation | ||||||||
| Yes | 100,523 | 156,548 | 314 | 201 (179–224) | Referent | NA | Referent | NA |
| No |
2,693 |
4,241 |
9 |
212 (105–387) |
0.87 (0.43–1.76) |
0.698 |
0.81 (0.4–1.65) |
0.568 |
| Handwashing water available in HH | ||||||||
| Yes | 99,578 | 155,046 | 308 | 199 (177–222) | Referent | NA | Referent | NA |
| No |
3,638 |
5,744 |
15 |
261 (153–420) |
1.31 (0.74–2.3) |
0.358 |
1.3 (0.74–2.29) |
0.363 |
| Handwashing soap available in HH | ||||||||
| Yes | 101,581 | 158,246 | 318 | 201 (180–224) | Referent | NA | Referent | NA |
| No |
1,635 |
2,543 |
5 |
197 (75–431) |
0.88 (0.34–2.28) |
0.787 |
0.86 (0.33–2.22) |
0.749 |
| Waste disposal place: fixed disposal | ||||||||
| Yes | 97,714 | 152,047 | 307 | 202 (180–225) | Referent | NA | Referent | NA |
| No |
5,502 |
8,743 |
16 |
183 (109–290) |
0.92 (0.53–1.62) |
0.782 |
0.85 (0.48–1.49) |
0.574 |
| Distance to drinking water source: shorter than median distance | ||||||||
| Yes | 53,075 | 82,428 | 167 | 203 (174–235) | Referent | NA | Referent | NA |
| No |
50,141 |
78,362 |
156 |
199 (170–232) |
1.01 (0.8–1.27) |
0.926 |
0.97 (0.77–1.22) |
0.821 |
| Water filter available in HH | ||||||||
| Yes | 11,804 | 19,125 | 30 | 157 (108–221) | Referent | NA | Referent | NA |
| No | 91,412 | 141,665 | 293 | 207 (184–232) | 1.31 (0.89–1.92) | 0.168 | 1.27 (0.87–1.87) | 0.218 |
*HH, household; HR, hazard ratio; IR, incidence rate, cases/100,000 persons/year; PY, person-years; WASH, water sanitation and hygiene. †Adjusted by age and sex.
1These first authors contributed equally to this article.
2Thes authors contributed as joint senior authors.
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