Delayed diagnosis and treatment of typhoid fever: Socio-demographic barriers in a tertiary care setting

Background: Typhoid fever, caused by Salmonella enterica serotype Typhi, remains a major public health concern in low- and middle-income countries (LMICs), particularly in South Asia. Socio-demographic barriers such as poor health literacy, economic constraints, and limited healthcare access often hinder timely care but are underexplored in current literature. To evaluate the role of socio-demographic factors in delaying the diagnosis and treatment of typhoid fever in a tertiary care setting in Pakistan. Material and Methods: A cross-sectional study was conducted at Bahawal Victoria Hospital, Bahawalpur, from January to December 2024. A total of 42 patients aged ≥15 years with laboratory-confirmed typhoid fever were enrolled. Data were collected using a structured questionnaire and analyzed via SPSS version 27.0. Associations between socio-demographic factors and delays were evaluated using chi-square and independent t-tests. Results: The mean age was 29.4 ± 11.2 years, with males comprising 59.5% of participants. Diagnostic delays (≥5 days) occurred in 66.7% and treatment delays (≥7 days) in 57.1% of patients. Significant associations were observed between diagnostic delay and education level (p=0.047), monthly income (p=0.043), and distance from the hospital (p=0.031). Patients lacking formal education, earning <20,000 PKR/month, or living >10 km away experienced more delays. Conclusion: Socio-demographic disparities are key contributors to delayed diagnosis and treatment in typhoid fever. Interventions targeting health education, financial support, and improved healthcare access are critical to reducing delays and improving outcomes.