When Surgery Unmasks the Typhoid Fever Epidemic in Niger: a Multicentre Retrospective Cohort Study of 2,931 Ileal Perforations (2014–2019)

Typhoid fever remains a major public health challenge in low-income countries, where surgical complications particularly ileal perforation account for the greatest share of associated mortality. In Niger, restricted access to bacteriological investigations leads to substantial under recognition of the true disease burden. To describe the epidemiological, clinical, therapeutic, and outcome characteristics of presumed typhoid ileal perforations managed surgically in two referral hospitals in Niger, and to identify factors independently associated with in-hospital mortality. A multicentre retrospective descriptive study was conducted at the Zinder National Hospital (ZNH) and the Maradi Regional Hospital Centre (RHC/M) between January 2014 and December 2019. All patients who underwent surgery for acute peritonitis secondary to presumed typhoid ileal perforation, defined on the basis of epidemiological, clinical, and intraoperative criteria, were included. Factors associated with in-hospital mortality were identified by multivariate logistic regression. A total of 2,931 cases of presumed typhoid ileal perforation were recorded among 4,271 operated acute peritonitis cases (68.6