# Clinical Audit of Enteric Fever Diagnostic Practices at Kosti Teaching Hospital: A Retrospective Evaluation

## TL;DR

This study evaluated typhoid fever diagnosis at a Sudanese hospital and found a heavy reliance on outdated tests, leading to potential misdiagnosis.

## Contribution

The study identifies diagnostic gaps in a resource-limited setting and proposes actionable recommendations to improve typhoid fever diagnosis.

## Key findings

- The Widal test was used in 67.9% of cases, while blood culture was used in only 1.9%.
- Diagnostic practices deviated significantly from WHO guidelines due to limited resources and infrastructure.
- Stool culture and typhoid-specific testing were not performed in any cases.

## Abstract

Background and objective

Enteric fever remains a major public health problem in Sudan, particularly in areas with poor sanitation and limited health care resources. Accurate diagnosis is essential for appropriate management; however, diagnostic practices often rely on unreliable methods. This clinical audit aimed to evaluate current diagnostic practices for enteric fever at Kosti Teaching Hospital, assess adherence to WHO standards, identify gaps in diagnostic methods, and propose recommendations to improve diagnostic accuracy.

Methods

This study was a retrospective clinical audit conducted at Kosti Teaching Hospital, Sudan, reviewing the medical records of patients diagnosed with enteric (typhoid) fever during the study period. Data were extracted using a structured audit checklist to evaluate diagnostic practices, including documentation of clinical features, laboratory investigations requested (e.g., Widal/Felix-Widal test, serology, antibody testing, blood culture, and stool or rectal swab culture), and adherence to recommended diagnostic guidelines. Descriptive analysis was performed, and results were summarized using frequencies and percentages.

Results

Fifty-six patient records were reviewed. Headache and body pain (87.5%) and fever (85.7%) were the most common presenting symptoms. The Widal test was the most frequently used diagnostic tool (67.9%), followed by antibody detection (22.6%) and serology (Widal test) (17%). Blood culture, the diagnostic gold standard, was performed in only 1.9% of cases. No patients underwent stool culture or typhoid testing. The heavy reliance on the Widal test and clinical features, with minimal use of confirmatory tests, indicates substantial deviation from international guidelines.

Conclusions

The audit revealed significant gaps in enteric fever diagnosis at Kosti Teaching Hospital, characterized by heavy reliance on clinical assessment and Widal testing, with minimal use of blood culture due to limited resources. These practices compromise diagnostic accuracy and reflect broader health system challenges, including inadequate laboratory capacity and underfunding. Strengthening diagnostic infrastructure, improving access to reliable tests, and providing ongoing health care worker training are essential to align practices with WHO standards and improve patient outcomes in Sudan.