Protective and Risk Associations of Household Waste Management Practices with Typhoid Fever: A Cross-Sectional Study in Goma- DR Congo

Typhoid fever remains a significant public health concern in sub-Saharan Africa, particularly in urban settings with inadequate sanitation and waste management systems. While the role of water and sanitation in typhoid transmission is well established, the specific contribution of household waste management practices remains underexplored. This study assessed the associations between household waste management practices and typhoid fever incidence in Goma, Democratic Republic of Congo (DRC), identifying both protective and risk-related behaviours. A cross-sectional comparative study was conducted among 521 households in Goma, with 260 from the intervention group and 261 from the control group. Data were collected using semi-structured questionnaires and verified against health facility records. Associations between waste practices and typhoid fever were analysed using chi-square tests and odds ratios (OR) with 95% confidence intervals (CI). Overall, 41.1% of households reported typhoid fever cases, with no statistically significant difference between intervention and control groups (OR = 1.29; 95% CI: 0.90–1.84; p = 0.199). However, composting was significantly associated with reduced odds of typhoid fever (OR = 0.34; p = 0.007), while evacuation practices were linked to increased risk (OR = 1.78; p = 0.010). Other practices, including incineration, separation, and storage, showed non-significant associations. Although the overall intervention did not yield a significant reduction in typhoid incidence, specific household waste practices, particularly composting, demonstrated protective effects. These findings underscore the need for integrated, community- based waste management strategies that complement water, sanitation, and hygiene (WASH) interventions to effectively reduce typhoid transmission in high-risk urban settings.