Self-Assessment Questions (SAQs) for Study Session 36

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 36.1 (tests Learning Outcomes 36.1 and 36.2)

  • a.What are the similarities in how relapsing fever (RF) and typhus are transmitted from person to person?
  • b.Can you describe one difference?


  • a.The major similarity in the way that relapsing fever (RF) and typhus are transmitted from person to person is that the infectious agents of both these vector-borne diseases are transmitted by the human body louse. Lice acquire the causative bacteria when they take a blood meal from an infected person, and they transmit the bacteria to new hosts when people come into close contact with infected lice in clothes, bedding or on bodies. The bacteria causing both diseases multiply in the gut of the louse. The infection enters the new host through breaks in the skin, caused mainly by scratching the itching louse bites.
  • b.One difference is that the bacteria that cause RF are transmitted in the fluids leaking from crushed lice, whereas the bacteria that cause typhus are transmitted in infected louse faeces.

SAQ 36.2 (tests Learning Outcome 36.4)

During your visit to a rural area, you observe that many people in a particular village wear dirty clothes and do not change their clothes for several weeks. What educational messages do you give the families in that village and what is your health education aiming to prevent?


There is poor personal hygiene in the village. Relapsing fever and typhus can quickly spread in such poor hygienic conditions if someone brings infected lice into the village on their body or clothes. You have to educate families to wash their clothes, bedding and bodies frequently to prevent diseases related to poor personal hygiene, particularly relapsing fever and typhus.

SAQ 36.3 (tests Learning Outcomes 36.1, 36.2, 36.3 and 36.4)

Which of the following statements is false? In each case, explain what is incorrect.

A  It is possible to distinguish between relapsing fever and typhus at Health Post level by identifying differences in their symptoms.

B  Relapsing fever and typhus occur only in the rainy seasons in Ethiopia.

C  Treatment with the correct antibiotics is sufficient to control epidemics caused by relapsing fever or typhus.

D  The correct antibiotics can effectively treat relapsing fever and typhus if the patient is referred immediately.

E  Health workers should protect themselves from developing relapsing fever or typhus by avoiding close contact with patients with these diseases.


A is false. Relapsing fever and typhus have similar clinical manifestations such as fever, headache, joint and muscle pains. It is very difficult to distinguish between them by clinical manifestations alone, without laboratory investigations.

B is false. Relapsing fever and typhus can occur at any season if poor hygienic conditions and overcrowding encourage lice infestation.

C is false. Treatment with drugs is not sufficient to control an epidemic of relapsing fever or typhus. Health education about personal hygiene, and delousing clothes and bedding with chemicals such as permethrin, are other necessary control measures.

D is true. The correct antibiotics can effectively treat relapsing fever and typhus if the patient is referred immediately.

E is true. Health workers are at risk from close contact with patients with RF or typhoid because they can get the infection from the body lice of the patient; therefore, close contact should be avoided.

SAQ 36.4 (tests Learning Outcomes 36.3 and 36.4)

Estifanos is a 30-year-old farmer who came to your Health Post with fever, severe headache and extreme muscle pain. He tells you that there are many similar illnesses in his village.

  • a.What are the possible diagnoses for Estifanos?
  • b.What action do you take?


  • a.Estifanos may have one of the febrile illnesses such as malaria, relapsing fever, typhus or typhoid fever.
  • b.You should immediately refer him to the nearest health centre for further diagnosis and treatment. Visit his village to see the other sick persons and actively search for other cases, which you should immediately report to the District Health Office. There might be an epidemic of one of the febrile illnesses, which needs to be controlled by sustained preventive actions.

Summary of Study Session 36