Everyone in Nigeria knows someone who has “typhoid”. In many households, typhoid is the default explanation for everything, from headaches to body pain to stubborn fever. The diagnosis often comes quickly, long before a proper test is done. But health experts insist that what we casually call typhoid may not always be at all, and the real danger is that misdiagnosis keeps rising, while the true disease remains under-detected.

Typhoid fever is caused by Salmonella enterica serotype typhi, and the only way to confirm it is through proper laboratory testing. Yet, for decades, the Widal test has become Nigeria’s go-to option because it is cheap, fast, and widely available. It is also most unreliable.

Dr Egemba Chinonso Fidelis, popularly known as Aproko Doctor, has been one of the strongest voices challenging the blind reliance on this test. In a widely shared video, titled: LISTEN UP! They’ve been lying to you about the sickness, he explained that a single Widal test “does not diagnose typhoid”, noting that antibodies can linger long after a past infection or appear due to reasons unrelated to the virus. His message aligns with what infectious-disease specialists have said for years: the Widal test often misleads both patients and doctors.

Nigeria Health Watch captured this problem in a vivid report about a woman who tested “positive” for typhoid 10 times over nearly two years. Each time, she was placed on another round of antibiotics. When a proper blood culture was finally done, it revealed she never had typhoid at all. The report highlighted why many clinics still rely on the Widal test: it is simple and inexpensive, even though it causes more confusion than clarity.

Scientific studies back this up. A peer-reviewed paper titled Typhoid fever among febrile Nigerian patients: prevalence, diagnostic performance of the Widal test and antibiotic multi-drug resistance examined 810 suspected cases. Only 114 of them, about 14 percent, had cultures confirming Salmonella typhi. Meanwhile, the Widal test had a sensitivity below half and a positive predictive value of 46 percent. In straightforward terms, many who tested positive did not have typhoid, and many who actually had it were missed entirely.

What proper typhoid diagnosis looks like

This is why experts insist that proper diagnosis begins with blood and stool cultures. These tests detect the bacteria directly and also help identify typhoid carriers, people who may feel fine but continue to shed the bacteria, causing new infections. Carriers contribute significantly to recurring outbreaks, especially in areas with poor water quality and sanitation. Without accurate testing, carriers remain unidentified and transmission continues unchecked.

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Misdiagnosis has also fuelled another crisis: antibiotic misuse. When people are repeatedly told they have typhoid, they are immediately placed on antibiotics they may not need. Over time, bacteria in the environment develop resistance, making real infections harder to treat. Several Nigerian studies have already reported emerging drug-resistant strains, a warning sign that the country may be nurturing tougher versions of the disease.

The confusion is worsened by the overlap between typhoid and malaria symptoms. Fever, headache, weakness, and body pain are common to both. Many Nigerians also have persistent malaria antibodies due to living in endemic zones, so symptoms and quick assumptions often replace a real diagnosis. A doctor relying on a single Widal result is more likely to treat the wrong illness.

Aproko Doctor has repeatedly urged Nigerians to request accurate testing rather than accept quick assumptions. He warns that treating every fever as typhoid and malaria allows real illnesses to go unnoticed and untreated. “If the test cannot confirm the disease, then the treatment cannot fix it,” he has said consistently across interviews and health campaigns.

Public-health experts add that the obsession with diagnosing typhoid distracts from bigger systemic issues. True typhoid outbreaks are linked to contaminated water, poor sanitation, and unsafe food handling. Without improving these conditions, the cycle of false diagnoses and real outbreaks will continue.

Typhoid remains a serious illness and can be deadly when left untreated. But, Nigeria’s bigger threat today is the blurred line between what is truly typhoid and what only appears to be. Breaking that cycle depends on awareness, accurate diagnosis, and a healthcare system rooted in science, rather than guesswork.

For now, the message from experts, clinicians, researchers, and advocates like Aproko Doctor is clear: not every fever is typhoid, and not every Widal test tells the truth.

Meiza Nigeria