Typhoid Fever Surveillance and Forecasting in the Eastern Region of Ghana, 2016-2024: Secondary Data Analysis, Epidemiological Trends, Spatial Distribution, and Predictive Modelling

Background: Typhoid fever remains a persistent public health challenge in sub-Saharan Africa, largely driven by inadequate water, sanitation, and hygiene (WASH) systems. In Ghana’s Eastern Region, comprehensive longitudinal analyses of surveillance data are limited. This study examined temporal trends, seasonal patterns, spatial distribution, demographic characteristics, and projected future incidence of reported typhoid fever from 2016 to 2024. Methods: A retrospective secondary analysis of routine surveillance data extracted from the District Health Information Management System 2 (DHIMS2) was conducted. Annual and monthly incidence rates were calculated using mid-year population estimates. Temporal trends and seasonal variation were assessed using descriptive time-series analysis. District-level incidence per 1,000 population was mapped using quintile classification to identify high-burden areas. Alert and epidemic thresholds were determined using the C2 method (Mean + 1 SD; Mean + 2 SD). Forecasting for 2025–2030 was performed using an autoregressive integrated moving average model ( ARIMA (1,1,1)) fitted to annual case data. To approximate the laboratory-confirmed burden, true cases were estimated at 4.14% of reported cases, based on pooled prevalence in Ghana [1]. Ethical approval was obtained from the Ghana Health Service Ethics Review Committee (GHS-ERC: 039/11/25). Results: A total of 446,553 cases were reported between 2016 and 2024. Annual incidence increased from 108 per 10,000 population in 2016 to 273 per 10,000 in 2024, representing a 2.5-fold increase. Adults aged 20–49 years bore the highest burden, and females accounted for 62.4% of cases. Recurrent mid-year seasonal peaks were observed, with epidemic threshold exceedances occurring in 2023 and 2024. Marked spatial heterogeneity was identified, with persistent high-incidence districts, including Birim Central. Forecast modelling indicates sustained elevated transmission through 2030. Conclusion: Typhoid fever incidence has increased substantially, with pronounced demographic concentration, seasonal amplification, and geographic clustering. Targeted WASH improvements, strengthened laboratory diagnostics, hotspot-focused vaccination strategies, and enhanced surveillance are essential to mitigate continued transmission by health authorities.