Typhoid fever epidemiology in a tertiary health facility in Northern Ghana, 2021- 2024

Introduction: Typhoid fever remains a neglected yet important cause of morbidity and mortality in Ghana. National estimates obscure district-level heterogeneities. Inconsistent reporting and fragmented surveillance between tertiary facilities and district health systems further undermine the accuracy of local burden estimates. We described the burden, complications, and predictors of mortality among patients managed at Tamale Teaching Hospital (TTH). Methods: We analysed data on all typhoid fever cases managed at TTH between January 2021 and December 2024. Cases were diagnosed by clinical and laboratory assessment using the ICD – 10. We extracted, cleaned, and analyzed data in Stata BE18. We described patient characteristics using summary statistics (95% CI). We assessed temporal trends and thresholds using the CUSUM method and mapped spatial distributions by district using QGIS 3.32.3. We analyzed mortality predictors using logistic regression at p<0.05. Results: Of 1,396 reported typhoid cases, 39.3% were hospitalized. The median age was 17 years (IQR: 23), with the highest burden (46.7%) among children aged 0–15 years. Females constituted 53.2%, and students/pupils were 56.3%. Transmission was sustained, peaking predominantly in 2023 with 11 missed outbreaks. Most cases, 42.2% (345/817) originated from Tamale Metropolis. Complications occurred in 47.6% (664/1396) of patients, of which 56.1% (390/664) were unspecified. Among specified complications, extra-intestinal complications predominated 86.9% (238/274). The overall mortality rate was 2.6% (37/1,396). Admitting a case-patient for 1–5 days (aOR = 4.14, 95% CI: 0.44–5.05) and being a child/student (aOR = 0.27, 95% CI: 0.07–0.90) were significant predictors of mortality. Conclusion: Typhoid is endemic in northern Ghana. High complication rates and early-admission mortality reaffirm the need to strengthen emergency care, early diagnosis, rapid referral, and targeted interventions like the Typhoid Conjugate Vaccine (TCV) in high-burden districts. Missed outbreaks likewise underscore the need to improve facility-based surveillance.