Spatiotemporal patterns and forecasted reported incidence of typhoid fever in Ghana’s Eastern Region, 2016–2024, with forecasts to 2029

Typhoid fever remains an important public health concern in Ghana, particularly in the Eastern Region, where variation in water, sanitation and hygiene conditions may contribute to differences in reported typhoid incidence. We assessed temporal, demographic, spatial, seasonal, and forecast patterns of reported typhoid fever from 2016 to 2024 and forecasted monthly reported incidence for 2025 to 2029. We conducted a retrospective secondary analysis of typhoid fever surveillance data reported through the District Health Information Management System 2 (DHIMS2) from 2016 to 2024. We calculated incidence rates using population data. Temporal and seasonal patterns were assessed using time-series analyses, while spatial distribution was examined using district-level incidence rates and quintile mapping. Alert and epidemic thresholds were assessed using the C2 method with a rolling 12-month reference window. We used a Seasonal Autoregressive Integrated Moving Average (SARIMA) model for forecasting. We obtained rainfall data from Climate Hazards Group InfraRed Precipitation with Station Data (CHIRPS) Version 2.0. We generated a sensitivity/exploratory series by applying the pooled laboratory-confirmed prevalence estimate of 4.14% from a Ghanaian meta-analysis to the surveillance case series. A total of 446,553 typhoid fever cases were reported. Reported typhoid fever incidence increased from 108 to 273 reported cases per 10,000 population, a 2.5-fold increase. Adults aged 20–49 years accounted for the largest proportion of reported cases, while females represented 62.4%. However, age-specific incidence rates were highest among adults aged ≥ 50 years. Seasonal peaks occurred, with alert exceedances more frequent than epidemic exceedances. Spatial heterogeneity was observed, with Birim Central recording the highest incidence. An exploratory one-month lagged correlation was observed between rainfall and reported typhoid fever incidence ( r = 0.230, nominal p = 0.018); however, this analysis did not account for temporal autocorrelation or confounding. Forecasts indicated continued high reported incidence with seasonal fluctuations through 2029. Reported typhoid fever incidence remained persistently high in Ghana’s Eastern Region, with higher reported incidence in later years, recurrent seasonal peaks, spatial heterogeneity, and age- and sex-related differences. Strengthened surveillance, diagnostic confirmation, targeted hotspot interventions, and improved WASH measures are needed to reduce the reported burden.