755 - Addressing the Unaddressed: Challenges in Geospatial Mapping of Typhoid Fever Cases in Ghana

Publication Number: 755.3702

Rabia Pirzada, McGovern Medical School at the University of Texas Health Science Center at Houston, Katy, TX, United States; Dominique Dagdag, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Patrick Apisigu, Baptist Medical Center-Nalerigu, Ghana, Nalerigu, Northern, Ghana; Heidi Haun, Baptist Medical Center, Nalerigu, Ghana, Saint Petersburg, FL, United States; Anastasia Furtak, St. Nicola’s Lviv Children’s Hospital, Lviv, Ukraine, Lviv, L'vivs'ka Oblast', Ukraine; Zoabe Hafeez, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Kristina Tebo, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States

Background: Typhoid fever remains a significant public health issue in many areas, like northeastern Ghana, due to insufficient water and sewage infrastructure. However, challenges arise in some resource-limited areas when performing geospatial mapping due to a paucity of accurately updated and detailed maps.  Despite these barriers, public health interventions can make a meaningful impact through initiatives on hand hygiene and improving water potability.

Objective: Spurred by an observed uptick in cases of typhoid fever intestinal perforations, we conducted a geospatial mapping project involving patients treated at a regional referral hospital in northeast Ghana. The study’s primary goal was to identify potential clusters of cases and any possible sources of contaminated water. The project’s secondary goal was to mitigate further cases via focused public health interventions near identified clusters.

Design/Methods: A retrospective chart review was completed of patients who underwent exploratory laparotomy for typhoid fever bowel perforation at Baptist Medical Centre in Nalerigu, Ghana between September 2023 and January 2024. Patients with incomplete records or perforations from other etiologies were excluded. Basic patient characteristics were collected, including the town or village name, and language spoken. Each town or village was then identified on a map using Google Maps and/or focused interviews with patients and hospital leaders.

Results: There were 87 cases of typhoid intestinal perforation, but 3 were excluded for missing data. The hometowns or villages for the remaining 84 patients were located using Google Maps (45%) or focused interviews (43%). Villages were mapped with a reasonable degree of certainty for 74 patients (88%). Upon map analysis, clusters of disease were not identified. Since more granular geospatial mapping data, such as the patient’s neighborhood or precise address, was unavailable, identifying contaminated water sources was unachievable (Fig 1 and 2).

Conclusion(s): The study located the hometown for most of our patients, however there are still significant challenges to geospatial mapping in regions without robust address systems and gaps in infrastructure. The lack of detailed address systems impeded the ability to identify case clusters and potentially contaminated water sources. Our findings underscore the urgent need for improved mapping technologies and standardized addressing systems in resource-limited regions. These efforts, combined with continued focus on improving basic infrastructure, will be crucial in combating communicable diseases in resource-limited settings worldwide.

Figure 1
Map of northeast Ghana indicating locations of patients admitted for typhoid fever perforations during the study period.

Figure 2
Map of northeast Ghana indicating the density of typhoid fever perforation patients during the study period.