Malaria and typhoidal co-infection among febrile patients: a health facility-based cross-sectional study in Northern Ghana

Background: Malaria and typhoid fever constitute a significant public health burden in developing countries, often traced to a common predisposing factor such as poverty and poor water, sanitation, and hygiene (WASH) practices. This study investigated the prevalence of malaria, typhoid fever, their co-infection and associated factors among febrile patients in the Kassena Nankana Municipal and Nabdam Districts of the Upper East Region, Ghana. Methods: A health facility-based cross-sectional study was conducted in seven selected health facilities in the two districts in the Upper East Region of Ghana during peak rainy seasons (July to November) in 2023 and 2024. After informed consent documentation, a total of 332 febrile patients were recruited. Sociodemographic and clinical information of participants was obtained using a structured questionnaire. A finger prick capillary blood sample was collected for malaria antigen rapid test and typhoid fever IgM antibody serology. Results: The prevalence of febrile patients with either malaria, typhoid fever or both was 60.0%. The seroprevalence of malaria and typhoid fever was 37.7% and 36.7%, respectively, with a 14.7% co-infection rate. The Nabdam district was associated with increased odds of malaria (adjusted odds ratio (aOR) = 3.87; 95%CI: [1.71–8.76]; p < 0.01), while a tertiary education background was significantly associated with increased odds of typhoid fever (aOR = 5.33; 95%CI: [1.20–23.72]; p = 0.03). The use of a tap water source was associated with reduced odds of typhoid fever (aOR = 0.36; 95%CI: [0.15–0.87]; p = 0.02) and malaria-typhoid fever co-infection (aOR = 0.07; 95%CI: [0.01–0.60]; p = 0.02). Febrile patients presenting with vomiting were a predictor of malaria (aOR = 2.45; 95%CI: [1.36–4.40]; p < 0.01). Conclusion: Our study found high prevalence of malaria (37.7%), typhoid fever (36.7%), and their co-infection (14.7%) among febrile patients in the Upper East Region of Ghana. These rates exceed national averages and highlight persistent regional disparities, underscoring the need for integrated diagnostic and treatment strategies for febrile illnesses in the region. Our study also shows that malaria risk was higher in Nabdam district, tertiary education was associated with increased typhoid fever risk, and tap water use reduced odds of typhoid fever and malaria-typhoid co-infection, highlighting the need for targeted interventions addressing these factors. Clinical trial number: Not applicable.