Background Setting up a robust typhoid demographic surveillance system (DSS) in low-resource areas will help in characterizing, and defining priorities and strategies for typhoid control activities such as the deployment of new conjugate typhoid vaccines. The study describes the DSS methodology, data, strengths and use in achieving high vaccine coverage.

Methods Enumeration areas (EAs) were used as the clusters for the Typhoid Conjugate Vaccine Trial in Ghana (TyVEGHA) study. The existing EA maps had two main limitations: they did not capture the structures and the boundaries were not clearly defined. We employed drones to take spatial pictures of the study area and generated GIS maps with well-defined boundaries. With the GIS maps, enumerators located and enumerated every participant in each structure within a cluster. A census form, developed on Commcare running on tablets, was used to capture the demographic, socio-economic and WASH attribute information of participants and households. For purposes of the mass vaccination, each participant in the study area was given a census identification (ID) card.

Results Overall, demographics of 73,625 individuals (i.e., 55,881 during baseline and 17,744 during the first update) from 15,029 households (13,266 for baseline and 1,764 for first update) were recorded. It was observed that 1,125(1.95%) birth, 343(0.59%) death, 2,219(3.84%) in-migration and 1,101(1.91%) out-migration occurred in the TyVEGHA catchment area between the baseline and first update. The eligible participants for the TyVEGHA trial during the baseline was 22,539/55,881 (40.33%). Due to the robust DSS, we observed a high vaccine coverage rate of 88.36% (20,323) including screen failures. Overall, 4.7% (961 per 20,323) queries were detected and quality control guidelines were used to resolve all queries weekly.

Conclusion Setting-up robust demographic surveillance in low-resource areas is necessary for improving the dearth of reliable data for planning health and socio-economic interventions and achieving high vaccine coverage rates.