Diarrhoea incidence and outbreak alerts among children under five before, during and after major flooding in Ghana’s Volta Region, 2019–2023

Introduction: Diarrheal disease remains a major cause of death in children under five years globally, with the highest burden in low- and middle-income countries. In October 2023, controlled dam spillage caused severe flooding in Ghana’s Volta Region and displaced 26,000 people. This study assessed potential diarrhoea outbreaks and examined incidence and temporal trends among children under five years in flood-affected districts from 2019 to 2023. Methods: We conducted a descriptive secondary data analysis using diarrheal surveillance data from 2019–2023 in the District Health Information Management System II (DHIMS II). We applied the Early Aberration Reporting System (EARS) C2 algorithm to detect unusual increases in cases before, during, and after the October 2023 floods. We calculated the cumulative incidence rate as the number of cases per 1,000 under-five population and summarized the data by person, place, and time. Results: Outbreaks occurred in all districts across the five-year period, but none were detected during or immediately after the October 12, 2023, floods. A total of 39,085 diarrheal cases were reported, with a five-year cumulative incidence of 871 per 1,000 population (95% CI: 867.6–873.9). Infants aged 0–11 months and males had the highest incidence, at 1,321 per 1,000 (95% CI: 1,298–1,345) and 978 per 1,000 (95% CI: 964–991), respectively. Central Tongu District recorded the highest incidence rate (1,761 per 1,000; 95% CI: 1,733–1,788). Incidence rate fluctuated yearly, peaking in 2019 and reaching its lowest in 2020. Conclusion: Targeted WASH and breastfeeding interventions are essential for high-risk groups, particularly infants under one year and male children. The Volta Regional Health Directorate should integrate diarrheal disease surveillance into flood preparedness plans.