Ghana has just experienced its heaviest monthly rainfall since 1995, with severe flooding across Accra and surrounding communities.

Beyond the immediate destruction, health authorities are warning of a second wave of danger: outbreaks of cholera and typhoid fever in the weeks that follow.

What Are Cholera and Typhoid

Cholera and typhoid are both bacterial infections spread through contaminated water and food. Neither spreads through casual person-to-person contact; the danger lies in what people drink, eat and touch after floodwater has mixed with sewage, refuse and human waste.

Cholera, caused by the bacterium Vibrio cholerae, tends to strike suddenly and violently. It produces severe watery diarrhoea and vomiting, and without prompt treatment, it can cause fatal dehydration within hours. Typhoid, caused by Salmonella Typhi, moves more slowly.

It builds over one to three weeks into a prolonged high fever, weakness, headache and abdominal pain. Where cholera is an emergency measured in hours, typhoid is a slow burn that can be just as dangerous if ignored.

Flooding creates the perfect conditions for both:
• Broken pipes and open wells become contaminated
• Sachet water and street food can be exposed to dirty water during storage or transport
• Vegetables grown near flooded water bodies carry contamination onto plates
• Displacement and overcrowding in shelters make spread even easier
• The stagnant water left behind also breeds mosquitoes, adding malaria to the list of risks in the same period.

How These Infections Are Diagnosed

Diagnosis usually starts with clinical judgement rather than a lab result, because treatment often cannot wait. For cholera, sudden watery diarrhoea (sometimes described as “rice water” stool) alongside vomiting, particularly during a known outbreak, is usually enough to begin treatment immediately.

A stool sample can confirm it afterwards through a rapid test or culture, but a clinician will assess dehydration by checking skin, eyes, pulse and blood pressure well before those results are back, since that assessment drives urgent care.

yphoid is suspected clinically from a fever that climbs over several days, together with headache, abdominal pain and sometimes a slower pulse than the fever would suggest. Blood culture is the most reliable confirmatory test, especially in the first week of illness.

In Ghana, the Widal test is commonly used instead because it functions as a point of care option: a blood sample tested for antibody reaction, with results back the same day, sometimes within hours, without needing the incubation time a full culture requires. That speed is its main value in busy primary care and district-level settings.

Its limitation is accuracy.

The Widal test can show false positives, cross-reacting with malaria, other Salmonella strains, past typhoid infection or prior vaccination. It can also miss true cases early in the illness, before antibody levels have risen enough to detect.

For this reason, a single Widal result is treated as a prompt to support clinical suspicion rather than a definitive answer on its own. Ideally it would be paired with a repeat sample after a week to look for a rising titre, though in practice that slows down the very speed that makes it useful. Blood culture remains the reference standard where it is accessible, particularly in that first week.

Warning Signs That Need Urgent Care

Anyone with profuse watery diarrhoea, vomiting, sunken eyes, extreme thirst or little to no urination should be treated as a cholera emergency. Anyone with a fever that persists or worsens daily, alongside severe headache, abdominal pain or a rash, should be assessed for typhoid.

Both conditions are treatable: oral rehydration and, where needed, IV fluids and antibiotics for cholera; antibiotics for typhoid. What makes the difference between recovery and death is how quickly someone seeks care. A negative rapid test early in illness does not rule anything out, and worsening symptoms should never be waved away because one test came back clear.

Protecting Households During and After Flooding

Prevention comes down to a handful of consistent habits, and they matter most in the days and weeks right after floodwater recedes, not just during the storm itself.
• Boil drinking water, or use bottled or sachet water from a trusted source
• Eat only hot, freshly cooked food, and avoid raw salads or uncooked vegetables unless certain they were kept away from floodwater
• Wash hands with soap under running water before eating and after using the toilet
• Avoid wading through floodwater where possible, and wash and dry feet and legs thoroughly if exposed
• Dispose of waste properly and keep it away from water sources
• Clear stagnant water and blocked drains around the home to reduce both disease and mosquito risk.

The Ghana Health Service has echoed these same measures in its recent public alert, alongside guidance to keep surroundings clear of stagnant water and to seek medical attention promptly rather than waiting to see if symptoms pass.

Floodwaters recede, but the health risks they leave behind can linger for weeks if these basic protections are not taken seriously.

By: Dr. Vanessa Apea, CEO The Accra London Health Centre.