Telangana recorded 202 typhoid and paratyphoid deaths in 2023, nearly one in every five such deaths registered across India, according to official data from the Office of the Registrar General of India.
Telangana accounted for the second highest number of typhoid fatalities in the country, after Uttar Pradesh which recorded 377 deaths.
However, when population is factored in, Telangana’s burden appears disproportionately high, raising questions over disease surveillance and public health infrastructure in the state.
The figures come from the Report on Medical Certification of Cause of Death (MCCD) for 2023, which documents all medically certified deaths across India.
Of the 1,075 total typhoid and paratyphoid deaths recorded nationwide, Telangana alone accounted for 18.8 percent, a striking concentration for a state that represents just 2.5 percent of India’s population.
Punjab ranked third with 118 deaths, followed by Delhi with 36 deaths. Maharashtra, despite being India’s second-most populous state, recorded only 53 deaths.
Surveillance gap
However, these official figures do not reveal the full story. A comprehensive modelling study published this month in The Lancet Regional Health – Southeast Asia estimates that India actually witnessed 7,850 typhoid deaths in 2023, more than seven times the number captured in official death certificates.
The study, which analysed data from 4.9 million estimated typhoid cases nationwide, paints a far grimmer picture than government records suggest. The seven-fold gap between official death certificates (1,075) and research estimates (7,850) exposes critical weaknesses in India’s disease surveillance system.
Thousands of typhoid deaths are going uncounted, particularly in rural areas and among those who never reach a hospital.
The Medical Certification of Cause of Death system captures only deaths that occur in medical facilities with proper documentation. It systematically misses large segments of the actual death toll.
The Lancet study specifically estimated that around 2,470 people died from typhoid in 2023 without ever seeking treatment, perhaps unable to afford care, living too far from hospitals, or unaware of how serious their illness had become. These deaths often do not generate medical certificates and are therefore excluded from official statistics entirely.
Without proper diagnostic testing, such as blood cultures, many typhoid deaths may be recorded under vague categories, including “fever of unknown origin,” “sepsis,” or “multi-organ failure,” rather than specifically as typhoid. The disease gets buried in paperwork under different names.
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The MCCD data have a well-documented urban bias and incomplete coverage. Many deaths in rural areas go unregistered entirely, while private hospitals may not consistently report deaths to the civil registration system. In a country where millions receive healthcare outside government facilities, this creates enormous blind spots.
The stark differences between states may reflect not just actual disease burden but also dramatic variations in healthcare access, diagnostic capacity, and the quality of death registration systems.
The study estimated that Uttar Pradesh, Maharashtra, West Bengal, Tamil Nadu, and Andhra Pradesh together account for almost half of all typhoid cases nationwide. Yet Tamil Nadu shows only five certified deaths, and Andhra Pradesh only six in official records.
These glaring contradictions suggest that Karnataka, Tamil Nadu, and Andhra Pradesh are not necessarily doing better than Telangana at controlling typhoid. Rather, Telangana may simply have better disease surveillance and death reporting systems that capture cases other states are missing entirely.
Alternatively, these states may have higher proportions of deaths occurring in private healthcare facilities that don’t feed into the MCCD system, or their rural death registration may be particularly weak.
The Lancet study estimated 4.9 million typhoid cases in 2023. Of them, 7.30 lakh people required hospital admission. The study used data from the Surveillance for Enteric Fever in India (SEFI) project, a population-based, multi-site study conducted from 2017 to 2020. SEFI employed active surveillance across four community-based sites and six hospital-based surveillance sites, tracking both children and adults. This methodologically rigorous approach captures cases that routine health systems miss.
The researchers combined SEFI’s incidence data with state-wise population figures, healthcare utilisation patterns, and mortality estimates to model the true national burden.
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