TVI will also conduct clinical surveillance in Manghopir and Songal. AKU will identify the clinical surveillance sites and TVI will perform data collection in the identified sites. Cases of suspected and confirmed typhoid fever and cases of diarrhea from selected health care facilities/BHUs and will be enrolled based on eligibility criteria.  The objectives of the study are as under:

1. To conduct GIS mapping or blue line waterway tracing of formal and informal sewage systems in Gadap Town, Karachi.
2. To identify sites using GIS maps and field mapping for sewage sampling for Environmental surveillance (ES) of enteric pathogens in Gadap Town, Karachi, Pakistan.
3. To identify selected enteropathogens in sewage samples in selected Union Councils of Gadap Town and follow trends over a period of 3 years.
4. To provide the result of ES in real time to implementation partners in Gadap town for actionable public health interventions to reduce transmission of enteropathogens.
5. To monitor trends of typhoid and diarrhea overtime using clinical and lab-based surveillance in Gadap Town Karachi.
6. To perform Next Generation Sequencing for enterovirus including poliovirus and pathogens responsible for vaccine preventable diseases including typhoid, cholera, and shigellosis in clinical and environmental specimen.