Vaccination services for people and livestock often fail to achieve sufficient coverages in Africa's remote rural settings because of financial, logistic, and service delivery constraints. In Chad from 2000 through 2005, we demonstrated the feasibility of combining vaccination programs for nomadic pastoralists and their livestock. Sharing of transport logistics and equipment between physicians and veterinarians reduced total costs. Joint delivery of human and animal health services is adapted to and highly valued by hard-to-reach pastoralists. In intervention zones, for the first time ≈10% of nomadic children (>1-11 months of age) were fully immunized annually and more children and women were vaccinated per day during joint vaccination rounds than during vaccination of persons only and not their livestock (130 vs. 100, p<0.001). By optimizing use of limited logistical and human resources, public health and veterinary services both become more effective, especially at the district level.

No abstract

Malnutrition, resulting from various etiologies, is common in rural Chadian women and children. This cross-sectional study assessed the spectrum of parasitic infection and level of anemia and their effect on nutritional status in settled and mobile pastoral mothers and children near Lake Chad. Intestinal parasites were evaluated using direct fecal smears and the Kato–Katz technique. Malaria status was determined using Paracheck-Pf® rapid diagnostic test, and anemia was assessed with the Hemocue photometer. Nutritional status was evaluated using anthropometric parameters. At the end of the 2008 wet season, the prevalence of malnutrition was 36% [confidence interval (CI) 30–42] among women and 15% (CI 11–18) among children. The prevalence of intestinal parasitic infection was 75% (CI 68–83) among women and 60% (CI 53–66) among children. The predominant helminth species was Ascaris lumbricoides while Entamoeba histolytica/dispar was the most common protozoan. The hookworm prevalence was 14% (CI 8–20) in women and 18% (CI 13–23) in children. Malaria prevalence was low among women (1%, CI 0.5–2) and children (3% CI 2–5). No significant difference was observed in the prevalence of parasitic infection between the mobile pastoralist and rural sedentary populations. Thirty-four percent (CI 27–40) of nonpregnant women, 53% (CI 34–72) of pregnant women, and 27% (CI 23–32) of children were anemic. In subjects infected with Plasmodium, all women and 54% (CI 22–85) of children were anemic. Malnutrition was significantly associated with anemia in mothers and with selected intestinal parasites, anemia and age in their children.

BackgroundSevere acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in Chad. The reasons behind persistently high prevalence of SAM in the Kanem region are still poorly understood, leaving national and international partners without clearly identified drivers to address. Current knowledge of SAM determinants in this context is largely based on very limited data. The aim of this study was thus to investigate individual and household-level risk factors for SAM among under-five children in Mao health district.MethodsA matched case-control study was conducted on 411 (137 cases and 274 controls) children aged 6–59 months with their caretakers from mid-February to August 2017. Data were collected by using a structured interviewer administered questionnaire, anthropometric measurements and through direct observations of household environment. Controls were matched to their cases on place of residence and on age (± 3 months). Data were double-entered, processed and analysed using Epi Info 7.2.0.1. Conditional logistic regression was used to analyse the association of independent variables with SAM. For multivariable analysis, two models were constructed to investigate risk factors for SAM, at individual and household level. A stepwise backwards elimination approach with a significance level of p = 0.05 was used to build the final models.ResultsAt the individual level, SAM was significantly associated with diarrhoea [AOR (95% CI) = 10.7 (4.2–27.3)], fever [AOR (95% CI) = 8.4 (3.1–22.8)], vomiting [AOR (95% CI) = 7.6 (3.0–19.7)], being stunted [AOR (95% CI) = 5.3 (1.7–16.3)], and type of complementary meal [AOR (95% CI) = 4.4 (1.0–19.6)]. At the household level, SAM was significantly associated with undernourished caretaker [AOR (95% CI) = 2.6 (1.2–5.5)], caretaker’s hand washing habits [AOR (95% CI) = 1.9 (1.2–3.1)], absence of toilet [AOR (95% CI) = 1.9 (1.1–3.6)], caretaker’s marriage status [AOR (95% CI) = 7.7 (2.0–30.1)], and low household food diversity [AOR (95% CI) = 1.8 (1.0–3.1)].ConclusionThe present study identified the need to address both treatment and prevention of infections in children through an integrated approach. Well-organized efforts to improve child feeding practices, household hygiene and sanitation conditions, women’s nutritional status, along with increasing household food diversity are likely to lead to improved nutritional status of children in this setting.