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Malnutrition, meningitis and malaria were among the recurring health emergencies faced in Chad in 2012.
Internal strife has diminished since 2010, and the main public health problem for Chadians today is a lack of quality health services or, in most cases, an absence of health services altogether.
Doctors Without Borders/Médecins Sans Frontières (MSF) teams continued programs designed to meet the neglected medical needs of women and children, and responded to malnutrition and other emergencies.
Widespread Child Malnutrition
Immunization rates are very low and the country is regularly affected by outbreaks of preventable disease, which increase the exposure of young children to malnutrition.
In 2012, MSF treated more than 23,000 children for severe malnutrition in different areas of the Sahel strip, which runs across the middle of Chad. Two regular programs run nutrition activities, and four additional short-term nutrition programs were opened in places where the existing capacity to tackle malnutrition was overwhelmed. MSF handed over these emergency programs to other associations and the Ministry of Health at the end of the peak of the crisis. In Biltine, Wadi Fira region and Aboudeia, Salamat region, 5,180 children were treated for malnutrition at two inpatient feeding centers and 20 outpatient feeding centers. In and around Yao, Fitri district, Batha region, MSF ran an emergency nutrition program from April to September. Staff at the hospital in N’Djamena Bilala in Fitri ran a 30-bed pediatric ward for children suffering severe malnutrition and other diseases, and teams screened for and treated malnutrition in 27 surrounding villages. Staff also carried out 1,330 pediatric consultations and ensured routine immunization for 6,300 children. In June, MSF opened one inpatient and 10 outpatient feeding centers in Bokoro, Hadjer Lamis, which treated 3,800 children.
An MSF team has worked at Massakory hospital, Hadjer Lamis region, since 2010. Staff offer emergency medical care for children up to 15 years old and provide treatment for children under five with severe malnutrition with complications. In 2012, 8,530 patients were treated for malnutrition and over 1,000 for malaria. A nutrition program operated in six health zones, where teams also monitored for common diseases. More than 17,000 children were also vaccinated against measles and 182 patients were treated for meningitis.
Chad lies in a swathe of countries across Africa that see recurrent outbreaks of meningitis, an infection of the thin membranes surrounding the brain and spinal cord. Meningitis can cause headaches, fever, nausea, sensitivity to light and can lead to disability or death.
When meningitis epidemic thresholds were passed in early 2012, MSF launched vaccination campaigns in districts in the regions of Batha, Salamat, Mayo Kebbi Ouest, Mandoul and Hadjer Lamis. Some teams were able to use a newer vaccine, which offers 10 years of protection against the disease.
Teams treated hundreds of patients for the disease in Am Timan and Aboudeia, Salamat region and Moissala, in Mandoul. In April, MSF responded to a meningitis outbreak in Léré, Mayo Kebbi Ouest. Medical supplies were donated and a team worked with hospital staff to provide patient care and staff training. More than 700 treatment kits were donated to health centres and staff led awareness sessions in the villages and through local radio broadcasts.
Malaria Prevention and Treatment
A quarter of all deaths in Chad are attributed to malaria and it is the most common cause of death for children. Cases of the mosquito-borne disease peak from July to November.
In Moissala, Mandoul region, MSF has trained health care workers to diagnose and respond to simple malaria. They treated 39,500 people for the disease, while staff in clinics treated another 20,000. MSF donated drugs and medical supplies and ran an inpatient malaria ward for children in the district hospital, treating 2,100 children.
A new preventive strategy was also implemented. Between July and October, teams distributed antimalarial medicine to children once per month in two health zones of Moissala district. In the eight weeks following the first distribution of the medicine, staff in the health centers recorded a 78 per cent reduction in the number of patients with simple malaria.
Specialist Services for Women and Children
In Am Timan, Salamat region, MSF supports the district hospital with an emphasis on emergency services for women and children. On top of treatment for malnutrition, the team offers reproductive healthcare and emergency obstetric care, including an HIV–TB program and prevention of mother-to-child transmission of HIV. Ante- and postnatal consultations are held in six health zones and therapeutic feeding programs in nine health zones. In 2012, teams conducted 20,790 antenatal consultations and assisted 1,870 births.
Women who have sustained an obstetric fistula, damage to the birth canal most often caused by obstructed and prolonged labor, suffer physical pain, incontinence and rejection by their families and communities. MSF runs a women’s health village in Abéché, Ouaddai region, where patients can stay for their weeks-long treatment and receive nutritional support and counseling. Surgery and post-operative care is carried out at the regional hospital, in collaboration with the Ministry of Health. In 2012, 166 women received this surgery.
Assisting Refugees from the Central African Republic
Some 20,000 refugees from the Central African Republic have lived for several years in camps in the Moyen-Chari region of Chad. Heavy rains caused flooding in the camps in October and the refugees had to be relocated. MSF carried out 8,000 medical consultations, built 100 latrines and provided clean water and blankets, mosquito nets, water containers and soap to some 4,000 families.