Health emergencies affect nearly two million people in Chad
Health emergencies are among the three main humanitarian crises that Chad is facing -in addition to food insecurity and malnutrition, and population movements. The country regularly records cases of malaria, measles, meningitis, yellow fever, and cholera. This year, new diseases have been added to this already long list: COVID-19, chikungunya in the East, and leishmaniosis in the northern provinces of Tibesti and Borkou, mostly affecting goldmine workers.
Chad crosses the 1,000 COVID-19-case mark
Even if Chad did not report a high number of COVID-19 cases compared to other African countries, to the subregion and to the rest of the world, the fatality rate is among the highest in the world. According to the data reported in the daily epidemiological report, jointly published by the Ministry of Public Health and National Solidarity and by the World Health Organization (WHO), as of 23 September, 1,171 COVID-19 cases have been reported cumulatively in 17 provinces, as well as 82 deaths with a fatality rate of 7 percent. New cases are primarily travelers (incoming and prospective), including Chadian students from Cameroon and contact cases. The epidemiological curve - which had flattened in June and July - has been on the rise again for the past 10 weeks, with 282 reported cases during this time. Of all the diseases Chad is confronting, COVID-19 is the one that had the most impact, especially on the economic and social aspects of life (see our report based on a recent impact study).
Nearly 30,000 cases of chikungunya in the East
According to the joint situation report by WHO and the Ministry of Public Health, the first official case of chikungunya was reported in the health district of Abeche on 14 August 2020. Before this date, the chief-doctor of the Abeche district had been alerted in July, by the manager of the Salamat health center, of the occurrence of a pathology locally called “Kourgnalé”. This pathology is characterized by a strong fever, headaches, intense and debilitating joint pain, and sometimes associated with vomiting. It was considered and treated as malaria. In August, the increase in the number of reported cases captured the attention of local health authorities and led local and national health authorities and WHO to conduct an investigation that concluded with the confirmation of chikungunya by PCR and to the identification of the vector, the aedes aegypti mosquito.
As of 22 September, there have been 28,991 reported cases and one death. All the affected people come from four health districts in eastern Chad: Abeche (Ouaddaï), Biltine (Wadi Fira), Abdi and Goz-Beida (Sila). On 9 September, the Ministry of Public Health organized a virtual meeting with the national and regional WHO offices and Geneva HQ in order to monitor the crisis response and identify gaps and needs. Local authorities deployed community agents to sensitize the community to the disease, and they continue to disinfect entire neighborhoods as well as public transportation. Though this disease normally has a low mortality rate, its combination with other health risk factors is worrying. It increases the vulnerability of the population even further and places greater demands on health response capacities and resources.
Malaria: a worrying and underestimated situation
Malaria is the disease that currently kills the most people in Chad. According to the data from the National Committee for Epidemic Control (CTNLE), out of the 943,040 malaria tests conducted between 1 January and 13 September 2020, a total of 571,258 cases were confirmed (60.5 percent), with 1,280 deaths across the country. In addition to these numbers, there are close to 1,140,000 suspected cases based on clinical symptoms but who have not been tested. Among these suspected cases, 1,368 people have died. The situation is slightly better than last year around the same period when 689,563 cases were confirmed and 1,323 died - a difference of 118,305 cases and 43 deaths. However, the situation has worsened compared to 2017 and 2018 when the number of confirmed cases were 524,148 and 534,781 (with 957 and 922 deaths) respectively.
The most affected provinces are, among others, Logone oriental (with a total of 80,930 cases), Mandoul (82 258 cases), Moyen-Chari (60 207 cases), Tandjle (55 777 cases) and N'Djamena (53 976 cases).
The great number of suspected cases can be explained by various factors. First, there is the unavailability of tests in certain areas to confirm the clinical symptoms observed, then there is the financial incapacity of patients to pay for the tests. To some extent, the reliability of the test can suffer from poor conservation conditions, particularly in remote areas, where rapid diagnosis tests (RDR) are more commonly used, instead of the microscope which requires maintenance. Moreover, the increase in new malaria cases in 2019 can be explained by the integration of malaria data from some private health structures, national hospitals and some provincial hospitals which did not transmit their reports to the PNLP before.
The financial incapacity of patients may be attributable to the Government’s revision of the free healthcare package, through the Ministry of Health, in August 2017. The Ministry of Health reduced, by decree, to five the types of health emergency covered by the free healthcare policy - severe malaria, prenatal and neonatal consultations, C-section deliveries, child nutrition care, and snake and scorpion bites. Not all health centers and public hospitals comply with this policy, namely because they lack medical supplies to provide the necessary care. Considering the mortality due to malaria, it would be vital to make malaria tests free as well as facilitate healthcare for the disease itself.
An endemic measles with more than 8,000 cases
Measles is endemic in Chad with an annual epidemic that mostly affects children and teenagers. According to a situation report issued by the Ministry of Public Health and WHO last April, the 2020 epidemic is actually a flare-up of the one that started in May 2018, with 127 suspected cases reported as early as the first week of January. The following weeks saw the cases triple or quadruple, with peaks of 814 and 810 suspected cases between the end of February and early March. The number of weekly cases only fell under 100 around the end of May.
As of 30 April 2020, 28 health districts were in a declared measles epidemic. As of 13 September, the Ministry of Public Health reported 8,520 suspected cases including 39 deaths, with the highest number of cases in the districts of Beboto, Kyabe and Goundi. The persistence of this epidemic over the past two years can be explained by an insufficient vaccination coverage, the poor quality of the response and epidemiological surveillance. In fact, according to the joint situation report, out of a sample of 396 investigated cases in 2020, only 72 had been vaccinated - less than 20 percent. At the same time, the risk assessment conducted at the beginning of the year shows that Chad runs a very high risk of a measles outbreak during the next season of strong transmission which should start in the fourth trimester of 2020 and continue through June 2021. Considering this, Chad, with the support of partners, is strengthening routine vaccination through the implementation of Intensified Vaccination Activities (IVA), mixed vaccination (man/livestock) and proposes a national measles campaign targeting children aged nine to 59 months by the end of 2020. Moreover, COVID-19 containment measures have impacted the measles response (see our situation report from 22 May 2020).
It is important to note the correlation between measles and acute malnutrition as well as other diseases. Indeed, a measles condition can lead to malnutrition for a child. Also, a child with malnutrition is more exposed to other diseases such as malaria. As of 13 September 2020, the Ministry for Public Health reported more than 450,000 cases of acute malnutrition including 173,000 cases of severe acute malnutrition and 207 deaths.
Other diseases, such as meningitis, yellow fever and neonatal tetanus, even with fewer cases continue to cause deaths. Since the beginning of the year, Chad has reported 436 cases of meningitis with 41 deaths; 197 babies have been affected by neonatal tetanus and 47 of them have died; there have been 318 suspected cases of yellow fever and three deaths.
The humanitarian community estimates that, in 2020, 1.8 million people are affected by health emergencies in Chad, of whom 760,000 are targeted to receive assistance. The diseases taken into account in this report represent only some elements of the health emergencies Chad faces.