Rapid Nutritional and Health Assessment of the Population Affected by Drought-Associated Famine -- Chad

Chad, a landlocked country of approximately 4.5 million people, was one of the countries most severely affected by sub-Saharan Africa's recent drought and associated famine. The drought caused many Chadians to leave their villages. Some voluntarily resettled in food-for-work settlements along dried-up river beds; others moved to makeshift encampments near towns and villages. Food aid and health care for the majority of these displaced persons was limited. The U.S. Agency for International Development (AID), with the concurrence of the Government of Chad, asked CDC to provide a team to conduct a rapid assessment of the health and nutritional status of the displaced population. This assessment was performed in January 1985, with the cooperation of AID, the Chadian Ministry of Health, Medecins Sans Frontieres (MSF), and other private voluntary agencies.

Seven sites were assessed in seven of the country's 14 prefectures. The sites included a variety of displaced-person settlements, food-for-work programs, and unstructured population concentrations around villages, but these sites were not randomly chosen. At each site, the nutritional status of a random sample of children 1-5 years of age was assessed by anthropometric methods. Except at two sites, where weight-for-height surveys had been conducted by MSF, the mid-upper arm circumference method was used. Recent measles occurrence and measles vaccination coverage at each site were determined, along with the estimated incidence of recent diarrhea. Diarrhea treatment methods also were determined. Respondents were asked about recent malaria or unexplained fever, and water availability and sanitation needs were assessed.

Levels of acute undernutrition (less than 80% of median weight-for-height or mid-upper arm circumference under 12.5 cm) ranged from 8% in an established resettlement site to 67% in an unorganized camp where only minimal food aid had been given (Tables 2 and 3). Levels of severe undernutrition (less than 70% of median weight-for-height or less than 11.1 cm arm circumference) ranged from 0 to 18% among children in the various sites (1).

Measles had occurred in many sites. At the time of the survey, immunization campaigns had been conducted in only a few of the larger camps. In the rest of the country, vaccination coverage was estimated to be less than 5%. Water quality and quantity in most sites were poor. Diarrhea was prevalent. Little malaria-like disease was reported. In one area where mortality had been determined by another voluntary agency, the rate was at least three times the normal level of 20 deaths per 1,000 population per year.

In addition to anthropometric studies, MSF conducted nutritional status assessments in 45 areas that had an estimated population of 300,000. This assessment was based on socioeconomic factors, including migration, family composition, and food supplies and on whether traditional famine foods, such as leaves and roots, were being consumed. The results correlated with nutritional data that MSF collected later in several of the areas. The MSF studies indicated that less than 3% of the population lived in areas with adequate food reserves, 45% lived in areas with a potential for deterioration over the next few months, and 53% lived in areas with serious current nutritional problems. Reported by the Government of Chad; US Agency for International Development, Ndjamena, Chad; Medecins Sans Frontieres, Chad; Africa Bureau/Regional Affairs, Africa Bureau/Technical Resources/Health and Nutrition, Office of Foreign Disaster Assistance, Agency for International Development, Washington, DC; Div of Field Svcs, Epidemiology Program Office, Div of Nutrition, Center for Health Promotion and Education, International Health Program Office, CDC.

Editorial Note

Editorial Note: The major health problem observed was the poor nutritional status of the Chadian population. The levels of malnutrition were as high as or higher than those seen in the Sahel during the 1969-1974 drought (2,3). It appeared that if the food assistance were not increased, widespread mortality could result. Based on MSF observations of areas in need, the CDC team estimated that the minimum aid needed per month was 17,000 tons of food; this amount considerably exceeded the existing delivery capacity of 10,000 tons per month and was more than double the amount then being provided.

Efforts were successful in increasing the delivery of food through ports in Nigeria and Cameroon and in augmenting the distribution capacity within Chad. New food-for-work settlement projects were temporarily suspended until the already displaced population could be partially rehabilitated nutritionally. Supplementary feeding programs run by voluntary agencies were expanded.

Measles is a serious threat to malnourished populations; low vaccination coverage levels among children in the displaced population constitute a major risk. Efforts were undertaken to increase vaccination coverage of this highly vulnerable population, such as mass immunizations in several of the larger camps.

Recommendations were presented to improve the water situation by using simple technology to build shallow wells in areas with superficial water tables. Oral rehydration was well accepted by the local population, where introduced, and attempts were made to augment local supplies and use.

Malaria did not appear to be a problem at the time of the assessment; however, many areas of the country are malarious at least seasonally. With the beginning of the rains this year, the disease may pose a significant threat to those whose immunity has waned during the drought and to those who have migrated from nonmalarious areas. Adequate supplies of chloroquine are available in the country.

References

1. National Center for Health Statistics. NCHS growth curves for children, birth-18 years, United States. Rockville, Maryland: National Center for Health Statistics, 1977; DHEW publication no. (PHS) 78-1650. (Vital and health statistics; series 11: data from the National Health Survey, no. 165).

2. Hogan RC, Broske SP, Davis JP, et al. Sahel nutrition surveys, 1974-1975. Disasters 1977;1:117-24.

3. Kloth TI, Burr WA, Davis JP, et al. Sahel nutrition survey, 1974. Am J Epidemiol 1976;103:383-90.

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