Health of mobile pastoralists in the Sahel - assessment of 15 years of research and development

In the Sahel, between Mauritania and Somalia including Northern Kenya, about 20-30 million people live as mobile pastoralists. The rhythm of their migration follows the seasons and the availability of resources such as water, pasture and salt. Despite their high exposure to zoonoses and problems caused by extreme climatic conditions, mobile pastoralists are virtually excluded from health services because the provision of social services adapted to their way of life is challenging. In cooperation with various partners in the region, the Swiss Tropical and Public Health Institute has been active in research and development in the Sahel for 15 years. Based on the perceived needs of mobile pastoralists and the necessities of development, interdisciplinary research has considerably contributed to better understanding of their situation and their problems. Close contact between humans and livestock necessitates close cooperation between human and animal health specialists. Such useful approaches should be continued and extended.

Retinol assessment among women and children in sahelian mobile pastoralists

Micronutrient deficiencies are widespread in developing countries, particularly in remote communities such as mobile pastoralists. The nutritional and vitamin A status of this population is not well-documented in Chad. This study assessed serum retinol levels among women and children under five-year-old in nomadic and semi-nomadic pastoralist and rural-settled communities, who are similarly exposed to risk factors such as gastrointestinal parasitic infection, anaemia and emaciation. The novel method of portable fluorometry was used for the first time to measure β-carotene and retinol levels in a pastoral nomadic area. Moderate level blood retinol deficiency (<0.7 μmol/L) was observed in 5% (CI 1-11) of nomadic, 29% (CI 13-45) of semi-nomadic and 22% (CI 8-35) of sedentary women. In children, 1% (CI 0.1-4), 17% (CI 9-25) and 28% (CI 18-39), respectively, had moderate level blood retinol deficiency. In nomadic communities, women and children had blood retinol levels close to normal. Deficiency of retinol was strongly linked with lifestyle (nomadic, semi-nomadic and settled) among women and lifestyle and age among children. The results support an ecological linkage between human retinol levels and livestock milk retinol. This study shows the feasibility of portable retinol and β-carotene measurement in human blood as well as human and animal milk under remote field conditions, but the approach requires further validation.

Parasitic infections, anemia and malnutrition among rural settled and mobile pastoralist mothers and their children in Chad

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.

[Nutritional status and dietary diversity in nomadic and sedentary rural women on the southeast bank of Lake Chad]

Malnutrition and undernourishment are widespread in the Sahelian region of Africa. The purpose of this study was to assess nutritional status and associated risk factors among nomadic and sedentary rural women on the southeast bank of Lake Chad. It was a repeated cross-sectional study based on semi-structured interviews and anthropometric measurements. A total of 734 women including 398 nomads and 336 sedentaries were randomly selected. Only non-pregnant women were included for calculation of the body mass index. Results showed a higher prevalence of malnutrition among nomadic women than sedentary women during the dry season: 48% (95% CI: 42-53) versus 16.2% (95% CI: 12-20). Obesity was observed in 4% (95% CI: 2.4-7) of sedentary women versus 0% of nomadic women. These rates were similar during the wet season. Malnutrition rates differed significantly (p<0.01) between the two groups within each season but not between seasons within each group. The average household dietary diversity score (HDDS) determined on a scale of 12 was low in both nomadic and sedentary women: 4.5 (95% CI: 4.4-4.6) and 5.1 (95% CI: 5.0-5.3) respectively. Malnutrition was significantly correlated with HDDS, number of children and ethnic group.

[Seasonal variations in the nutritional status of nomad and sedentary children less than 5 years of age living in the Sahel in Chad]

Malnutrition is widespread among rural and nomad populations in the Sahel. It is linked to socio-economic factors and exhibits significant seasonal variations. The aim of this study was to assess the prevalence of malnutrition and associated risk factors among children less than 5 years of age. A repeated cross-sectional study design based on interviews and anthropometric measurements was used. A total of 653 nomad children and 579 sedentary children ranging in age from 0 to 59 months were randomly selected in households/camps on the south-eastern shore of Lake Chad. Data were collected from the same number of children at the end of the dry season (May/June, 2007) and at the end of rainy season (October 2007). Findings showed significant interseasonal variation in the prevalence of global acute malnutrition (GAM) between the end of the dry season and end of the rainy season. The respective variations were 17.9% to 13.7% (p = 0.03) in nomad children and 16.5% to 10.6% (p = 0.004) in sedentary children. Backward stepwise multivariate analysis by logistic regression showed that GAM among children under 5 years of age was significantly correlated with the following risk factors: seasonal variation, child's age, mother's nutritional status, ethnic group, and place of residence (LRT=172 and p < 0.001 for the logistic regression model). These findings demonstrate the critical state of the nutritional situation in the Sahel and rural areas.

[Health care services for nomadic people. Lessons learned from research and implementation activities in Chad]

To overcome barriers of access to health care of nomadic people and to alleviate inequities in health, a transdisciplinary team has initiated research and intervention activities among three nomadic groups of Chad: Foulbé, Arabes and Gouranes. A regular and consistent communication among all actors involved (nomadic groups, researchers, planners and administrators of health and veterinary services, etc.) through repetitive meetings and workshops showed to be a crucial element for success. Differences between ethnic nomadic groups made it necessary to develop specific communication strategies adapted to each group. As to interventions to improve the vaccination coverage, mixed teams combining health and veterinary specialists were able to vaccinate an important number of children and women and showed to have a high potential in terms of organisational and logistic feasibility, acceptability as well as good cost-effectiveness. With regard to improving access to health care, Information--Education and Communication approaches adapted to the intervention context and linked to the provision of essential services and generic drugs showed to be crucial.

[An innovative approach combining human and animal vaccination campaigns in nomadic settings of Chad: experiences and costs]

The purpose of this report is to describe a network of public health care workers, veterinarians and nomadic pastoralists that was set up in Chad to increase vaccination coverage to nomadic children and women who had rarely been vaccinated before. The objectives of the project were to provide human vaccination in conjunction with existing veterinary services, to evaluate the feasibility and limitations of such campaigns, to determine what other services could be provided concurrently, and to estimate the savings for public health care cases in comparison with carrying out vaccination separately. In a series of 12 vaccination campaigns in the Chari-Baguirmi and Kanem districts, more than 2100 children, 2100 women and 52000 cattle were fully immunized. These results confirmed the feasibility of joint campaigns in nomadic settings and provided important experience for improving organization. Information-Education-Communication (IEC) campaigns adapted to the realities of the pastoral setting were an important factor in mobilizing nomadic pastoralists for attendance at vaccination clinics. The savings in logistics costs (i.e., personnel, transportation and cold chain costs excluding vaccine costs) was 15% in Gredaya where 3 out of 6 campaigns were carried out together with veterinarians and 4% in Chaddra/Am Dobak where only 1 out of 6 campaigns was carried out in conjunction with veterinarians. The cost per fully immunized child (FIC) was considerably higher in Chaddra/Am Dobak than Gredaya (EUR 29.2 vs. EUR 11.5). The joint vaccination campaign approach is innovative, appreciated by nomadic pastoralists and less expensive than separate vaccination. By using the mobility of veterinarians in remote zones far from health care facilities, vaccination can be provided to nomadic children and women in countries with limited resources.