Date Published: November 26, 2009
Publisher: Public Library of Science
Author(s): Gilles Guerrier, Malaïka Zounoun, Olimpia Delarosa, Isabelle Defourny, Michelo Lacharite, Vincent Brown, Biagio Pedalino, Daniel Tomé. http://doi.org/10.1371/journal.pone.0008077
Abstract: Certain population groups have been rendered vulnerable in Chad because of displacement of more than 200,000 people over the last three years as a result of mass violence against civilians in the east of the country. The objective of the study was to assess mortality and nutritional patterns among displaced and non-displaced population living in camps, villages and a town in the Ouddaï and Salamat regions of Chad.
Partial Text: Selecting a target population is a priority before implementing a food and relief aid program. Humanitarian aid agencies usually focus their effort on displaced population in emergency situations but pay little attention to the host population. Differences in outcome between residents and refugees have been reported in two studies but only after implementation of an intervention , . There has been little research on the nutritional status and mortality among internally displaced and non displaced population prior to an intervention, particularly in Chad.
We undertook 2-stage, 30 cluster household consecutive surveys in three sites in Eastern Chad: one in camps welcoming internally displaced people (IDPs) (Goz Beida region), one in villages (Am Dam district) and one in a small town (Am Timan), both in areas surrounded by camps hosting IDPs.
Surveys were performed from May 21–26, 2007, in Goz Beida, from October 10–17, 2007, in Am Timan, and from October 21–25, 2007, in Am Dam district. We surveyed 898, 901 and 900 households in IDP camps, NDPs in villages and NDPs in a town respectively. One household (0.1%) refused to take part in the survey in Am Dam district. Adults were not present in their households on the day of the survey in 10 cases (1.1%). The main characteristics of the surveyed population are described in Table 1. Overall, the number of reported deaths over the recall period in Goz Beida, Am Dam district and Am Timan were 45, 27 and 28 respectively. Of these, 23 (51%), 13 (48%), and 13 (46%) respectively were in children younger than 5 years. Among the 4902 IDPs, 4477 NDPs living in a village and 4073 NDPs living in a town surveyed during the period of interest, the CMRs were 1.8 (95% CI, 1.2–2.8), 0.3 (95% CI, 0.2–0.4), 0.3 (95% CI, 0.2–0.5) per 10 000 per day respectively and the respective mortality rates for children younger than 5 years were 4.1 (95% CI, 2.1–7.7), 0.5 (95% CI, 0.3–0.9) and 0.7 (95% CI, 0.4–1.4) per 10 000 per day. Diarrhoea was reported to be the leading cause of death among NDPs (Table 2).
The prevalence of malnutrition was surprisingly high among NDPs living in villages, with more than 16% of children younger than 5 years being affected. This figure surpasses the 15% suggesting a very serious situation . Our observation is even more alarming since the study was not performed at the peak season of acute malnutrition which is usually during the lean season (June to September) in similar areas of the Sahel –. However, comparisons with similar surveys carried out in the Sahelian zone should carefully be interpreted, since the effect of seasonality on malnutrition prevalence may differ from year to year, from country to country, and even from area to area . Salamat region is considered the granary of Chad. The counter-season culture of berbere (a variety of sorghum) provides two harvests per year, creating a surplus that traditionally is exported to other regions including Ouaddai. This could explain the difference in the prevalence of malnutrition found between the two NDP populations. The 2006/2007 harvest was considered above average allowing exchanges of harvested cereals between the areas with surplus and those with shortages. Moreover, according to the National Rural Development Agency, productive rains were recorded in July and August, 2007, in the Sahelian zone of Chad. Producers were thus able to undertake agricultural activities. Despite this potential access to available food, several factors could explain our worrying results. Prices for food were higher than normal in the Ouaddai’s regional capital, Abeche  partly due to disruptions in trade because of insecurity and heavy rainfalls rendering roads impassable. In addition, certain crops were threatened by pests such as grain-eating birds, which reduced harvests in the affected areas.