Trends and determinants of anemia in children 6-59 months and women of reproductive age in Chad from 2016 to 2021.

BACKGROUND: Hemoglobin assessments in children and women have been conducted annually in Chad since 2016 through the Standardized Monitoring and Assessment of Relief and Transitions (SMART) cross-sectional surveys. This analysis aims to characterize national and sub-national trends in anemia among children under five and women of reproductive age from 2016 to 2021 and to compare risk factors for anemia before and during the COVID-19 pandemic. METHODS: Hemoglobin concentrations were measured in approximately half of the 12,000 to 15,000 included households each year, except for 2020 when hemoglobin tests were omitted. For children 6 to 59 months of age, anemia was defined as hemoglobin less than 11.0 g/dL. Anemia was defined as hemoglobin less than 11.0 g/dL and 12.0 g/dL for pregnant women and non-pregnant women, respectively. Trends were stratified by agroecological zone, and tests of proportions were used to assess statistical significance. Simple and multivariate logistic regression models were conducted for 2019 and 2021 to identify risk factors for anemia. RESULTS: Reductions in anemia over the 6-year period were significant among women (47.6-30.8%, p = 0.000) and children (68.6-59.6%, p = 0.000). The Sudanian zone had consistently higher rates, particularly in children, compared to the Sahelian and Saharan zones. Significant declines in women's anemia were observed in all zones from 2019 to 2021, but this global decline was not observed among children, where rates in the Saharan zone significantly increased. In 2019, only minimum dietary diversity significantly reduced the odds of anemia in children (AOR: 0.65, 95%CI: 0.46-0.92), whereas in 2021, improvements in all diet indicators were associated with lower odds of anemia. Improved household socio-economic factors, including head of household literacy, were associated with lower odds of anemia in children (2019 AOR: 0.76, 95%CI: 0.67, 0.88) and women (2019 AOR: 0.75, 95%CI: 0.65, 0.87; 2021 AOR: 0.81, 95%CI: 0.70, 0.93). CONCLUSIONS: Anemia declined significantly in Chad among women of reproductive age and children from 2016 to 2021, but the national prevalence of 60% among children remains unacceptably high. Sub-national differences in anemia rates underline the need to identify and address regional causes of anemia while strengthening national level programs.

Community Clustering of Food Insecurity and Malnutrition Associated With Systemic Drivers in Chad.

BACKGROUND: Chad suffers from protracted hunger, facing high food insecurity (Integrated Food Security Phase Classification 3 and above), and acute malnutrition levels that surpass the emergency threshold (15% global acute malnutrition) yearly. The Food Security Sector, with European Union support, leads an inclusive effort to increase synergy between humanitarian, development, and peace-building actors to understand and address drivers of hunger. OBJECTIVE: To understand the spatial distribution of child wasting and household food insecurity and systemic drivers (conflict, livelihoods, vegetation, cultural norms) as well as better understand the relationship between child wasting and household food insecurity in Kanem and Bahr el Ghazal (BeG) region, Chad, with the goal of improving nexus programming and targeting. METHODS: A cross-sectional randomized cluster survey was conducted in August 2021 in Kanem and BeG across 86 villages, reaching 7002 households and 6136 children. Data were collected on child anthropometry, household food security, and livelihoods. Using mixed methods, primary data were triangulated with secondary geospatial data on vegetation index and conflicts as well as qualitative interviews with local actors. Analysis was conducted using comparison tests, linear and logistic crude, and adjusted models, as well as looking at the design effect as a measure of clustering of outcomes at the community level. RESULTS: The geospatial distribution of hunger indicators shows child wasting and food insecurity are highly clustered. However, communities with a high prevalence of child wasting were not those with the highest levels of food insecurity, indicating different pathways. Clustering of food insecurity and child wasting is due to basic drivers of conflict, health, and seasonal access to natural resources. CONCLUSIONS: The high levels of food insecurity and child wasting are each concentrated in specific survey clusters and are not necessarily connected. They result from different causal pathways at the community level linked to the systemic drivers of the rule of access to natural resources, environmental seasonality, and livelihoods. This suggests a greater need for an integrated humanitarian, development, and peace-building interventions to address the persistent high prevalence of food insecurity and child wasting. It also suggests that these community-level and systemic drivers require greater consideration from the start in research design and data collection.

Plain language titleUnderstanding Linkages Between Household Food Insecurity, Child Malnutrition, and Their Respective Clustered Drivers in ChadPlain language summaryChad experiences emergency levels of household food insecurity and child malnutrition. To address this issue, the United Nations Food and Agricultural Organization has undertaken a collaborative effort to enhance cooperation among humanitarian, development, and peace-building actors. The objective of this study was to examine how child malnutrition, food insecurity, and their drivers cluster across communities in Kanem and Bahr El Ghazal to improve response planning and targeting. The study collected data in August 2021 on malnutrition, food security, livelihoods, vegetation, and conflict and carried out interviews with local informants. In total, the research covers 86 villages, 7,002 households, and 6,136 children. The research shows that the 2 measures of hunger, child malnutrition and food insecurity, are highly clustered, affecting some communities more than others. However, villages with a high prevalence of child acute malnutrition did not have the highest levels of food insecurity, suggesting different community-level drivers. The clustering of food insecurity and malnutrition at the village level was linked to the diversity of livelihoods, the experience of conflict, health, and seasonal limitations in accessing natural resources. These findings are crucial for informing the targeting and design of integrated humanitarian, development, and peace programs. Taking a systemic approach and fostering strong coordination across interventions to address the drivers of food insecurity and malnutrition holds great potential for tackling hunger in Chad.

Trends and Determinants of Children's Wasting and Women's Thinness in Chad, 2015 to 2021.

BACKGROUND: Cross-sectional surveys using the Standardized Monitoring and Assessment of Relief and Transitions methodology have been conducted annually in Chad since 2015 to evaluate population-level nutritional status. OBJECTIVE: This analysis characterizes national and subnational trends in child wasting and women's thinness from 2015 to 2021 in Chad and identifies risk factors during the COVID-19 pandemic. METHODS: Annual survey data with 12,000 to 15,000 households were included. Wasting was estimated for children 6 to 59 months using the WHO child growth standards, and among women 15 to 49 years, thinness was defined as mid-upper arm circumference <23 cm. Trends were stratified by agroecological zone, and chi-square tests used to assess statistical significance. Simple and multivariate logistic regression models were conducted for 2020 and 2021 to identify risk factors of wasting and thinness. RESULTS: About 11,958 to 17,897 children and 9883 to 15,535 women contributed values each year. National wasting and thinness rates did not significantly decrease over the 7-year period (wasting: 14.1% to 12.1%, P = .43; thinness: 15.2% to 13.4%, P = .51) and wasting rose from 2020 to 2021. The Saharan and Sahelian zones had consistently higher rates compared to the Sudanian zone. Younger age, male sex, inadequate infant and young child feeding practices, and poorer household socio-economic factors were associated with greater odds of child wasting. For women, younger age, lack of nutrition knowledge, and poorer household socio-economic factors increased the odds of thinness. CONCLUSIONS: Undernutrition in Chad has not improved since 2015, and the COVID-19 pandemic likely exacerbated the crisis among children nationally and among women subnationally. Multisectoral approaches and regional targeting of interventions are recommended.