Human and animal health in nomadic pastoralist of Chad : zoonoses, morbidity and health services

The health of nomadic pastoralists is influenced by factors specific to their way of life.
Nomadic pastoralists depend on their livestock for subsistence, especially on the livestock’s
milk. Veterinary services provide vaccination against feared livestock diseases such as
anthrax. Agents transmissible between livestock and humans (zoonotic agents) may have an
important impact on the health status of pastoralists because they live in close contact to their
animals. However, morbidity of nomadic pastoralists in Chad had not been documented and
their everyday use of health services was virtually unknown. A research collaboration
between veterinary and public health was implemented to evaluate morbidity of nomadic
pastoralists and of their animals simultaneously and to test intersectoral pilot-interventions
following the concept of “one medicine”. The studies encompassed in this thesis were
conducted in the framework of an interdisciplinary research and action programme. Fulani and Arab cattle breeders and Arab camel breeders were visited during three
consecutive samplings, two in the dry season and one in the wet season, between April 1999
and April 2000. A physician clinically examined 1160 women, men and children and
completed a survey questionnaire. Sera, sputum and urine samples were collected from
humans, as well as sera and milk from 1640 animals. Complementary interviews mainly
directed at livestock health were recorded. Brucellosis and Q-fever were selected to investigate a possible correlation between the
occurrence of these zoonoses in livestock and in humans. No active foci of brucellosis were
found. The impact of brucellosis and Q-fever on the health status of the three nomadic
communities included in the study appeared marginal in comparison to other diseases
recorded. Pulmonary diseases were frequent, e.g. bronchitis in children under 5 years of age
(18%). Arab cattle and camel breeders were severely diseased by malaria during the wet
season. Clinically diagnosed malaria was prevalent during the entire year among Fulani, who
stayed in the vicinity of Lake Chad. Human serum retinol concentrations were significantly
correlated to livestock milk retinol, illustrating the significance of milk as a dietary
component. However, serum retinol levels of women were generally low. A 24-hours dietary
recall showed that nomadic pastoralists only rarely consumed fruits and vegetables. The utilisation study provided an overview on health service utilisation patterns of sick
nomadic pastoralists. Participants with respiratory disorders went early to a dispensary for
consultation and successively also used more other health services. Dispensaries where antimalarial
drugs were known to be in short supply were rarely visited during the wet season.
Our data suggest that young unmarried women and men had fewer opportunities to visit a
marabout or a dispensary than other members of the community. Women gave birth assisted
by relatives in the camps, and prenatal health care was virtually not used. No fully immunised
nomadic child was found in the study population. In contrast, livestock had been vaccinated
by veterinarians visiting the nomadic camps during compulsory vaccination campaigns.
Breeders observed an increasing inefficacy of anthrax, blackleg and pasteurellosis vaccines.
Deaths of cattle after vaccination against contagious bovine pleuropneumonia and visits of
veterinarians solely to take blood for rinderpest serosurveillance without treating diseased
animals were recurrent complaints of nomadic pastoralists towards veterinary services.
Nevertheless, the idea of joint human and animal vaccination campaigns was appreciated
because nomadic pastoralists wanted vaccination for their children, especially against
measles. To which extent knowledge and experiences with livestock vaccination were
transposed to children vaccination remained unclear. A cost analysis of subsequent joint
vaccination campaigns showed that the public health sector can save up to 15% of
infrastructure and personnel costs when vaccination services for nomadic children and women
are delivered together with interventions of the livestock production sector. Improvement of the quality of dispensary services has a potential to increase the utilisation of
dispensaries by nomadic people. Health workers belonging to the nomadic community itself
and better able to reach the camps may, nevertheless, be more accessible to women and
children. Static or outreach dispensary-based vaccination services do not have the same
efficiency to reach nomadic children as mobile vaccination campaigns have. Private
veterinarians, who almost exclusively have access to pastoralists in remote areas would be
interested in more fully capitalising their transportation infrastructure. Joint human and
animal vaccination campaigns should be extended to other services (such as the selling of
drugs) and especially to information campaigns. The provision of appropriate information
may be as important as health care interventions themselves.