Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Sten H. Vermund

Abstract

Background: Infectious diseases remain a leading cause of mortality and morbidity in Chad. We aimed to assess trends in the most recent ten years of surveillance data collected by the Ministry of Public Health in Chad to characterize the country’s current disease burden.

Methods: In this analysis of Chadian surveillance data, we analyzed reports of suspected cases across seven diseases from 2014-2023. Data included weekly aggregated case counts by district. We used the data to describe temporal and spatial trends, particularly from 2014-2019 compared to 2020-2023.

Findings: Measles case counts showed seasonal peaks of varying intensity throughout most of 2014-2023. Province-level incidence decreased throughout most of the country between the pre-pandemic and post-pandemic periods, but increased most in Mandoul (356·6%) and Moyen-Chari (493·3%). Meningitis cases declined in the past four years, reaching their lowest level in ten years. Yellow fever cases significantly increased in the past three years. Six provinces had increases of over 100% between the two periods: Guéra (129·6%), Mandoul (505·5%), Mayo-Kebbi Ouest (164·4%), Ouaddaï (113·4%), Tandjilé (281·7%), and Tibesti (137·9%), five of which are in the southern half of the country. Neonatal tetanus experienced a slight upward trend throughout the ten-year period, with a similar distribution across nearly all provinces between the two periods under examination. Malaria had a similar steady increase throughout the ten-year period, with most provinces reporting slightly higher incidences during the post-pandemic period (2·6 to 68·1%). Acute flaccid paralysis experienced larger increases in the past four years, with the largest increases in incidence in the south, in Mandoul (185·6%) and Tandjilé (188·5%). The number of Guinea worm cases was abnormally high in 2019, then declined to pre-2019 levels. Fewer provinces reported cases of Guinea worm in the post-pandemic period compared to the pre-pandemic period.

Interpretation: Trends in the seven diseases included in this report varied throughout the time period, highlighting the importance of a shift in future priorities to best respond to infectious disease challenges in Chad.

Funding: The U.S. Agency for International Development.

Comments

This is an Open Access Thesis.

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