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Local-level planning gives Chad’s nomadic children polio protection

Local-level planning gives Chad’s nomadic children polio protection

28 juin 2023 | Chad
“We’ve been coming back to this site every year for the past seven years and I never travel without my children’s vaccination cards,” says mother-of-two Zrega Nour. Her children have just received their nOPV2 polio doses as part of the four-day campaign.

N’Djamena – Around 5.4 million children in Chad were recently vaccinated against polio in a broad and synchronised campaign. Carried out with support from World Health Organization (WHO) and Global Polio Eradication Initiative (GPEI) partners, the immunisation drive included neighbouring Cameroon, Niger and the Central African Republic.

In Chad, where polio was detected in 2019 after no cases were reported for six years, efforts were made to ensure communities living in hard-to-reach locations, such as nomadic populations, were not left behind. 

Nomadic populations account for 3.4% of Chad’s population. They are among the most underserved communities, with very limited access to health services.The first polio campaign targeting nomadic children, who at the time comprised 40% of the country’s total polio cases, was launched in 2012. Thanks to effective micro-planning and geolocation tools, in 2023 polio vaccination teams reached 51 242 nomadic children nationwide.
 

Nour’s family has a tent in Mara, in N'djamena north district along the river Chari, which separates Chad from Cameroon. “We always take the polio vaccine at the health centre and also during the campaigns,” she adds.

In addition to the standard four doses administered at two months, four months, six to 18 months, and between four and six years of age, the campaign offers every child under five an extra two doses of oral polio vaccine, regardless of their vaccination status.

“Nomads have settled here for a long time, returning after every rainy season,” explains Abacar Mahamat Kouta, head of the Mara Health Centre and polio campaign coordinator for the zone. WHO and partners opted for a decentralized approach to micro-planning, which is an essential component of the polio campaign toolbox. This requires health centres to take responsibility for counting the number of nomads in their zone, and compiling comprehensive data to ensure every child receives their polio vaccine, regardless of the difficulty in reaching them. As the campaign draws to a close, Kouta is supervising the work of his teams, verifying finger and house markings, as well as vaccination documents. “Unfortunately, we’ve had some difficulties with nomadic communities accessing health services,” he adds. “There were a few instances when they were not included in mosquito nets or vitamin distribution.”

Bourdjia Hassaballah, a settlement elder, confirms that her people have felt sidelined in the past. “One time, vaccinators came to us but had run out of vaccines,” she says. But things are better now, she adds: “I help by talking to anyone worried about the polio vaccine in the community.”

Far from being a homogenous group, different nomadic communities are dissimilar. What they all have in common is that their access to health care is restricted by seasonal movement. Some caravans cross into neighbouring countries or insecure zones, where health services are unavailable. To rebuild their lost trust, leaders are being engaged and tailored communication approaches adopted. Among these are vaccination micro-plans.

“People always think mobility is the biggest challenge," says Dr Mahamat Abdoulaye Ahmed, consultant at the Africa Center for Disease Control (CDC), a GPEI partner. Ahmed has worked to improve access to vaccination for nomadic communities for a decade, and is assisting WHO on the polio campaign. “The hardest is actually getting health centres to understand that nomads must be included in their target,” he stresses.

Health centres use a nomad data collection form developed by WHO to record all individuals, their duration of movement, and time spent around the health centre where they were tallied. “Thanks to this form, we can design a micro-plan to reach nomadic children, which includes the number of settlements, geographic coordinates and exact target numbers for the vaccination,” Ahmed explains.

Dr Lamine Camara, vaccination coordinator at WHO Chad, says they will continue working with GPEI and the country’s Health Ministry o to prioritize nomadic children in the next round of the campaign. “We’ve worked closely with nomadic leaders and recruited specialized teams. We’ve had excellent results so far. The Ministry of Health even created a programme dedicated to nomadic populations,” explains Camara.

In Mara, Marc Allaramadji, a student and experienced polio vaccinator, is following a detailed plan to reach all the nomadic children in his zone. “I've vaccinated 20 nomadic children over the past two days,” says Allaramadji, who is busy speaking to families and checking for any missed children during mop-up operations.

While checking a tent, his team notices a missing house marking and immediately takes corrective action. “We don’t usually mark tents because they’re made of material that is difficult to write on. If we use a marker, people can’t erase that and we need to respect their homes. So we mark the nearest tree instead,” he explains. "I do what I can to support the children. Whether I am a nomad or not, we are all part of the same community.”

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