Chad faces significant challenges in providing adequate healthcare to its population. Poor healthcare-seeking behavior is a major contributing factor to increased morbidity and mortality among children in low- and middle-income countries. Understanding the factors that influence healthcare access and utilization is crucial for improving health outcomes in this region. This article delves into the statistics surrounding healthcare access in Chad, with a focus on maternal and child health, and explores the various factors impacting healthcare-seeking behaviors.
Healthcare Infrastructure and Access
Chad's healthcare system is challenged by a shortage of medical staff, medicines, and equipment. Skilled health personnel are scarce, with significantly fewer physicians and nurses/midwives compared to other African nations. A large portion of the skilled health workforce is concentrated in the capital, N’Djamena, leaving rural areas underserved.
Healthcare in Chad is provided through direct payment, free access to selected services, health insurance, and health mutual (payment of cost of healthcare by both private and public health organization). More than half of the total health expenditure is through out-of-pocket payment, with free access to some selected healthcare through the financial support of the state.
The UNHCR reported that Chad has a large population of concern, including refugees and asylum seekers. The physician density is 0.04 per 1,000 population, and the nurse and midwife density is 0.31 per 1,000 population.
Life expectancy at birth in Chad is 53 years for men and 55 years for women (2016). Diarrheal diseases are the leading cause of death, with a death rate of 163.5 per 100,000 in 2017.
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Factors Influencing Healthcare-Seeking Behavior
A study utilizing data from the 2014-2015 Chad Demographic and Health Survey examined factors associated with healthcare-seeking behavior for childhood illnesses. The study included 5,693 mothers who reported that their children under five had either fever accompanied by cough or diarrhea within the two weeks preceding the survey. The outcome variable was healthcare-seeking behavior for childhood illnesses.
Out of the 5,693 mothers, 79.6% sought treatment for their children’s illnesses. The study revealed that both individual and community-level factors are associated with healthcare-seeking behavior for childhood illnesses in Chad.
Individual-Level Factors
- Financial Barriers: Mothers who faced financial barriers to healthcare access were less likely to seek healthcare for childhood illnesses (aOR = 0.80, 95% CI = 0.65-0.99).
- Geographical Barriers: Mothers who reported that distance to the health facility was a barrier were less likely to seek healthcare (aOR = 79, 95% CI = 0.65-0.95).
- Marital Status: Cohabiting mothers were less likely to seek healthcare compared to married mothers (aOR = 0.62 95% CI = 0.47-0.83).
- Radio Exposure: Lower odds of healthcare seeking were noted among mothers who did not listen to the radio at all (aOR = 0.71, 95% CI = 0.55-0.91).
- Child Size at Birth: Mothers who mentioned that their children were larger than average size at birth had a lesser likelihood of seeking childhood healthcare (aOR = 0.79, 95% CI = 0.66-0.95).
Community-Level Factors
- Community Literacy: Community-level literacy is significantly associated with healthcare-seeking behavior.
These findings are consistent with previous studies in other sub-Saharan African countries, highlighting the importance of addressing these barriers to improve healthcare access.
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Maternal Health Disparities
The Republic of Chad has one of the highest rates of maternal mortality in the world. In 2020, the WHO reported a maternal mortality ratio (MMR) of 1063 maternal deaths per 100,000 live births. A comprehensive response to improving maternal health (MH) in Chad is hindered by inadequate resources including limited national health financing, weak health infrastructure, an insufficient and inequitably distributed health workforce, lack of coordination in the health system, and underreporting of maternal deaths.
Important regional disparities in coverage for key MH interventions across antepartum, intrapartum, and postpartum stages have been identified in national health surveys.
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A study aimed to identify priority regions/provinces for intervention in Chad based on aggregate MH coverage gap scores (Target-Coverage = Coverage Gap). The study used data from the 2019 Multiple Indicator Cluster Survey and other national surveys for selected indicators at the provincial level.
Eleven key indicators of maternal health were included:
- Adolescent Birth Rate (ABR)
- Delivery by skilled health personnel
- Tetanus vaccination coverage
- Contraceptive coverage
- Postnatal consultation coverage
- Insecticide-treated net (ITN) use
- Intermittent preventive treatment of malaria in pregnancy (IPTp)
- Poverty
- Education
- Anemia
- Emergency Obstetric Care (EmOC)
Wide provincial variation in aggregate MH coverage gaps was identified (mean score 374.3, SD: 77.4). The provinces with the greatest calculated aggregate coverage gap were Borkou (491.4), Tibesti (475.2), and Batha (471.1).
KIIs and FGDs revealed that existing MH planning in Chad differs provincially and by health system level, with no clear prioritization processes identified. Main themes regarding MH risks reported by stakeholders included challenges relating to the health system, policy landscape, country and population-specific factors, along with specific MH threats.
Current centralized planning approaches may benefit from greater consideration of provincial differences to support more efficient and equitable resource distribution.
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The use of geographic information systems (GIS) may enable a more comprehensive understanding of the significant regional disparities and variation in MH service coverage to support health planning and prioritization decisions.
Raw aggregate MH coverage gap map of Chad (Source: MDPI)
Malnutrition and Diarrheal Diseases
Chad experiences high levels of malnutrition, with almost half of all child deaths in the central town of Borko attributed to malnutrition. Additionally, 40% of Chadian children experience growth stunting due to a lack of access to food.
Diarrheal disease is also a major health burden, with a mortality rate of 300 per 100,000 people, significantly higher than in developed countries.
Interventions and Improvements
Several organizations are working to improve healthcare access and outcomes in Chad. The Bill and Melinda Gates Foundation partners with the United Nations to provide immunizations and sanitary facilities. Doctors Without Borders conducts healthcare efforts towards treating and preventing malaria, HIV/AIDS, and malnutrition.
The World Food Programme has established the School Meals Program to decrease childhood malnutrition.
Recommendations
The study revealed that both individual (financial barriers to healthcare access, geographical barriers to healthcare access, marital status, frequency of listening to radio and size of children at birth) and community level factors (community level literacy) are associated with healthcare-seeking behaviour for childhood illnesses in Chad.
To improve healthcare access and outcomes in Chad, the following recommendations are crucial:
- The government of Chad, through multi-sectoral partnership, should strengthen health systems by removing financial and geographical barriers to healthcare access.
- The government should create favorable conditions to improve the status of mothers and foster their overall socio-economic wellbeing and literacy through employment and education.
- Other interventions should include community sensitization of cohabiting mothers and mothers with children whose size at birth is large to seek healthcare for their children when they are ill.
Addressing these factors will contribute to reducing child mortality and improving the overall health and well-being of the population in Chad.
| Statistic | Value |
|---|---|
| Maternal Mortality Ratio (2020) | 1063 deaths per 100,000 live births |
| Physician Density | 0.04 per 1,000 population |
| Nurse and Midwife Density | 0.31 per 1,000 population |
| Life Expectancy (Men) | 53 years |
| Life Expectancy (Women) | 55 years |
| Diarrheal Disease Mortality | 163.5 per 100,000 (2017) |
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