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Living free from malaria

In Chad, community health workers combat one of the world's deadliest diseases

April 24^th, 2023

“We don’t fear malaria because we follow the health recommendations.”

Ngominan Esaie is referring to advice from community health workers in Ngatounou, a village in Koumra health district, Chad. Ngominan is a farmer and lives with his wife, children and their spouses. In 2022, four members of Ngominan’s family contracted malaria, a potentially fatal disease spread through mosquito bites. Three children were referred to a public health centre for serious illness.

Despite the health threat, Ngominan and his family do not fear malaria and heed the advice of community health workers. Each night, Ngominan and his family sleep under bed nets, which help prevent the disease. They remove standing water outside their homes, which is a common breeding ground for mosquitoes. When sick, they take malaria medicines as advised.

Ngatounou is one of two villages supported by Djotoinan Odjadoum, a 34-year-old community health worker. Djotoinan encourages people to use bed nets, which are treated with insecticides to kill malarial mosquitoes.

Nightly bed net use is crucial for pregnant women, infants and young children, all of whom face the highest risk of severe infection.

Djotoinan educates people about malaria and identifies people with flu-like symptoms, such as low-grade fever and muscle aches. If someone has these symptoms, he conducts a finger-prick rapid diagnostic test to see if they have malaria.

“I am happy if I do not find malaria, as children are often the worst affected,” Djotoinan remarked.

Residents are encouraged to use insecticide-treated bed nets, a key method to prevent malaria.

With a confirmed case, Djotoinan provides medicines to treat the malaria and prevent it from progressing. Untreated, malaria can lead to seizures, coma and death.

“Almost daily, I visit households to raise awareness of malaria, give advice, diagnose and treat malaria, or refer patients to health centres,” he said.

In addition to community health work, Djotoinan supports his family and manages activities at his local church.

Nearly all of Chad’s population is at risk of malaria, with 1.8 million confirmed cases and over 2,500 inpatient deaths in 2022. The country ranks 13th highest for malaria mortality, with children under 5 years of age accounting for almost 60 percent of malaria deaths.

Mandoul province, where Djotoinan works, is in Chad’s south, where a longer rainy season increases malaria risk for the country’s most populous region.

Difficult terrain and long distances there make it hard to access health services. On average, patients must travel 18 kilometres to reach a health centre, while hospitals are 69 kilometres away.

In 2022, heavy rains caused floods that affected over a million people and further raised malaria risk, including in Mandoul. The flooding also made travel more difficult, underscoring the need for on-site malaria services in rural areas.

With Global Fund financing, the Ministry of Health and Prevention, the National Malaria Control Programme (PNLP) and UNDP support community-based malaria prevention, diagnosis and treatment and patient referrals to health facilities for potentially severe cases.

Launched in 2017 in Mandoul and Moyen-Chari, a neighbouring province, the programme complements other PNLP efforts to achieve universal access to malaria prevention and care.

In 2022, the health ministry and UNDP supported 950 community health workers to provide malaria treatment to more than 211,000 people in the two provinces. During the floods, UNDP supported communities with weather stations and rain gauges, while strengthening government, civil society and media capacities for a multi-hazard early warning system.

Despite heavy rain in Ngatounou, community health services continued. Elsewhere, PNLP distributed bed nets to support people displaced by the floods, including in the capital, N’Djamena.

While nearly all of Chad’s population is at risk from malaria, infants, young children and pregnant women face the highest risk of severe illness.

In 2023, PNLP and UNDP will distribute 11.6 million bed nets, supporting malaria prevention for over 18 million people. Community-based health services are expanding to Logone Oriental with the health ministry through BASE, a local non-governmental organization.

The ministry and UNDP trained 377 health workers on managing malaria and other diseases in the province, and these workers are now being deployed. Community health services will be scaled up in another eight provinces.

In 2023, UNDP will support the distribution of 11.6 million bed nets in Chad to strengthen the fight against malaria.

There were 247 million malaria cases worldwide in 2021, with an estimated 619,000 deaths. The Government of Chad, UNDP and the Global Fund are improving prevention, diagnosis and treatment efforts to end malaria by 2030 and leave no one behind.

By supporting community-based and community-led health services for malaria, the partners are strengthening the resilience of the health system and helping to achieve a more equitable, healthier and sustainable future.