Background:

Cross-sectional surveys using the Standardized Monitoring and Assessment of Relief and Transitions methodology have been conducted annually in Chad since 2015 to evaluate population-level nutritional status.

Objective:

This analysis characterizes national and subnational trends in child wasting and women’s thinness from 2015 to 2021 in Chad and identifies risk factors during the COVID-19 pandemic.

Methods:

Annual survey data with 12,000 to 15,000 households were included. Wasting was estimated for children 6 to 59 months using the WHO child growth standards, and among women 15 to 49 years, thinness was defined as mid-upper arm circumference <23 cm. Trends were stratified by agroecological zone, and chi-square tests used to assess statistical significance. Simple and multivariate logistic regression models were conducted for 2020 and 2021 to identify risk factors of wasting and thinness.

Results:

About 11,958 to 17,897 children and 9883 to 15,535 women contributed values each year. National wasting and thinness rates did not significantly decrease over the 7-year period (wasting: 14.1% to 12.1%, P = .43; thinness: 15.2% to 13.4%, P = .51) and wasting rose from 2020 to 2021. The Saharan and Sahelian zones had consistently higher rates compared to the Sudanian zone. Younger age, male sex, inadequate infant and young child feeding practices, and poorer household socio-economic factors were associated with greater odds of child wasting. For women, younger age, lack of nutrition knowledge, and poorer household socio-economic factors increased the odds of thinness.

Conclusions:

Undernutrition in Chad has not improved since 2015, and the COVID-19 pandemic likely exacerbated the crisis among children nationally and among women subnationally. Multisectoral approaches and regional targeting of interventions are recommended.

Plain language title

Undernutrition Among Women and Children in Chad: A Persistent Challenge Exacerbated by the COVID-19 Pandemic

Plain language summary

Standardized Monitoring and Assessment of Relief and Transitions (SMART) surveys have been conducted annually in Chad since 2015. These nationally representative surveys capture data on women and children’s health and nutrition condition. In this study, we conducted a secondary data analysis of SMART surveys to explore if rates of undernutrition have changed over the past 7 years, and whether the pandemic played a role. We also explored what factors were associated with children and women’s nutritional status in 2020 and 2021, specifically. Our findings indicate that rates of undernutrition in Chad have remained high, with 12.1% of children younger than 5 years suffering from wasting and 13.4% of women of reproductive age experiencing thinness in 2021. While wasting appeared to be on the decline between 2018 and 2020, the COVID-19 pandemic likely contributed to an uptick seen in 2021. Conversely, women’s thinness at the national level experienced little change before or during the pandemic. Differences in undernutrition by region were apparent; the Saharan and Sahelian zones experienced consistently higher rates of wasting and thinness compared to the Sudanian zone. However, in 2021, the Sudanian zone experienced a considerable increase in wasting and thinness not observed in the rest of the country, indicating potential regional differences in the pandemic’s effect on food security and nutritional status. In the pandemic period, regional differences in wasting could be only somewhat explained by infant and young child feeding practices. Other important predictors included child age, sex, and household socioeconomic factors. Risk factors for women’s thinness included younger age, lack of nutrition knowledge, and lower household socioeconomic status. These findings highlight the need for multisectoral interventions for the prevention of undernutrition, and regional targeting of treatment programs to address high burden areas in Chad.