PubMed · 15382402
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2004-08-27. Hepatitis E, Chad.. https://pubmed.ncbi.nlm.nih.gov/15382402/
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The within-outbreak diversity of hepatitis E virus (HEV) was studied during the outbreak of hepatitis E that occurred in Sudan in 2004. Specimens were collected from internally displaced persons living in a Sudanese refugee camp and two camps implanted in Chad. A comparison of the sequences in the ORF2 region of 23 Sudanese isolates and five HEV samples from the two Chadian camps displayed a high similarity (>99.7%) to strains belonging to Genotype 1. But four isolates collected in one of the Chadian camps were close to Genotype 2. Circulation of divergent strains argues for possible multiple sources of infection.
The current structure of the health care system in Chad, which is characterized by a weak public health system and a nascent and largely unaffordable private sector, raises questions about how low-income households manage illnesses. These questions are also compelling because of claims about the potential of oil-related investments to restructure the current landscape of care over the next 25-30 years. This paper focuses on household strategies for treating episodes of malaria reported in an on-going, longitudinal study of household health and access to care in Chad. Treatment of malaria outside the health care system is widespread in endemic areas, therefore it is not surprising that low-income households in this study rely heavily on unregulated drug markets for care. However, the paper shows how self-medication and the use of these drug markets are shaped by the current organization and delivery of care, and are not simply the outcome of a lack of information about the dangers associated with such practices. The paper also shows the consequences of this particular constellation of services for health in low-income households. We see, for example, the emergence of regimes for managing illness that consist of keeping debilitating symptoms at bay through the use of intermittent, sub-optimal therapies that provide a temporary reprieve but not a 'cure.' We also see that households ignore health problems--absorbing them into the experience of everyday life--that might elsewhere demand attention. When illnesses appear as crises it is often because cash-strapped households are unable to sustain this type of management regime, and easily treatable problems spiral out of control. Whether and how the experiences of the low-income households described in this paper will be impacted by the public investment of oil revenues in the health sector is the question our longitudinal study is designed to address.