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Mycobacterium bovis Isolates from Tuberculous Lesions in Chadian Zebu Carcasses
Diguimbaye, Colette
"This slaughterhouse study in Chad shows higher proportions of Mycobacterium bovis isolates among Mbororo than Arabe zebu cattle. Spoligotyping shows a homogenetic population structure for M. bovis and lack of spacer 30, as were found in neighboring Cameroon and Nigeria. This finding suggests transborder and ongoing transmission between cattle." Emerging Infectious Diseases 2006, Vol. 12, No. 5, pp. Available online from: Emerging Infectious Diseases Download PDF from: Emerging Infectious Diseases
Urban malaria in the Sahel: prevalence and seasonality of presumptive malaria and parasitaemia at primary care level in Chad
Othnigué, Nadjitolnan
The objective of this study was to assess malaria prevalence rates and seasonal patterns among clinically diagnosed malaria cases at the level of primary care facilities in an urban Sahelian setting. Clinical diagnosis of malaria has a very low positive predicted value in this low endemicity urban setting, and its low specificity leads to inappropriate care for a large proportion of patients. This has a major impact on economic costs for health services and households. In the Sahel, systematic use of microscopy-based diagnosis and/or rapid diagnostic tests should be considered to appropriately manage malaria and non-malaria cases. Tropical Medicine & International Health 2006, Vol. 11, Issue 2, page 204 Available for purchase from: Blackwell Synergy
Evaluation of the discriminatory power of variable number tandem repeat (VNTR) typing of Mycobacterium bovis strains
Hilty, Markus
The discriminatory power of variable number tandem repeat (VNTR) typing based on 16 known loci (12 MIRUs, 3 ETRs and VNTR 3232) was assessed for Mycobacterium bovis strains collected sequentially at the slaughterhouse of N’Djaména, Chad. Of 67 M. bovis strains analyzed, 67% were clustered. In this study, VNTR typing was highly discriminative with an overall allelic diversity (hoa) of 0.922. We defined five loci (ETR A, B, C and MIRU 26, 27) as highly (h > 0.25), two loci (MIRU 4, and VNTR 3232) as moderately (0.11 < h < 0.25) and three loci (MIRU 16, 20, 31) as poorly (0.01 < h < 0.11) discriminative. Six loci (MIRU 2, 10, 23, 24, 39, and 40) showed no polymorphism at all. VNTR typing of the five highly discriminative loci (h = 0.917) proved to be most appropriate for first line typing of M. bovis strains of Chad and superior than spoligotyping (hsp = 0.789). In contrast to Mycobacterium tuberculosis strains, a consensus on VNTR loci needs to be found for M. bovis strains. The selection of a generally agreed set of VNTR loci for molecular discrimination of M. bovis in different geographical settings is discussed. Veterinary Microbiology 2005, Vol. 109, Issues 3-4, pp. 217-222 Available from: ScienceDirect
Epidémiologie moléculaire des premiers isolements de mycobactéries chez l'animal au Tchad
Schelling, Esther
"The first laboratory to culture mycobacteria was established in Chad to confirm the presence of bovine tuberculosis and to describe the distribution of M. tuberculosis complex strains in livestock and humans. Specimens were collected on condemned animal carcasses due to tuberculosis. Spoligotyping and analysis of Variable Numbers Tandem Repeats (VNTRs) have been used on 67 M. bovis strains. The prevalence of tuberculosis-like lesions at the slaughterhouse was 7.3%. More M’bororo than Arab zebus were condemned (p = 0.04), M’bororo carcasses were more often entirely condemned in comparison to a partial condemnation (p ≤ 0.001) and M. bovis was more often isolated from Mbororo carcasses than from Arab zebu (p = 0.004). [...]" "Le premier laboratoire de culture des mycobactéries a été établi au Tchad pour confirmer la présence de la tuberculose bovine chez le bétail et pour évaluer la répartition des souches du complexe Mycobacterium tuberculosis. Les prélèvements ont été réalisés sur des carcasses d’animaux saisis pour cause de tuberculose. Le typage moléculaie par spoligotypie et le typage des VNTR (séquences répétées en nombre variable) ont été réalisés avec 67 souches M. bovis du Tchad. La prévalence de lésions tuberculeuses à l’abattoir était de 7,3%. Davantage de carcasse de zébus M’bororos ont été saisies par rapport aux zébus Arabes (p = 0,04); une saisie totale en comparaison à une saisie partielle a été plus souvent effectuée chez les Mbororos (p ≤ 0,001) et M. bovis a été plus fréquemment isolé chez les zébus Mbororos que chez les Arabes (p = 0,004). [...]" Épidémiologie et Santé Animale 2005, No. 48, pp. 81-91 Available for download from: L'Association pour l'Étude de l'Épidémiologie des Maladies Animales
Serum Retinol of Chadian Nomadic Pastoralist Women in Relation to their Livestocks' Milk Retinol and beta-Carotene Content
Zinsstag, Jakob
Human serum retinol and livestock milk retinol levels were assessed as part of a study on the health status of Chadian nomadic pastoralists and their livestock in close partnership between Chadian public health and livestock institutions. Our study supports the use of goat and cow milk as an important source of vitamin A in pastoral nomadic settings. However, the levels still require to be complemented further by promoting green leafy vegetables, fruits, and supplements. International Journal for Vitamin and Nutrition Research 2002, 72(4): 221-228 Available from: Verlag Hans Huber
Molecular epidemiology of mycobacteria
Hilty, Markus
PhD Thesis, University of Basel, Switzerland "One approach of molecular epidemiology of mycobacteria is the genotyping and comparison of DNA of infectious strains in order to monitor the transmission pathways of diseases. It is based on the assumption that patients infected with clustered strains are epidemiologically linked. Such results may help in understanding the modes of transmission and therefore in putting in place an adapted control strategy. [...] Therefore the overall aim of this study was to contribute to the development and refinement of innovative molecular typing tools in order to study Mycobacterium tuberculosis, bovis and ulcerans infections." Download
Species identification of non-tuberculous mycobacteria from humans and cattle of Chad
Diguimbaye, Colette
"In Chad, during a study on tuberculosis in humans and cattle, 52 non-tuberculous mycobacteria (NTM) strains were isolated. By means of INNO-LiPA, PRA-hsp65 amplification and sequencing of 16S rDNA, NTM species of 25/52 isolates were identified. M. fortuitum complex (8) was the most frequent species, followed by M. nonchromogenicum (4) and M. avium complex (4). PRA method could identify M. fortuitum 3rd variant among isolates derived from cattle specimens. This finding could confirm the existence of farcy in the Chadian cattle population as M. fortuitum 3rd variant and putitative pathogen M. farcinogenes can't be distinguished by the methods used in this study. Half of the NTM isolates could not be specified and we considered them as contaminants from the environment." Schweizer Archiv für Tierheilkunde 2006, Vol. 148, No. 5, pp. 251-256 Available to purchase from: Verlag Hans Huber
Potential of cooperation between human and animal health to strengthen health systems
Zinsstag, Jakob
"The WHO ministerial summit held in Mexico City, Mexico, on Nov 16–20, 2004, recognised the pivotal role of strengthened health systems in achieving the Millennium Development Goals (MDGs) in an equity-effective manner. Its resolutions encourage health systems research to include broad societal dimensions. One extension involves closer interaction between human and animal health, for which the US epidemiologist Calvin Schwabe coined the term “one medicine”, to focus attention on the similarity between human and veterinary health interests. [...]" The Lancet 2005, Vol. 366, Issue 9503, pp. 2142-2145 Available online from: The Lancet Download PDF from: The Lancet
Approche novatrice des vaccinations en santé publique et en médecine vétérinaire chez les pasteurs au Tchad
Béchir, Mahamat
This report describes a network of public health care workers, veterinarians and nomadic pastoralists that was set up in Chad to increase vaccination coverage to nomadic children and women who had rarely been vaccinated before. The objectives of the project were to provide human vaccination in conjunction with existing veterinary services, to evaluate the feasibility and limitations of such campaigns, to determine what other services could be provided concurrently, and to estimate the savings for public health care cases in comparison with carrying out vaccination separately. The joint vaccination campaign approach is innovative, appreciated by nomadic pastoralists and less expensive than separate vaccination. By using the mobility of veterinarians in remote zones far from health care facilities, vaccination can be provided to nomadic children and women in countries with limited resources. Médecine Tropicale 2004, Vol. 64, No. 5, pp. 497-502 Download
Répartition de la morbidité dans trois communautés nomades du Chari- Baguirmi et du Kanem, Tchad
Daugla, Doumagoum Moto
Within the framework of an multidisciplinary research and action program, morbidity patterns were assessed in three nomadic communities in Chad. A total of 1092 women, men and children were interviewed and examined in the course of three surveys carried out by a physician during the dry and rainy season. Nomads reporting no health problems were rare. Tuberculosis was suspected in 4,6 % of adults after clinical examination and bronchopulmonary disorders in children less than five years of age. Febrile diarrhea was more prevalent during the wet season when access to clean drinking water was more difficult. Simple malaria was rarely diagnosed in Arabs during the dry season. In contrast simple malaria was frequent in Fulani who stay in the vicinity of Lake Chad during the dry period. Protein-energy malnutrition was observed in only 3 of 328 children younger than 15 years of age. Médecine Tropicale 2004, Vol. 64, No. 5, pp. 469-473 Download
A la recherche des déterminants institutionnels du bien-être des populations sédentaires et nomades dans la plaine du Waza-Logone de la frontière camerounaise et tchadienne
Fokou, Gilbert
"Cette contribution présente les articulations d’une étude actuellement en cours dans la région du Logone et Chari au Cameroun et dont le but est d’oeuvrer pour l’élaboration des savoirs et des connaissances pour le développement pastoral. De nombreux groupes de populations sédentaires et nomades vivent dans cette localité et dépendent des plaines inondées du Sud du lac Tchad pour leur subsistance. Or, les ressources naturelles connaissent de grandes variations saisonnières et deviennent parfois la propriété des groupes sédentaires. De ce fait, les éleveurs nomades éprouvent de nombreuses difficultés pour accéder non seulement aux pâturages et à l’eau, mais aussi aux services de santé de qualité (centres hospitaliers, médicaments efficaces). L’ambition ici est de définir de nouvelles conditions institutionnelles d’accès aux soins de santé pour les populations sédentaires et nomades. En fait, la plupart des problèmes auxquels sont confrontés les nomades de nos jours seraient dus à l’inadaptation des règles formelles en vigueur aux stratégies de survie des populations rurales. Celles mises en place à l’époque pré-coloniale ne sont plus opérationnelles. L’on pourrait conclure, sous forme d’hypothèse à vérifier, que la définition de nouveaux cadres institutionnels de gestion des ressources naturelles pourrait contribuer à l’amélioration des conditions de santé des pasteurs nomades." Médecine Tropicale 2004, Vol. 64, No. 5, pp. 1-5 Download
Assessing health impacts of the Chad–Cameroon petroleum development and pipeline project
Utzinger, Jürg
"Health impact assessment (HIA) of projects, programmes and policies is increasingly recognized as a powerful methodology for mitigating negative health impacts and enhancing equitable and sustainable development, yet applications in the developing world are sparse. Here, we focus on a large infrastructure development in sub-Saharan Africa, namely the Chad–Cameroon petroleum development and pipeline project. We adapted a five-step process for HIA, consisting of (1) screening of project documents, (2) profiling of affected communities, (3) identifying priority health areas, predicting potential impacts, and proposing mitigation measures, (4) implementing interventions, and (5) monitoring and evaluation of health impacts. [...]" Environmental Impact Assessment Review 2004, Vol. 25, No. 1, pp. 63-93 Available from: ScienceDirect
Comment combattre les inégalités en matière de santé?
Wyss, Kaspar
In: Schneider J, Roost Vischer L, Péclard P. editors. 2003.Werkschau Afrikastudien 4 - Le forum suisse des africanistes 4, Schweizerische Afrikastudien - Etudes africaines suisses. Münster, LIT Verlag, pp. 151-167 Order from: LIT Verlag
Finding the answers to Chad’s health workforce crisis
Wyss, Kaspar
Massive shortages of qualified health workers are recognised by the Chad authorities to be a primary "bottleneck" for the development of the health sector. This paper shortly reviews policies implemented which prioritise human resource development and concludes that more choherent policies are needed, particularly to improve motivation and retention. id21 insights health # 7: Responding to the health workforce crisis. Download
Santé et vulnérabilité des populations défavorisées de l'Afrique de l'Ouest. Etudes de cas en Côte d'Ivoire, Mauritanie et au Tchad.
Wyss, Kaspar
Les articles dans cet ouvrage collectif sont regroupés autour de trois piliers de la notion vulnérabilité : (1) la monnayabilité/marchandisation (anglais «commoditization»), (2) les risques environnementaux («environmental hazards»), et (3) fragmentation sociale. À la suite de la présentation du cadre conceptuel emprunté par l’équipe de recherche, chacune des notions est reprise par une série d’articles. Enfin, le dernier chapitre établit une synthèse des différents chapitres précédents tout en élargissant la notion de vulnérabilité et son lien avec la santé urbaine. VertigO - la revue canadienne et électronique en sciences de l'environnement hors série 3: 1-2. Download
Owner valuation of rabies vaccination of dogs, Chad
Dürr, Salome
Emerg Infect Dis 14:1650-1652. Download
Santé, pratiques sexuelles et VIH/SIDA chez les adolescents dans les écoles en milieu urbain au Tchad
Nodjiadim, Abdias Laoubaou
Master's Thesis, Université Marc Bloch de Strasbourg II, Strasbourg, France "Notre étude tente de comprendre les comportements, pratiques et attitudes des jeunes dans deux établissements scolaires au Tchad vis à vis de la sexualité et du VIH/SIDA et répond aux objectifs suivants : • Analyser les perceptions, attitudes et pratiques que les jeunes en milieu scolaire ont de la sexualité et des facteurs de risques d’infection à VIH ; • Identifier les comportements à risques chez les adolescents en milieu scolaire et les problèmes de santé sexuelle auxquels ils sont confrontés ; • Déterminer leur dynamique relationnelle en matière d’engagement pour un changement de comportement." Download
Molecular Characterization and Drug Resistance Testing of Mycobacterium tuberculosis Isolates from Chad
Diguimbaye, Colette
"The molecular characterizations of the first 40 Mycobacterium tuberculosis isolates from Chad revealed a high proportion of isolates of the Cameroon family (33%), of which one isolate showed a monodrug resistance. In total, 9/33 (27%) isolates were resistant to isoniazid. The implications of these findings are discussed." Journal of Clinical Microbiology 2006, Vol. 44, No. 4, pp. 1575-1577 Available from: Journal of Clinical Microbiology
Synergy between public health and veterinary services to deliver human and animal health interventions in rural low income settings
Schelling, Esther
This article argues that the collaboration between public health and veterinary services could increase coverage of essential health interventions for people and livestock in remote rural areas. British Medical Journal BMJ 2005, No. 331, pp. 1264-1267 Download from: British Medical Journal BMJ
Costs attributable to AIDS at household level in Chad
Wyss, Kaspar
"This paper assesses the economic costs of AIDS at the household level in Chad, one of the poorest countries in the world. One hundred and ninety-three AIDS patients living in four different regions were found by case identification at hospital level and through community based organizations providing psycho-social relief. They were matched by age, sex, professional category and zone of residence with controls. Costs were evaluated through a standard questionnaire. Costs at household level attributable to AIDS up to death were US$836 per case. Costs related to productivity losses made up 28% of total costs. More than half of total costs (56%) were health care related expenditures, and funeral costs contributed 16%. AIDS cases relied more often on borrowing and the selling of household assets than controls for treatment. Household expenditures of AIDS cases were much higher than control households mainly due to health related expenditure. The response of concerned families to HIV/AIDS implies high costs and for most households, especially in low-income settings, the consequences of AIDS are devastating. Innovative strategies on how best to assist households are thus requested and may include the strengthening of care and treatment services being offered to AIDS cases." AIDS Care 2004, Vol. 16, No. 7, pp. 808-816 Available from: Informaworld
Taux sérique de rétinol chez les femmes nomades pastoralistes tchadiennes en relation avec la teneur en rétinol et en carotène dans le lait de leur bétail
Zinsstag, Jakob
"Human serum retinol and livestock milk retinol levels were assessed as part of a study on the health status of Chadian nomadic pastoralists and their livestock in close partnership between Chadian public health and livestock institutions. Of the examined women (n = 99), 43% (95% CI 33 – 54 %) were retinol deficient (levels from 0.35 ?mol/L to 0.7 ?mol/L) and 17% (95% CI 10 - 26 %) severely deficient (Médecine Tropicale 2004, Vol. 64, No. 5, pp. 478-481 Download
Prioritization of prevention activities to combat the spread of HIV/AIDS in resource constrained settings
Hutton, G.
"In Chad, as in most sub-Saharan Africa countries, HIV/AIDS poses a massive public health threat as well as an economic burden, with prevalence rates estimated at 9% of the adult population. In defining and readjusting the scope and content of the national HIV/AIDS control activities, policy makers sought to identify the most cost-effective options for HIV/AIDS control. The cost-effectiveness analysis reported in this paper uses a mixture of local and international information sources combined with appropriate assumptions to model the cost-effectiveness of feasible HIV prevention options in Chad, with estimates of the budget impact. The most cost-effective options at under US$100 per infection prevented were peer group education of sex workers and screening of blood donors to identify infected blood before transfusion. These options were followed by mass media and peer group education of high risk men and young people, at around US$500 per infection prevented. Anti-retroviral therapy for HIV infected pregnant women and voluntary counselling and testing were in the order of US$1000 per infection prevented. The paper concludes with recommendations for which activities should be given priority in the next phase of the national HIV/AIDS control programme in Chad." The International Journal of Health Planning and Management 2003, Vol. 18, No. 2, pp. 117-136 Available from: Wiley InterScience
Incidence of canine rabies in N’Djaména, Chad
Kayali, U.
"This work describes for the first time the incidence risk of passively reported canine rabies, and quantifies reported human exposure in N’Djaména (the capital of Chad). To diagnose rabies, we used a direct immunofluorescent-antibody test (IFAT). From January 2001 to March 2002, we were brought 34 rabies cases in dogs and three cases in cats. Canine cases were geographically clustered. The annual incidence risk of canine rabies was 1.4 (95% CI: 1.2, 1.7) per 1000 unvaccinated dogs. Most of the rabid dogs were owned—although free-roaming and not vaccinated against rabies. Most showed increased aggressiveness and attacked people without being provoked. Eighty-one persons were exposed to rabid dogs and four persons to rabid cats (mostly childrenPreventive Veterinary Medicine 2003, Vol. 61, Issue 3, pp. 227-233 Available from: ScienceDirect
Brucellosis and Q-fever seroprevalences of nomadic pastoralists and their livestock in Chad
Schelling, Esther
"As a part of a research-and-action partnership between public health and veterinary medicine, the relationships between the seroprevalences of brucellosis and Q-fever in humans and livestock were evaluated in three nomadic communities of Chad (Fulani cattle breeders, and Arab camel and cattle breeders). Nomad camps were visited between April 1999 and April 2000. A total of 860 human and 1637 animal sera were tested for antibodies against Brucella spp., and 368 human and 613 animal sera for Coxiella burnetii. The same indirect ELISA was used for livestock and human sera, and the test characteristics for its use on human sera were evaluated. Twenty-eight people were seropositive for brucellosis (seroprevalence 3.8%). Brucella seroprevalence was higher in cattle (7%) than other livestock, and brucellosis seropositivity was a significant factor for abortion in cattle (OR=2.8). No correlation was found between human brucellosis serostatus and camp proportions of seropositive animals. [...]" Preventive Veterinary Medicine 2003, Vol. 61, No. 4, pp. 279-293 Available from: ScienceDirect
Morbidity and nutrition patterns of three nomadic pastoralist communities of Chad
Schelling, Esther
"As a part of an interdisciplinary research and action programme, morbidity and nutritional patterns were assessed in three nomadic communities: Fulani and Arab cattle breeders and Arab camel breeders, of two prefectures in Chad. The predominant morbidity pattern of Chadian nomadic pastoralists (representing approximately 10% of the total population of the country) had not been documented so far. A total of 1092 women, men and children was examined by a physician and interviewed during two surveys in the dry season and one in the wet season (1999–2000). Participants with no complaint were rare. Pulmonary disorders (e.g. bronchitis) were most often diagnosed for children under 5 years of age. Of the adult participants, 4.6% were suspected of tuberculosis. Febrile diarrhoea occurred more often during the wet season when access to clean drinking water was precarious. Malaria was only rarely clinically diagnosed among Arabs during the dry season, whereas Fulani, who stayed in the vicinity of Lake Chad, were also affected during this period. A 24-h dietary recall showed that less Arab women than men consumed milk during the dry season (66% versus 92%). [...]" Acta Tropica 2005, Volume 95, Issue 1, pp. 16-25 Available from: ScienceDirect
Cost-description of a pilot parenteral vaccination campaign against rabies in dogs in N'Djaména, Chad
Kayali, U.
"In the discussion about policies and strategies for rabies prevention in developing countries, intervention costs arise as a major issue. In a pilot mass vaccination campaign against rabies in N'Djaména, Chad, 3000 dogs were vaccinated. We assessed vaccination coverage and cost, showing the cost per dog vaccinated for the public sector and for society. An extrapolation to city level calculated the approximate cost of vaccinating all 23 600 dogs in N'Djaména. In the pilot mass campaign with 3000 dogs the average cost per dog was 1.69 €. to the public and the full societal cost was 2.45 €. If all 23 600 dogs in N'Djaména were vaccinated, the average cost would fall to 1.16 € to the public and 1.93 € to society. Private sector costs account for 31% of the cost to vaccinate 3000 dogs, and 40% of the cost to vaccinate 23 600 dogs. Mass dog vaccination could be a comparatively cheap and ethical way to both control the disease in animals and prevent human cases and exposure, especially in developing countries. The cost-effectiveness of dog vaccination compared with treating victims of dog bites for prevention of human rabies should be further assessed and documented." Tropical Medicine & International Health 2006, Vol. 11, Issue 7, pp. 1058 Available for purchase from: Blackwell Synergy
Quels types de services de santé pour les populations nomades?
Wyss, Kaspar
"To overcome barriers of access to health care of nomadic people and to alleviate inequities in health, a transdisciplinary team has initiated research and intervention activities among three nomadic groups of Chad: Foulbé, Arabes and Gouranes. A regular and consistent communication among all actors involved (nomadic groups, researchers, planners and administrators of health and veterinary services, etc.) through repetitive meetings and workshops showed to be a crucial element for success. Differences between ethnic nomadic groups made it necessary to develop specific communication strategies adapted to each group. As to interventions to improve the vaccination coverage, mixed teams combining health and veterinary specialists were able to vaccinate an important number of children and women and showed to have a high potential in terms of organisational and logistic feasibility, acceptability as well as good cost-effectiveness. With regard to improving access to health care, Information – Education and Communication approaches adapted to the intervention context and linked to the provision of essential services and generic drugs showed to be crucial." Médecine Tropicale 2004, Vol. 64, No. 5, pp. 493-496 Download
Constraints to scaling-up health related interventions
Wyss, Kaspar
"This analysis of constraints to scaling-up health-related interventions in Chad shows that emphasis has to be put on systemic approaches which address absorptive capacity, on removal of structural constraints, and on efficient and equitable production of health services. In the production of services the development of infrastructure must not exceed the development of human resources. If the millennium development goals are to be achieved, major investments in basic and in-service training and in management skills are crucially needed. In addition, the study shows the importance of promoting health services which actively seek to fulfil community demands and those of disadvantaged groups." Journal of International Development 2003, Vol. 15, No. 1, pp. 87-100 Available from: Wiley InterScience
Coverage of pilot parenteral vaccination campaign against canine rabies in N’Djaména, Chad
Kayali, U.
"Canine rabies, and thus human exposure to rabies, can be controlled through mass vaccination of the animal reservoir if dog owners are willing to cooperate. Inaccessible, ownerless dogs, however, reduce the vaccination coverage achieved in parenteral campaigns. This study aimed to estimate the vaccination coverage in dogs in three study zones of N’Djaména, Chad, after a pilot free parenteral mass vaccination campaign against rabies. We used a capture–mark–recapture approach for population estimates, with a Bayesian, Markov chain, Monte Carlo method to estimate the total number of owned dogs, and the ratio of ownerless to owned dogs to calculate vaccination coverage. When we took into account ownerless dogs, the vaccination coverage in the dog populations was 87% (95% confidence interval (CI), 84–89%) in study zone I, 71% (95% CI, 64–76%) in zone II, and 64% (95% CI, 58–71%) in zone III. The proportions of ownerless dogs to owned dogs were 1.1% (95% CI, 0–3.1%), 7.6% (95% CI, 0.7–16.5%), and 10.6% (95% CI, 1.6–19.1%) in the three study zones, respectively. Vaccination coverage in the three populations of owned dogs was 88% (95% CI, 84–92%) in zone I, 76% (95% CI, 71–81%) in zone II, and 70% (95% CI, 66–76%) in zone III. Participation of dog owners in the free campaign was high, and the number of inaccessible ownerless dogs was low. High levels of vaccination coverage could be achieved with parenteral mass vaccination. Regular parenteral vaccination campaigns to cover all of N’Djaména should be considered as an ethical way of preventing human rabies when post-exposure treatment is of limited availability and high in cost." Bulletin of the World Health Organization 2003, Vol. 81, No. 10, pp. 739-744 Download PDF from: World Health Organization