Strategic satisficing : civil-military relations and French intervention in Africa

Few issues are more important yet less understood than outside interventions in intra-state conflicts. Under what circumstances do intervening states further their interests and when, contrarily, do they plunge into quagmires? France is a critical case. It is, statistically, the world’s second intervenor and earned the sobriquet of Africa’s gendarme through frequent interventions in African wars. The ability of such a medium-sized state to intervene with greater regularity and ostensible success than larger powers raises questions about how France manages its interventions. Do French interventions draw on the French Army’s distinctive “school” of population-centric counterinsurgency, which emphasizes the need to militarize governance in pursuit of comprehensive victories? Or do the French Fifth Republic’s civil-military institutions encourage policymakers to carefully regulate force’s employment in pursuit of limited ends? This study draws on declassified archives to test which approach most characterizes French interventions. To preview my conclusions, strategic satisficing—the use of minimal force for short durations to produce satisfactory outcomes—distinguishes the Fifth Republic’s interventions from other powers’ practices and prior French counterinsurgencies. This particular form of interventionism enables France to influence a disproportionately large number of intra-state conflicts and maintain a network of security agreements with African states.PostprintPeer reviewe

Continuous free access to HAART could be one of the potential factors impacting on loss to follow-up in HAART-eligible patients living in a resource-limited setting: N'djamena, Chad

International audienceBackground: Retention of HAART-eligible HIV-infected patients in clinical follow-up systems are now becoming an important issue in sub-Saharan African countries. Methods: In this retrospective study (April 2008 to November 2011), we assessed the attrition rate variations in a cohort of 509 HAART-eligible patients in Chad. Results: Decrease in levels of loss to follow-up were observed during the implementation of continuous free access to HAART (72.5 vs. 10%; p,0.001) and was independent of gender, age, WHO clinical stage and CD4+ T cell count at inclusion and of the time delay to initiate HAART (p.0.48). Conclusions: These data suggest that the implementation of free access to HAART without any interruption of supply, from autumn 2009, could be the factor that potentially changed the HIV patient attrition rate in this resource-limited setting

Syphilis diagnosis and serological response to Benzathine Penicillin G among patients attending HIV clinics in N’Djaména, Chad

International audienceSyphilis is endemic in the Sub-Saharan zone and disproportionately affects at-risk populations such as men who have sex with men, sex workers and HIV infected individuals. In this study, we measure the impact of syphilis among people living with HIV in the Republic of Chad, where no data are currently available.Method: Outpatients attending 2 HIV clinics in N'Djamena, Republic of Chad, were tested for syphilis. Subjects who tested positive for both non-treponemal (VDRL) and treponemal (TPHA) received a single dose of Benzathine Penicillin G, 2.4 MU. An additional VDRL test was performed 6 months after treatment to ensure appropriate serological response.Results: Of 207 patients included, 29 (14%) tested positive for VDRL at the first visit, with moderate/low antibody titers (ranging from 1/2 to 1/8); 24 (82.6%) of these had treponemal immunization confirmed by TPHA test. Six months after Benzathine Penicillin treatment, 22/24 of the patients (91.6%) tested negative for VDRL, and 2 showed a 4-fold titer decline.Conclusion: This first study in the Republic of Chad suggests that syphilis infection is frequent among people living with HIV in this country. Systematic screening of syphilis should be considered in this population

Management of COVID-19 Infection in a Context of Countries with Limited Resources: Case of the University Hospital Center of Renaissance (UHCR) in N’Djamena, Chad

Introduction: The aim of this study was to describe the clinical characteristics of patients admitted for Covid-19 in the department of Covid-19 of the University Hospital Center of Renaissance (UHCR) of N’Djamena in Chad. The pandemic of the sickness of Covid-19 constitutes a real public health problem in the world since its appearance in December 2019.&#x0D; Materials and Methods: This was an observational, transversal and descriptive study carried out from 19 March 2020 to 19 November 2021. All patients diagnosed with Covid-19, confirmed at least either by RT-PCR or chest computed tomography (CT) were included. The healing was defined through the disappearance of clinical signs and two negative RT-PCRs at 72 hours intervals.&#x0D; Results: Our study included 825 patients of which 613 (74.34%) men (sex ratio 2.9). Age Medium for patients was 50 ± 4 years with extreme ranging from 19 to 84 years old. Six hundred and thirty-three (76.70%) patients came directly from their residences. Respectively 82 and 71 were transferred from the provincial hospital of Farcha (9.9%) and from a private health structure (8.7%). Three hundred and thirteen patients had at least a comorbidity especially arterial hypertension (n = 173; 21%); the diabetes (n = 156; 19.7%); chronic renal failure (n = 28; 3.5%); heart disease (n =27; 3.3%) and obesity (n= 14; 1.6%), HIV infection (n = 9; 1.09%). five hundred and seventy-two (61.12%) patients performed the CT and all the RT-PCR. Four hundred and ninety-two patients (59.60%) presented severe forms of the disease, 160 (19.40%) were critical and 124 (15.10%) were moderates. The hospital lethality was 16.24% (n = 134). The treatment consisted in the administration of Hydroxychloroquine-Azythromycin in 99.4% of cases (n = 813) and by covid-organics in 0.6% of cases (n = 5).&#x0D; Conclusion: The infected patients with Covid-19 were admitted with the advance stage of the disease. Lethality was associate with the presence of comorbidities. The sensitization of the population on the importance of vaccination, barrier measures and recourse to care are necessary.</jats:p

Evidence of Zika virus circulation in human and livestock in Chad

Zika virus (ZIKV) is a major public health problem worldwide. After several reported outbreaks, the current extent of infections caused by this orthoflavivirus in the Sahel remains to be explored. We investigated the prevalence of neutralizing antibodies against ZIKV in the general population, in HIV-infected individuals and in livestock in Chad using a seroneutralization assay that ensures high specificity level. In this retrospective serological serosurveillance investigation, we estimated the neutralizing seroprevalence to be approximately 26 % (18/69) in healthy Chadian participants and 17 % (16/94) in HIV-infected individuals, with no statistical difference between these two subgroups or genders. In addition, we found an overall ZIKV prevalence of 14 % (8/59) in small ruminants (sheep and goats) living in the Lake Chad Basin area, demonstrating virus circulation in animals. Our pilot study shows for the first-time evidence of ZIKV circulation in humans and in livestock in Chad in close interaction with humans, and highlights the main challenges associated with this virus in Sahelian areas

Predictors of COVID-19 vaccine hesitancy in Chad: A cross-sectional study

Vaccination against the COVID-19 virus is currently the best option to combat the SARS-CoV-2 pandemic worldwide. However, in addition to logistical and economic barriers, hesitancy to be vaccinated threatens to jeopardize efforts to contain the disease. An increasing number of people in Africa are delaying or rejecting recommended vaccines. Since their launch, COVID-19 vaccines have frequently faced rejection worldwide. In this study, we interviewed 5,174 participants from Chad that were representative of the general population, on their perception of COVID-19 vaccines. The survey was conducted from April to May 2021, before the rollout of the COVID-19 vaccination. We found that 47.9% of respondents were willing to receive the COVID-19 vaccine, 29.8% were undecided and 22.3% would not accept the vaccine. We found that urban residents were much more likely to refuse the vaccine than rural residents. We also observed that distrust of COVID-19 vaccines and mistaken beliefs played a crucial role in the reluctance to be vaccinated. Hesitancy to vaccinate against COVID-19 was strongly associated with lack of knowledge, and acceptance of vaccination was primarily associated with fear of the disease. Finally, we identified population profiles among the undecided and the refractors, which will help in developing strategies to combat COVID-19 vaccine resistance.</jats:p

Predictors of COVID-19 vaccine hesitancy in Chad: a cross-sectional study

International audienceVaccination against the COVID-19 virus is currently the best option to combat the SARS-CoV-2 pandemic worldwide. However, in addition to logistical and economic barriers, hesitancy to be vaccinated threatens to jeopardize efforts to contain the disease. An increasing number of people in Africa are delaying or rejecting recommended vaccines. Since their launch, COVID-19 vaccines have frequently faced rejection worldwide. In this study, we interviewed 5,174 participants from Chad that were representative of the general population, on their perception of COVID-19 vaccines. The survey was conducted from April to May 2021, before the rollout of the COVID-19 vaccination. We found that 47.9% of respondents were willing to receive the COVID-19 vaccine, 29.8% were undecided and 22.3% would not accept the vaccine. We found that urban residents were much more likely to refuse the vaccine than rural residents. We also observed that distrust of COVID-19 vaccines and mistaken beliefs played a crucial role in the reluctance to be vaccinated. Hesitancy to vaccinate against COVID-19 was strongly associated with lack of knowledge, and acceptance of vaccination was primarily associated with fear of the disease. Finally, we identified population profiles among the undecided and the refractors, which will help in developing strategies to combat COVID-19 vaccine resistance