Republic of Madagascar

SUMMARY

The population of the Republic of Madagascar is very young and essentially rural; it is dense in the highlands. The rural population lives on a multitude of small farms, the products of which are for own consumption. Production is often destroyed by natural disasters.

Economically Madagascar belongs to the group of least-developed countries of Subsaharan Africa. Growth has been affected by numerous political and social crises. The coverage of health services is improving. Nevertheless access to basic health care is still limited and consequently rates of infant and maternal mortality are stagnating. The high level of morbidity is compounded by lack of access to improved water sources and by lack of hygiene and improved sanitation.

Poverty affects two-thirds of the population of Madagascar. Together with a reduction in food supplies, lack of access to food, and natural disasters, poverty is a major cause of food insecurity of households. Food supplies do not fulfil population energy requirements. A third of the population is undernourished. Food supplies are not only quantitatively insufficient, they also lack diversity.

Infant and young child feeding practices are healthy. Nevertheless the low quality of complementary foods, the high prevalence of infectious diseases and the lack of access to health care are important determinants of malnutrition. Stunting (chronic malnutrition) affects half of preschool children. Prevalence of wasting (acute malnutrition) is also high. Moreover, no reduction in the prevalence of malnutrition has been observed during the last decade. The nutrition situation of women of child bearing age is also of concern.

Alongside the high prevalence of malnutrition, important micronutrient deficiencies are observed. Goitre is prevalent in certain regions although consumption of iodized salt is widespread. The diet is low in fat and vitamin A-rich foods and consequently prevalence of vitamin A deficiency is high particularly among mothers. The coverage of Vitamin A supplementation is adequate for children but still insufficient for mothers. Anemia affects all the population but particularly vulnerable groups such as preschool children and women of child bearing age. Supplementation of these groups has been started recently. Parasitic causes of anemia need to be investigated.