Roll Back Malaria Progress & Impact Series
Focus on Madagascar
Progress and impact of malaria control in Madagascar at a glance
Since 1998, the Malagasy government has built a solid National Malaria Control Programme (NMCP), with well-defined objectives and organizational plans to reduce malaria morbidity and mortality.
Political commitment has been strong with highest level support. In 2000, African heads of state committed their countries to the Abuja Call to ensure universal access to antimalarial interventions, recognizing the main goal of the African Malaria Elimination Campaign. Madagascar added its support to this initiative.
Good planning and a clear national strategy have attracted partners and growing resources. The country has received grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in five different funding rounds (1, 3, 4, 7 and 9) and increasing investments from the United States President’s Malaria Initiative (US-PMI) to control malaria. External resources began to increase in 2005, peaking at US$ 96 million in 2010. Over the 2007–20111 period a total of US$ 240 million was available for malaria control activities.
These funds have been used to deliver many prevention and case-management interventions.
- Nearly 14 million insecticide-treated mosquito nets (ITNs)2 were distributed between 2005 and 2011. Since 2007, malaria control interventions have been intensified through targeted, then universal distribution campaigns.
- Indoor residual spraying (IRS) campaigns helped protect 1.2–2 million households each year between 2008 and 2011.
- About 5 million free rapid diagnostic tests (RDTs) were used between 2007 and 2011.
- More than 2 million free treatment courses of artemisinin-based combination therapy (ACT) were delivered between 2007 and 2011.
Deploying these interventions has resulted in improved coverage.
- Nationwide, 80% of households owned at least one ITN in 2011 (Malaria Indicator Survey [MIS]), a 43% increase in three years. In the 91 health districts subject to universal coverage campaigns (out of 111 in total), 94% of households owned at least one ITN.
- In these same districts, 89% of children under five and 85% of pregnant women used an ITN the night before the survey. In households owning an ITN, the rate of use was 91% for children under five and 89% for pregnant women.
- In 2011, 22% of pregnant women received at least two doses of sulfadoxine-pyrimethamine (SP) during antenatal care (ANC) in these same districts also targeted by IPTp, compared with 8% in 2008/2009.3
These results have allowed the Malagasy government to reduce the disease burden and save lives.
- Moderate to severe anaemia (haemoglobin level below 8 g/dL) decreased significantly, from 8% in 2003/2004 to 1.4% in 2011.
- Under-five mortality fell by 23%, from 94 deaths per 1000 live births in 2003/2004 to 72 per 1000 in 2008/2009. The mortality rate for children aged 1–4 years was reduced by 34%.
- According to the Lives Saved Tool (LiST), 35 000 children under five have been saved by malaria control interventions since 2001.
Improved malaria and health indicators reflect the progress and impact of the fight against the disease, and Madagascar is committed to further scaling up its malaria control programme. The next targets are universal long-lasting insecticidal net (LLIN) coverage (one for every two people), increased IRS coverage, higher coverage of intermittent preventive treatment during pregnancy (IPTp) with SP, accurate and prompt diagnosis, and treatment with ACTs for all confirmed malaria cases. Focused efforts will be required to maintain and increase coverage in future years, as well as to prevent and respond to epidemics. National authorities hope to keep up increased human and financial resources, and eventually free the island from the burden of malaria.