CDC in Madagascar

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The Centers for Disease Control and Prevention has assigned a malaria resident advisor in Madagascar since 2008 under the U.S. President’s Malaria Initiative (PMI). Malaria is endemic in Madagascar. Children and pregnant women are the most affected groups; however, 100% of the population is considered at risk for the disease. CDC supports the implementation of malaria prevention and control activities. CDC also works to strengthen other infectious and vaccine preventable diseases (VPD) programs in the country.

Madagascar map

What CDC is Doing in Madagascar

Through PMI, CDC activities include distributing bed nets treated with long-lasting insecticide (LLIN), preventing malaria in pregnancy, improving prompt case management and, in select high-transmission districts, spraying homes with insecticide (indoor residual spraying [IRS]).  IRS protects those living in sprayed homes for up to eight months.

PMI supports large-scale programs to diagnose malaria using rapid diagnostic tests (RDT) and treat those who test positive with artemisinin-based combination therapy (ACT), as well as intermittent treatment to prevent malaria during pregnancy (IPTp).  Malaria RDTs, ACTs and IPTp are being used in public facilities throughout much of the country and efforts to improve use in private clinics are underway.  In addition, PMI works closely with the National Malaria Control Program (NMCP) and the Global Fund (GF) to target remote, high-transmission areas to reduce malaria there. In districts with persistently low transmission, PMI is supporting Madagascar’s efforts to eliminate malaria.

Madagascar experienced a large outbreak of measles beginning in October 2018.  The CDC’s international measles group provided technical assistance to the Madagascar MOH and the WHO in support of the outbreak response.

Madagascar is the third country (and first Francophone country) to pilot a strategy to improve the management, quality and use of immunization and VPD surveillance data. The strategy is called Stop Transmission of Polio (STOP) Immunization and Data Specialists (ISDS). It is supported by CDC staff, in collaboration with WHO Madagascar and in partnership with the Ministry of Health.

The ISDS project aims to improve the capacity of the regional, district and health facility staff for the proper management and use of their immunization and VPD surveillance data through frequent mentorship and on-the-job training.

Influenza viruses are constantly changing and require continued vigilance to protect the United States and the rest of the world not only from seasonal influenza but also from novel viruses that could trigger a pandemic. CDC works with Madagascar to help build surveillance and laboratory capacity to detect and respond to influenza. Activities enhance efforts to detect, monitor, respond to, and control human seasonal, avian, and other novel influenza viruses with pandemic potential, such as H7N9, to reduce influenza-associated death and disease. Key activities supporting these goals include strengthening influenza surveillance; conducting research to estimate disease burden and vaccine effectiveness among populations at greatest risk, including young children, older adults, and pregnant women; promoting influenza vaccination; supporting outbreak investigations; and establishing pandemic influenza preparedness.

Diarrheal disease is among the highest causes of morbidity and mortality in Madagascar, particularly among young children. CDC supports a surveillance program based in one hospital in the capital city to monitor pathogens causing diarrhea and in two hospitals in the capital city to monitor vaccine performance.

CDC has worked with partner organizations to support surveillance, laboratory and epidemiologic investigations during plague outbreaks. CDC has also provided support to the MOH and partners to update plague surveillance, monitoring and treatment guidelines. In response to the 2017 pneumonic plague outbreak, in partnership with the WHO, CDC provided technical assistance and evaluated four international airports and three seaports to improve the exit screening. No cases were exported from the country.

CDC 2018 Impact in Madagascar

Together with PMI, GF and the NMCP:

  • Distributed 13 million LLINs protecting > 26 million individuals;
  • Purchased and distributed an estimated 1 million RDTs to confirm suspect malaria cases and over 2 million doses of ACTs to facilitate prompt effective treatment for uncomplicated disease;
  • Supported activities to prevent malaria among pregnant women including distribution of LLINs during the first prenatal visit and purchasing and distributing medication to prevent malaria

Treated almost 550,000 households with IRS, protecting > 22 million residents.

Together with the NMCP and the other partners

  • Conducted studies to monitor antimalarial resistance which revealed that ACTs remain effective;
  • Trained two Malagasy laboratorians at the CDC in Atlanta to conduct molecular analysis of malaria parasites in Madagascar;
  • Provided technical assistance to conduct a malaria elimination readiness assessment to inform the country’s first malaria elimination strategy.
CDC Staff in Madagascar
  • 1 U.S. Assignees
  • 0 Locally Employed
Madagascar at a Glance
  • Population: 27,000,000 (2019)
  • Per capita income: $1,510
  • Life expectancy at birth: F 68/M 65 years
  • Infant mortality rate: 40/1,000 live births

Sources: World Bank 2018, Madagascar
Population Reference Bureau 2018, Madagascar

Madagascar Top 10 Causes of Death
  1. Diarrheal diseases
  2. Lower respiratory infections
  3. Neonatal disorders
  4. Stroke
  5. Protein-energy malnutrition
  6. lschemic heart disease
  7. Malaria
  8. Congenital defects
  9. Tuberculosis
  10. COPD

Source: GBD Compare 2018, Madagascar

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Page last reviewed: March 19, 2020
Content source: Global Health