Madagascar

Madagascar: Progress in the fight against malaria

© UNICEF Madagascar/2005

Dr. Norolala Rabarijohn, UNICEF Health Officer in Madagascar, counsels pregnant women always to sleep under insecticide-treated bed nets to help prevent malaria.

By Sarah Crowe

MAJAKANDRINA, Madagascar, 30 June 2005 – Her fever dangerously high, a small child rides to hospital in a UNICEF vehicle, the only available transportation. The hospital is several hours away, but she must go because her life is seriously threatened – as a result of a mosquito bite.

Malaria, transmitted through mosquito bites, is the biggest killer of children in Madagascar, as it is in most African countries.

Children are at risk even before they are born. At a local clinic here in Majakandrina, a woman in the sixth month of her pregnancy nearly lost her baby when she came down with malaria.

Dr. Norolala Rabarijohn, UNICEF Health Officer in Madagascar, advises her always to sleep under a ‘moustiquaire’ – an insecticide-treated bed net. She will now get one to take home; her chances of giving birth to a healthy baby have received a boost.

Impressive gains in child survival

Children born on this vast island of 17 million people face significant threats to their survival. For example, only 45 per cent of the population uses improved drinking water sources, and only 33 per cent has access to adequate sanitation facilities. Here in the highlands, some two hours from the capital of Antananarivo, the damp climate leaves stagnant pools of water everywhere – a breeding ground for malaria and respiratory diseases.

And yet, Madagascar has managed to achieve an impressive reduction in under-5 child mortality – from 168 per 1,000 in 1990 to 126 in 2003 (source: SOWC).

“Despite poverty and difficulties, the country has put in place a sound primary healthcare strategy to fight child mortality and morbidity,” says UNICEF Representative in Madagascar Barbara Bentein. “The immunization rates have been going up. Each year there are two campaigns to reach all children with vitamin A, de-worming and related measures.

“There is also a huge effort underway to fight malaria by giving out insecticide-treated bed nets. In addition, actions to fight diarrhoea, the second biggest killer of children here are also undertaken.”

Making the most of each visit

Vast distances and poor infrastructure mean that many of Madagascar’s people visit health facilities only rarely. Therefore it is essential to provide them with as much benefit as possible when they do come.

When women come to a health clinic with their babies, staff provide them with a whole range of services: insecticide-treated bed nets to protect the family against malaria, vaccination against tetanus for the mothers, and full immunization for any children under 11 months.

Another big public health success involves the message out at the village market. Dressed up as giant puppets, volunteers and health workers enthral the children and parents. During the show the puppets tell the children how to avoid malaria by sleeping under an insecticide-treated bed net. They also warn everyone to seek immediate medical care if malaria-like symptoms occur.

The country is now waiting for the delivery of 3 million bed nets due in August, which will be distributed free to pregnant woman and children under five. With the new bed nets on their way, UNICEF and the government hope to achieve an even greater decline in child mortality on this large island and save tens of thousands more young lives each year.