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Madagascar, 3 August 2018: UNICEF responds to worst plague outbreak in 50 years

© UNICEF Madagascar/2017/Fanjaniaina

Two-year old Stelvia Raharimahefa was diagnosed with bubonic plague on 14 October. Warning signs were raised when her parents Lalao and Stevin, who had seen posters explaining the signs of plague, saw a ganglion cyst on their daughter’s neck and noticed that she had a raised temperature. They rushed her to Itaosy hospital in Analamanga region. The parents, who are from a little village in the centre of the country, panicked and felt helpless when they saw the condition of their child. “I cried and I felt disorientated when Stelvia became sick. She is my only daughter,” says her mother Lalao.

Stelvia was hospitalized for eight days at Itaosy Hospital. Lalao says that her condition improved a lot after a few days of treatment. She was discharged, cured from bubonic plague, on October 22 to the relief of her young parents.

Back in their neighbourhood in Behenjy Itaosy a rumour had quickly circulated that Stelvia had died of the plague. But the little girl is very much alive and in good health. The family reassured the neighborhood and informed them about the care received. They want to continue to lead a quiet life and in particular, to ensure that community pays more attention to hygiene, since their daughter can have been bitten in several places when staying at her grandfather place while her parents are at work.

Two concurrent forms of plague in one outbreak

Rakoto, 36-years-old and his 8-year-old son Tsiresy, have been admitted to the CHAPA hospital in Ambohimiandra, in the capital after feeling sick and having been informed about the place to go via posters and community communication. They live alone together since Tsiresy’s mother left them. Father and son were contaminated with the human to human transmitted pneumonic plague. Without medical intervention, this more dangerous form of plague is fatal.

Rakoto explains that a few days ago, he started to have a bad cough and felt unwell. He went to the health centre near his house in Analamahitsy, Antananarivo, Madagascar. He tested positive with pneumonic plague and was immediately referred and admitted to the plague treatment centre.

His son Tsiresy arrived at the treatment centre that same evening, showing similar symptoms as his father. Now they are both receiving specific treatment for the plague. “We are on a course of 36 injections for 8 days, but the treatment for Tsiresy is different as he is a child. It is encouraging to see that the free treatment we are receiving is effective. The cough disappeared after a few days and we are recovering now,” explains Rakoto.

Rakoto is convinced that plague can infect anyone. He is amazed by all the plague prevention and logistics that are ongoing at the treatment centre in Ambohimiandra, Antananarivo, Madagascar. The scale up of plague operations in the area is to ensure that patients infected with the plague receive the treatment, care, and hygiene advice required to take good care of themselves and thus prevent the plague from spreading further.

Rakoto and his son are looking forward to going back home. They will have to stay indoors for 10 days before resuming their daily lives. Though still very young, Tsiresy knows about pneumonic plague and is aware of what has happened to him.

Madagascar is one of three countries in the world where plague is endemic. This current outbreak differs to past outbreaks because both bubonic and pneumonic plague are spreading throughout the country. Plague outbreaks are often blamed on poor rubbish collection and a lack of adequate hygiene and sanitation measures.

UNICEF steps up response to the plague epidemic

UNICEF and partners are working to ensure that young health workers are trained to strengthen hygiene and infection prevention in plague treatment centres. More than 260 people who have received UNICEF training are supporting eight plague treatment centres – six of which are in the capital.

“One of the factors that propagates the spread of plague in Madagascar revolves around the lack of hygiene. Hygiene and sanitation in these treatment centres cannot be compromised. That is why this training is so important,” says Elke Wisch, UNICEF Representative for UNICEF Madagascar.

UNICEF action in plague prevention includes supporting the Ministry of Health with contact tracing. The system of tracing those who have been in contact with confirmed plague cases has led to a decline in the number of deaths. UNICEF has supported the training of 1,850 Community Health Workers and 188 Health Centre supervisors in Greater Tana for contact tracing and community response.

More than a hundred people have been killed by the plague in Madagascar and 1,000 more are infected since beginning of August. International communities including WHO, UNICEF, USAID, Medecins du Monde, Red Cross, Doctors Without Borders and European European Civil Protection and Humanitarian Aid Operations (UE-ECHO) are helping the government to coordinate the responses to the plague crisis.



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