In Madagascar 76.5 percent of the population lives in poverty, which means that most people are unable to afford adequate nutrition or access to health care. With 50 percent of under-five year-olds suffering from stunted growth, Madagascar is one of the 10 countries in the world with the highest burden of chronic malnutrition, and one of the 20 countrieswhere 90 percent of the world's stunted children live. Anaemia affects 35 percent of women of child-bearing age - threatening their health and that of their unborn children. Some 38,000 children die every year before their fifth birthday - or 104 children a day.
Now more than ever, preventing a deterioration in the health and nutrition status of the Malagasy people is vital to ensure that gains made in previous years are not lost, and that the most excluded women and children are reached with life-saving interventions.
Punctuated by repeated peaks of acute malnutrition, the situation in Madagascar is critical. Global acute malnutrition among children under five varies from 10 percent to 20 percent during the 'lean season,' when food supplies are limited, in the country's most vulnerable regions. This is mainly in the semi- arid south where unreliable rainfall frequently damages harvests.
While Madagascar has shown a decline in its under-five mortality rate in recent years, acute poverty threatens to turn back this progress.
Malaria, diarrhoea, neonatal complications and acute respiratory infections are the biggest causes of death in children. A lack of access to basic health care, especially in remote rural regions, means that many children do not receive routine immunisations including polio, tetanus, measles and the BCG vaccine to prevent childhood tuberculosis.
Access to safe drinking water and sanitation is poor, with significant idsparities between households in rural and urban invironments. In rural areas only 29 percent of families use improved drinking water sources, and only 11 percent of the population across Madagascar has acces to adequate sanitation. Access to water and sanitation in schools and basic health centres is limited. Less than a third of primary schools have latrines, and less then 15 percent of basic health centres are equipped with drinking water points.
Reducing child mortality globally
The latest UN under-five mortality estimates show that the global child mortality rate has dropped by a third since 1990. Yet the tragedy of preventable child deaths continues. Some 22,000 children under five still die each day.
Find out more in the latest report released by UNICEF