Reimagining Integrated programmes to fight against malnutrition in isolated areas of Madagascar.

Despite the many interventions carried out over the last two years, the humanitarian situation remains worrying in the Great South-East, which requires a fundamental adaptation to the circumstances of the communities.

Abela Ralaivita
Falia, âgée de 29 mois, reçoit gratuitement le traitement contre la malnutrition aiguë sévère lors du passage de la clinique mobile à Ampadimana, dans le sud-est de Madagascar. Ce traitement est destiné à favoriser sa prise de poids.
UNICEF/UNI539102/Ralaivita
20 March 2024

In the early morning, the mobile clinic team from the humanitarian organization Médecins du Monde, supported by UNICEF, disembarks by boat in the community of Ampadimana. The village is a 45-minute journey along the Pangalane Channel from the town of Mananjary in south-east Madagascar. Under the watchful eye of the local community, the team members divide the tasks among themselves and begin to set up for the day. Activities open with awareness-raising sessions on child protection and gender-based violence led by Mariel, a social worker. This dynamic team also includes a doctor and two paramedics.

Raharimanana Angela, a nurse, handles the care of malnourished children. "I have to examine each case carefully so that I can help them better," says Angela. After recording that 8-month-old Erica has gained weight, she is given vitamin A to support normal function of her immune system. The nurse then gives the family the weekly rations of therapeutic food to help Erica make a prompt recovery. These therapeutic foods are provided by UNICEF and donors include USAID, the Central Emergency Response Fund, the Government of Japan and the European Union Humanitarian Aid. Erica's mother is delighted with her weight gain. "Successive cyclones have limited access to food, which led to malnutrition in Erica. I am relieved to see that she is doing better," she says.

The mother of the next patient expresses concern that her daughter has lost 100 grams since the last check-up a week ago. After medical treatment, she is referred to Mariel, who is responsible for providing psychosocial support and identifying the reasons for the weight loss. Using his picture box, Mariel once again provides nutritional advice to maintain the child's good health. "It is essential to talk to patients because, this way, we can find solutions together," he says. 

L’équipe mobile à leur arrivée à Ampadimana
UNICEF/UNI539142/Ralaivita
The mobile team when they arrive in Ampadimana.
Angela donnant à Arcile, mère d’Erica, les rations hebdomadaires de produits alimentaires thérapeutiques fournis par l’UNICEF pour accélérer son rétablissement.
UNICEF/UNI539096/Ralaivita
Angela gives Arcile, Erica’s mother, the weekly rations of therapeutic food products provided by UNICEF to speed up her recovery.

An integrated team

Another team, which includes a doctor, is in charge of outpatient consults, which take place close to the main location. Lorie, age 10, has had a fever for the last two days. She tests positive for malaria. This has become a regular issue in this district, where the rate of positive tests for malaria is close to 50%. However, there are still frequent shortages of tests and treatment.

The latest food security and nutrition analysis underlined that almost 459,000 cases of acute malnutrition were expected between October 2023 and January 2024 in the South and South-East regions. It is important to be able to provide sufficient multi-sectoral humanitarian assistance if there is any hope of emerging from this crisis.

The mobile team will stay in Ampadimana for the night. Despite the tiredness, they will continue to travel along the Pangalane Channel and visit remote villages over the next few days. The commitment of this team showcases the efforts made by stakeholders to respond to this humanitarian crisis, even during the rainy season. They continue to strengthen and adapt their activities, with particular emphasis on involving vulnerable and isolated communities.

Désiré, a community worker, weighs 29-month-old Falia, using a scale.
UNICEF/UNI539099/Ralaivita
Désiré, a community worker, weighs 29-month-old Falia, using a scale.
Mariel provides nutritional advice to a mother using his picture box.
UNICEF/UNI539108/Ralaivita
Mariel provides nutritional advice to a mother using his picture box.