SEATTLE — Madagascar is one of the last habitable islands to be settled by humans. Located off the Southeast coast of Africa, the landmass has attracted an array of transient visitors and settlers throughout history. French colonizers conquered the island in 1896. Ultimately, the Republic of Madagascar won its independence in 1960, a status that is held today.
Madagascar’s rich history has been weaved by native and international influence, fostering the culturally complex climate of today. However, recent years of political strife stemming from military coups, corruption and overall political violence have produced a stall in infrastructure and overall socioeconomic development. Widespread poverty and malnutrition, coupled with poor access to health care make the country especially vulnerable to epidemics and major public health issues. For these reasons, the rise of easily preventable disease in Madagascar is reflective of an oddly familiar narrative.
The Power of Immunization
Measles is a highly contagious viral disease with symptoms such as high fever and rash. Measles can be serious for people of all ages, but most often severe complications affect children under 5 years and adults over 20. Though recent measles outbreaks have been reported even in developed countries such as the United States, these cases are often results of refusing vaccinations and not a serious epidemic.
In Madagascar’s case, large inequities in immunization rates stem from a weak public health infrastructure, a shortage of essential vaccines and one of the highest rates of poverty in the world. Low socioeconomic status is a major factor, as a child from the wealthiest quintile is 1.5 times more likely to be vaccinated than a child from the poorest quintile. Geographical location plays a role as well, being that living long distances from health facilities puts people at great risk for under-immunization. In Madagascar, 50 percent of citizens live over 5km from a health facility.
A Devastating Epidemic
Low immunization coverage has left Madagascar highly vulnerable, and it is no surprise that the disease has been able to spread so quickly. As of February 2019, 76,000 Malagasy people have been infected, and over 926 have lost their lives. These are unusually high numbers when compared to recent outbreaks in 2003 and 2004. Even more alarming, children aged 1 to 14 account for 64 percent of the total number of cases. According to WHO and UNICEF, 51 percent of the cases reported had not been vaccinated, or have unknown immunization status. In addition, approximately 47 percent of children under five are considered malnourished, the highest proportion in the African region. Malnutrition increases children’s risk of severe complications like pneumonia and encephalitis, often leading to death.
What can be done to combat the rise of easily preventable disease in Madagascar, and ensure long-term protection? According to UNICEF and Madagascar’s Ministry of Health, creating a well-functioning immunization program is the answer. Ensuring that all facilities are equipped to provide immunizations to patients is an obvious, and essential first step. This includes providing reliable cold chain, an especially challenging task considering rural areas do not have electricity and rely on kerosene to power refrigerators. Madagascar plans to install solar energy panels to tackle this issue, and hope to acquire 400 solar units over coming years.
In addition, opening more facilities with a minimum of two qualified health care workers each is a top priority, though many health care providers are concentrated in affluent and urban areas. For this reason, the Malagasy government adapted the Reaching Every District (RED) approach, which includes intervening in health care centers in all communities with the help of local workers. They plan to asses logistical problems, and create solutions through micro-planning sessions, in hopes to reach entire target populations and effectively manage resources.
Providing access to proper health care and immunization is a human right, and it ensures protection from future public health care crises; Madagascar has shown its desire to do just that. By planning and prioritizing for a healthier future, the island nation can ensure long and fulfilling lives for all citizens.
– Natalie Abdou