Madagascar is one of the countries most affected by malaria. According to the Ministry of Public Health, the reported number of malaria cases in 2023 exceeded the national epidemic threshold: 2.8 million cases and 400 deaths were recorded, compared to 1.7 million in 2022.

In Ikongo district, where Médecins Sans Frontières is providing health and nutritional care, people are struggling with a dual crisis of malaria and malnutrition, worsened by geographical challenges. Children under five are particularly at risk of complications. According to USAID, malaria affects around 7.5% of children under five in the country.

Roads Almost Unusable

The malaria peak season coincides with the cyclone and rainy season, from October to May. During this time, it becomes extremely difficult for people to access health centres, putting the lives of malnourished children at even greater risk. Dr. Nantenaina, a medical doctor at the Intensive Therapeutic Feeding Centre (ITFC) run by MSF, explains, “When the rain is heavy, providing care for children becomes difficult. The roads become muddy, flooded, and unusable. It is a struggle for both health workers and patients to move around, making it hard for patients to access to health centers or for us to send them back home.”

In hard-to-reach areas like Ikongo, the distance between households and healthcare facilities is significant. Soanary, the mother of a 4-year-old boy suffering from malnutrition and malaria, describes her journey: “After seeing my son’s condition deteriorate, I decided to go to the nearest health center. To get here, I had to walk for four hours and cross through water, carrying my son on my back“.

Soanary isn’t the only one facing this situation. The lack of transports and poor road conditions make it difficult for communities to access health centers, particularly during the rainy and cyclone seasons. As a result, people only seek medical care when their health has deteriorated to a critical condition.

Climate change at the heart of the crisis

Madagascar is one of the countries most threatened by climate change. The country has been severely affected by extreme weather events, which have challenged access to health facilities and undermined the overall state of health and nutrition. This situation has played a significant role in the rise of malaria and malnutrition.

According to the World Health Organization, the rates of malaria cases and deaths due to this disease increased by 25% to 55% between 2015 and 2022. Additionally, the 2023 World Malaria Report highlights that these rates surged by more than 100% between 2000 and 2022.

Changes in temperature and rainfall, as well as significant heat waves and floods, can impact the behavior and survival of the Anopheles mosquito, leading to increased disease transmission within communities. In Ikongo district, which already experiences a humid tropical climate, the effects of climate change are particularly severe. People are cut off from healthcare, exacerbating an already compromised nutritional situation.

Moreover, many villages in Ikongo are surrounded by marshes and rivers. Heavy rains cause flooding of plantations and rice fields, worsening the already precarious nutritional conditions in the area.

“During the rainy season, our health centers receive a lot of cases of malaria,” explains Evelyne, a nurse at the Ikongo primary health centre.. “We have at least one new case of a malnourished child who also suffers from severe malaria every week during the rainy season,” says Dr. Nantenaina, a doctor at the Intensive Therapeutic Feeding Centre operated by MSF.

MSF has been present in Ikongo since 2022. Between then and March 2024, MSF medical teams and working with Malgasy health authorities and health promoters have diagnosed and treated 2,205 children suffering from both malnutrition and malaria, including 256 cases this year. In response to food insecurity exacerbated by various climatic phenomena and cyclones, MSF teams have increased activities in the southern part of the country, which has been the most affected. Currently, MSF is supporting seven primary health centers and two intensive nutritional clinics to diagnose and treat malnourished children in Ikongo district.