Madagascar

Spray operators reviewing a compliance checklist. Photo by Arnaud Rakotonirina.

Malaria remains a health concern for most of the population of Madagascar, with endemic malaria found in southern, northern, and western Madagascar, and the fringe areas between the coasts and highlands. Although reported malaria cases have decreased from 2003-2009, according to the national health information system, the disease remains a major cause of death for children under 5.

The President’s Malaria Initiative (PMI) began supporting indoor residual spraying (IRS) to prevent malaria in Madagascar in 2008. Following the change in government in 2009, the U.S. government policy is to only provide humanitarian support (which includes IRS) directly to the Malagasy people. In compliance with this policy, AIRS works directly with community members to complete malaria control interventions.

Indoor Residual Spraying Areas

Currently, PMI-supported IRS, via the AIRS Madagascar project completes its IRS campaigns in the Central Highlands and Southern regions of Madagascar.

Through 2011, all IRS programming in Madagascar was categorized as “generalized” spraying, providing IRS to as close to 100% of the eligible structures in targeted districts as possible. This IRS strategy has been largely successful through the strong collaboration between PMI and the Global Fund; as both donors have provided funding, staff, and technical guidance towards IRS spray programs in all 53 targeted districts, and planned IRS programming effectively with the Malagasy National Malaria Control Programme.

In 2012, PMI-supported IRS, via the AIRS Madagascar project, began “focalized spraying” in communes or sub-districts with high malaria incident rates in the Central Highlands. The remaining communes in the Central Highlands that do not have high malaria incident rates are not sprayed; however, entomological monitoring continues in these communes, to assure that malaria transmission and vector density remains low. The transition from general to focalized spraying was based on recommendations in the current Malagasy National Malaria Plan, which has also noted a shift towards more focalized-spraying in most malaria endemic areas between 2013 and 2017.

In 2015, AIRS Madagascar conducted IRS campaigns along the country’s east and southeast coasts and supported NMCP-led IRS campaigns in the central highlands. AIRS Madagascar used mobile soak pits in remote areas to reduce the travel time of spray operators while still being able to safely dispose of liquid waste in the field. Seasonal workers were recruited in their communities and they continued to work in their communes or in neighboring areas. Drawing workers from the community saved costs related to vehicles, fuel, and other direct operations costs.

Impact

IRS and other malaria control initiatives have made remarkable gains in the fight against malaria.  From 2006-2009, all-cause mortality rates for children under five in Madagascar have decreased by 23%, according to the Malaria Indicator Survey.

Read the PMI Profile for Madagascar  to learn more.