Shifting Fortunes and Enduring Poverty in Madagascar

Osborne, Theresa; Belghith, Nadia Belhaj Hassine; Bi, Chiqiao; Thiebaud, Alessia; McBride, Linden; Jodlowski, Margaret

doi:10.1596/26303

Cited by 12 publications

(11 citation statements)

References 27 publications

(45 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In Madagascar, access to healthcare is notoriously limited as up to 60% of the population live in > 5 km distance to a primary healthcare facility and 20% live in enclaved areas [29]. The coverage for TB diagnostic and treatment centres is even more bleak as only 219 of the 2563 primary facilities (8.5%) are diagnosing TB, which can translate to distances of several days of walk to the nearest diagnostic and treatment centre [29,30]. Since programme onset in 2012, the geographical coverage and diagnostic and referral capacities of the MDR-TB surveillance programme were gradually expanded.…”

Section: Discussionmentioning

confidence: 99%

Multidrug-resistant tuberculosis surveillance and cascade of care in Madagascar: a five-year (2012–2017) retrospective study

Knoblauch

Lapierre

Randriamanana

et al. 2020

BMC Med

View full text Add to dashboard Cite

Background: In Madagascar, the multidrug-resistant tuberculosis (MDR-TB) surveillance programme was launched in late 2012 wherein previously treated TB cases and symptomatic MDR-TB contacts (hereafter called presumptive MDR-TB cases) undergo drug susceptibility testing. This retrospective review had per aim to provide an update on the national MDR-TB epidemiology, assess and enhance programmatic performance and assess Madagascar's MDR-TB cascade of care. Methods: For 2012-2017, national TB control programme notification, clinical management data and reference laboratory data were gathered. The development and coverage of the surveillance programme, the MDR-TB epidemiology and programmatic performance indicators were assessed using descriptive, logistic and spatial statistical analyses. Data for 2017 was further used to map Madagascar's TB and MDR-TB cascade of care. Results: The geographical coverage and diagnostic and referral capacities of the MDR-TB surveillance programme were gradually expanded whereas regional variations persist with regard to coverage, referral rates and sample referral delays. Overall, the rate of MDR-TB among presumptive MDR-TB cases remained relatively stable, ranging between 3.9% in 2013 and 4.4% in 2017. Most MDR-TB patients were lost in the second gap of the cascade pertaining to MDR-TB cases reaching diagnostic centres but failing to be accurately diagnosed (59.0%). This poor success in diagnosis of MDR-TB is due to both the current use of low-sensitivity smear microscopy as a first-line diagnostic assay for TB and the limited access to any form of drug susceptibility testing. Presumptive MDR-TB patients' sample referral took a mean delay of 28 days before testing. Seventy-five percent of diagnosed MDR-TB patients were appropriately initiated on treatment, and 33% reached long-term recurrence-free survival.

show abstract

Section: Discussionmentioning

confidence: 99%

Multidrug-resistant tuberculosis surveillance and cascade of care in Madagascar: a five-year (2012–2017) retrospective study

Knoblauch

Lapierre

Randriamanana

et al. 2020

BMC Med

View full text Add to dashboard Cite

show abstract

“…The districts are urban, peri-urban, and rural and include Antananarivo, the capital of the country. The study region has 2.2 million inhabitants, 31% of whom live under the national poverty line (535,603 Malagasy Ariary per capita income; 248.42 USD, 2011 PPP), considerably less than the Malagasy average (71%) [ 32 , 42 ]; 77.4% of the Malagasy population live below the international poverty line of 1.9$ per day (2011 PPP) [ 43 ]. The lingua franca is Malagasy.…”

Section: Methodsmentioning

confidence: 99%

The 4MOTHERS trial of the impact of a mobile money-based intervention on maternal and neonatal health outcomes in Madagascar: study protocol of a cluster-randomized hybrid effectiveness-implementation trial

Lacroze

Bärnighausen

Neve

et al. 2021

Trials

View full text Add to dashboard Cite

Background Mobile money—a service enabling users to receive, store, and send electronic money using mobile phones—has been widely adopted across low- and middle-income economies to pay for a variety of services, including healthcare. However, evidence on its effects on healthcare access and health outcomes are scarce and the possible implications of using mobile money for financing and payment of maternal healthcare services—which generally require large one-time out-of-pocket payments—have not yet been systematically assessed in low-resource settings. The aim of this study is to determine the impact on health outcomes, cost-effectiveness, feasibility, acceptability, and usefulness of mobile phone-based savings and payment service, the Mobile Maternal Health Wallet (MMHW), for skilled healthcare during pregnancy and delivery among women in Madagascar. Methods This is a hybrid effectiveness-implementation type-1 trial, determining the effectiveness of the intervention while evaluating the context of its implementation in Madagascar’s Analamanga region, containing the capital, Antananarivo. Using a stratified cluster randomized design, 61 public-sector primary-care health facilities were randomized within 6 strata to either receive the intervention or not (29 intervention vs. 32 control facilities). The strata were defined by a health facility’s antenatal care visit volume and its capacity to offer facility-based deliveries. The registered pre-specified primary outcomes are (i) delivery at a health facility, (ii) antenatal care visits, and (iii) total healthcare expenditure during pregnancy, delivery, and neonatal period. The registered pre-specified secondary outcomes include additional health outcomes, economic outcomes, and measurements of user experience and satisfaction. Our estimated enrolment number is 4600 women, who completed their pregnancy between July 1, 2020, and December 31, 2021. A series of nested mixed-methods studies will elucidate client and provider perceptions on feasibility, acceptability, and usefulness of the intervention to inform future implementation efforts. Discussion A cluster-randomized, hybrid effectiveness-implementation design allows for a robust approach to determine whether the MMHW is a feasible and beneficial intervention in a resource-restricted public healthcare environment. We expect the results of our study to guide future initiatives and health policy decisions related to maternal and neonatal health and universal healthcare coverage through technology in Madagascar and other countries in sub-Saharan Africa. Trial registration This trial was registered on March 12, 2021: Deutsches Register Klinischer Studien (German Clinical Trials Register), identifier: DRKS00014928. For World Health Organization Trial Registration Data Set see Additional file 1.

show abstract

“…Madagascar is of particular interest when considering the hunger gap, with close to 80% of its population working in the agricultural sector and poverty levels remaining some of the world's highest [9]. The United Nation's Millennium Development Goal 1, which focused on the eradication of extreme poverty and hunger, was not met in Madagascar [10].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the situation regarding food security has deteriorated, increasing from 29.7% of the population in 1993 being below the minimum level of dietary energy consumption to 32.5% in 2013 [11][12][13]. Factors such as population growth, political instability, global food price fluctuations, and the increasing frequency of extreme climatic events further push Madagascar's population into precarious situations and exacerbate the annual impacts of the hunger gap [9,14,15]. These socio-economic realities have a strong impact on the island's biodiversity and natural wealth.…”

Section: Introductionmentioning

confidence: 99%

Biting the Bullet: Dealing with the Annual Hunger Gap in the Alaotra, Madagascar

Stoudmann¹,

Reibelt

Kull

et al. 2019

Sustainability

View full text Add to dashboard Cite

The hunger gap (the annual period of hardship when most crops are growing but not yet ready for harvest) remains a reality for many smallholder farmers throughout the globe. With a population largely relying on agriculture, and high poverty and malnutrition rates continuously afflicting the country, farmers in Madagascar are particularly vulnerable to the impacts of the hunger gap, further putting pressure on already fragile ecosystems. Using a case study in the Alaotra region, we examine the seasonal trends of climate and agricultural resource dynamics, as well as characterize farmers’ experiences of and strategies used in response to the hunger gap, in order to assess how conservation may better consider the hunger gap to align its objectives with local needs. Results show that farmers are vulnerable to climatic events during a large part of the year, exacerbating the impacts of the hunger gap. The hunger gap appears to have varying degrees of impact on communities around Lake Alaotra, linked to factors such as road quality and agrarian structures—for example, land tenure and size of parcels—contributing to growing environmental degradation. We end by discussing various past and present responses aimed at improving the resilience of farmers of the Alaotra region, including improved accessibility, agricultural intensification, and conservation agriculture.

show abstract

Shifting Fortunes and Enduring Poverty in Madagascar

Cited by 12 publications

References 27 publications

Multidrug-resistant tuberculosis surveillance and cascade of care in Madagascar: a five-year (2012–2017) retrospective study

Multidrug-resistant tuberculosis surveillance and cascade of care in Madagascar: a five-year (2012–2017) retrospective study

The 4MOTHERS trial of the impact of a mobile money-based intervention on maternal and neonatal health outcomes in Madagascar: study protocol of a cluster-randomized hybrid effectiveness-implementation trial

Biting the Bullet: Dealing with the Annual Hunger Gap in the Alaotra, Madagascar

Contact Info

Product

Resources

About