Madagascar has faced an unprecedented measles epidemic affecting all 22 regions (since September 2018), due to low measles vaccination coverage (58 per cent nationwide before the epidemic broke out). As of 2 June, there were 146,750 registered cases, of which 20,894 cases were reported complicated. Since the nationwide vaccination campaign, the number of new cases is decreasing, and no death has been reported since April 2019.
In response, UNICEF supported the vaccination of more than 3.8 million children under 5 years old against measles. UNICEF also pre-positioned emergency stocks (medicines and basic equipment) in five targeted regions.
The Integrated Phase Classification (IPC) released in July indicates that 970,000 people are in a food security crisis or emergency. The number of municipalities classified in Alert or Emergency increased from 40 municipalities (27 per cent) in the last quarter of 2018 to 97 (63 per cent) in the first quarter of 2019 – confirming a deterioration in the nutrition situation.
From January to May, with UNICEF support 12,168 severely malnourished children were treated in the south. A total of 35,000 mothers were trained on screening techniques and equipped with Mid-Upper Arm Circumference (MUAC) tapes to conduct active and frequent “home-based” screenings and a referral of their children if found to be acutely malnourished.
UNICEF also helped more than 71,100 people gain access to safe water through water trucking and rehabilitation of boreholes.
Situation Overview and Humanitarian Needs
The measles outbreak began on 3 September 2018 and resulted in 146,750 cases as of 2 June 2019. It is a nationwide epidemic, with cases reported across all 22 regions in Madagascar and even exported to Comoros and La Reunion. Since the Government of Madagascar and its partners including UNICEF implemented a nationwide vaccination campaign and provided free medical care, the number of new cases decreased significantly, and no deaths has been recorded since April. International support has been critical in the fight against the measles epidemic as the country does not have the capacity to react to health emergencies of this scale with its weak health system and limited financial and human resources. Continued international attention is indispensable not only to finish the measles epidemic, but also to improve the overall health system so that the recurring health epidemic can be prevented in advance.
Drought (nutritional crisis) in the South
The first 2019 round of the screening exercise - part of the Nutrition Surveillance System (NSS) - in the eight droughtaffected districts was completed in March 2019 and the results confirmed a severe deterioration of the nutrition situation. Between the last quarter of 2018 and the first quarter of 2019, the number of municipalities classified in Emergency increased from 22 (15 percent) to 73 (47 percent) and the ones classified in Alert6 increased from 18 (12 percent) to 24 (18 percent). Districts worst affected by acute malnutrition are Ampanihy, Bekily, Betioky and Ambovombe, where around 190,000 children under five years old live (Map 1). As such, there was a sharp increase in the number of admissions in the Community Management of Acute Malnutrition (CMAM) programme from January to April 2019, well above the previous three years’ admission trends (Figure 1). The deployment of eight Mobile Nutrition Teams (MNTs) in municipalities worst affected have partly contributed to this sharp increase (30 per cent of the total CMAM admissions from January to April 2019).