• Madagascar is facing an unprecedented measles epidemic due to low measles vaccination coverage (58 per cent nationwide). As of 3 of April there were 122,840 registered cases, and 1,233 reported deaths. The measles epidemic affects 107 out of 114 districts across all 22 regions of Madagascar.
• For the first quarter of 2019, UNICEF vaccinated over 1.9 million children under 5 years against measles. UNICEF also prepositioned emergency stocks consisting of medicines and basic equipment in five targeted regions.
• The nutritional status of the population of southern Madagascar remains precarious. The October 2018 Integrated Food Security Phase Classification (IPC) results revealed that 970,000 people would be in a food security crisis or emergency between November 2018 and March 2019. From January to March 2019, a total of 6,767 severely malnourished children were treated in the UNICEF programme. While, 17,365 mothers were trained in nutrition screening techniques.
• More than 59,166 people gained access to safe water through ongoing water trucking supported by UNICEF and the rehabilitation of 129 boreholes and construction of six new boreholes.
Situation Overview and Humanitarian Needs
The measles outbreak, which began on 3 September 2018, has resulted in 122,840 cases as of April 3, 2019. It is a nationwide epidemic, with cases reported across all 22 regions in Madagascar. The epidemic has a national attack rate which is currently 3,3042 cases per 1,000,000 inhabitants; demonstrating a high rate of spread. Of concern, measles cases have been exported to Comoros and La Reunion. This epidemic is occurring in a context of poor immunization performance. Two-thirds of cases are either unvaccinated or their vaccination status is unknown. There have been 1,233 deaths reported among the people with measles. Of these, 640 deaths have been notified in health facilities, and 593 at the community level, of which 191 are measles related and 402 non-classified by the community agents.
In Madagascar, there are basic measures to combat measles as well as good testing expertise, particularly through the Pasteur Institute of Madagascar (IPM). However, due to an overall weak health system, the country does not have the capacity to react to health emergencies of this scale without additional international support.
According to the October 2018 IPC exercise, led by the National Risk and Disaster Management Office (BNGRC), the humanitarian situation deteriorated in the last quarter of 2018 in the eight southern drought districts. For the period November 2018 to March 2019, there are 973,202 people projected to be living in IPC phase 3 (crisis) and 4 (emergency), which represents 45 per cent of the population, including more than 175,000 children under five years old. The main cause has been a pluviometry (rainfall) deficit during the second half of 2018 resulting in the failure of the major harvests (rice, maize and cassava). A 60 per cent decrease in production has been registered to the average of the previous five years. In addition, crop losses due to armyworm infestation severely affected the area.
Information from the Nutrition Surveillance System (NSS) - fourth quarter of 2018 - revealed that out of the 146 municipalities in the eight drought-affected districts, 18 (12 per cent) have been classified in alert3 and 22 (15 per cent) in emergency4 . The district affected worst by acute malnutrition is Ampanihy West with 10 municipalities classified in emergency (59 per cent) and two in alert (12 per cent) – Map 1.
The deterioration in the nutrition situation from late 2018 in the eight drought-affected districts is reflected in the sharp increase in the number of new admissions in the Community Management of Acute Malnutrition (CMAM) programme as the lean season progresses. As shown in Figure 1, the level of admissions at the end of 2018 was well above the ones recorded during the 2016/2017 El Nino drought emergency. While there was a decrease in December 2018, it increased again from January to March 2019 (above the 2016/2017 levels). Results from the NSS - first quarter of 2019 will be reported in the next Situation Report.