ObjectiveIncreasingly unpredictable shifts in climate are triggering public health crises globally. Southern Madagascar is particularly vulnerable to climate impacts, despite contributing to only 0.2% of global emissions. Though endemic in Madagascar, climate impacts such as below average rainfall have increased the severity of droughts, putting over half of the population in southern regions at risk of being food insecure in 2022. The following review examines: How can interventions surrounding the current food emergency in southern Madagascar center community-based knowledge in their strategies? Through a social-ecological approach, this review aims to holistically discuss the complexity of the climate and food crises in this region, which is a topic that has not been widely covered in published review articles thus far.MethodsWe took a comprehensive and social-ecological approach by analyzing research pertaining to the impacts of colonial history, politics, economy, and culture on the current climate, ecology, and food systems of southern Madagascar.Main findingsMany current strategies to mitigate climate impacts and food security fail to incorporate community-based knowledge, leading to inequitable and ineffective interventions. Researchers who prioritize historical and cultural context illustrate how local knowledge may serve as a protective factor against climate impacts.ConclusionsAs climate shifts exacerbate public health crises, aid organizations must center community perspectives in their interventions to foster equitable and sustainable outcomes.
Droughts are slow-onset disasters with devastating impacts that can last for months and even years. The poorest communities are usually the hardest hit by droughts. In the Androy region of Madagascar, droughts are a constant major handicap for agriculture and farming which are the two main local economic activities. Human vulnerability to droughts differs according to age, sex, and physical conditions. The precariousness of the situation of Antandroy women caused by droughts motivated the choice of this study, which sought to understand the factors behind women’s vulnerability to this risk. To study these factors, documents on gender, vulnerability, droughts and the Androy region were collected and analysed. We then conducted interviews and a survey to understand the Antandroy’s living conditions. Several factors lead to women’s high degree of vulnerability, such as the particular climate of Androy, household’s size, duties, difficulties faced by the agricultural production, early marriage, migration and low educational levels. To contribute to the reduction of their vulnerability to droughts, Antandroy women should reinforce their adaptability by developing income-generating activities in diversified sectors, using varied seeds and protecting the environment, with the definitive eradication of slash-and burn cultivation and bushfires.
The deprived area of the Metzinger Valley in the city of Mahajanga has many healthcare concerns due to repeated flooding during the rainy season. Improving this health situation requires a better knowledge of the pathogens present in this area and of the risk factors favoring their propagation. The aim of this study was to analyze the relationship between the household socioeconomic status and the presence of parasites in the faeces of children between 1 and 10 years of age in order to determine the risk factors for intestinal parasitosis. The study included 746 children, of whom 30% were infected with parasites. Entamoeba coli, a good indicator of environmental fecal contamination, was the most prevalent parasite with an observation frequency of 16.7% followed by Giardia lamblia with a prevalence of 10%. For helminths, Trichuris and Ascaris were the most prevalent respectively 5.4% and 1.8%. A large heterogeneity in the prevalence of parasites was observed from one neighborhood to another. However, multivariate analysis showed that these differences were not related to environmental factors or household structure, but rather to the economic level of the family, the education level of the mother as well as the age of the child. For example, the prevalence of Giardia decreased from 23.5% to 8% for children of mothers with little education to those with higher education, respectively. For E. coli, the prevalence is higher among poor households and school-aged children. In the frame of IRCOD project, mothers are being sensitized to hygiene and risk factors for transmission by intestinal parasites and the present study proposes a multidimensional approach as an assessment tool.
Precision health mapping is a technique that uses spatial relationships between socio-ecological variables and disease to map the spatial distribution of disease, particularly for diseases with strong environmental signatures, such as diarrhoeal disease (DD). While some studies use GPS-tagged location data, other precision health mapping efforts rely heavily on data collected at coarse-spatial scales and may not produce operationally relevant predictions at fine enough spatio-temporal scales to inform local health programmes. We use two fine-scale health datasets collected in a rural district of Madagascar to identify socio-ecological covariates associated with childhood DD. We constructed generalized linear mixed models including socio-demographic, climatic and landcover variables and estimated variable importance via multi-model inference. We find that socio-demographic variables, and not environmental variables, are strong predictors of the spatial distribution of disease risk at both individual and commune-level (cluster of villages) spatial scales. Climatic variables predicted strong seasonality in DD, with the highest incidence in colder, drier months, but did not explain spatial patterns. Interestingly, the occurrence of a national holiday was highly predictive of increased DD incidence, highlighting the need for including cultural factors in modelling efforts. Our findings suggest that precision health mapping efforts that do not include socio-demographic covariates may have reduced explanatory power at the local scale. More research is needed to better define the set of conditions under which the application of precision health mapping can be operationally useful to local public health professionals.
