Standardisation sur la prévention et la prise en charge du Paludisme

Funded by the US Agency for International Development (USAID) under Cooperative Agreement No. AID-OAA-A-12-00057, the program focused on standardizing malaria prevention and treatment practices. Malaria remains a significant public health issue in Madagascar, with a mortality rate that decreased from 10.43% in 2003 to 8.32% in 2013. However, the use of malaria intermittent preventive treatment (IPT) among pregnant women was higher among children under 4 years and adults over 19 years. The program's goal was to reduce malaria morbidity by half in high-transmission areas and strive for zero morbidity in low-transmission areas by 2017. The National Malaria Strategic Plan (PSN) outlined key steps towards malaria elimination, including a continuum of control to elimination. This involved achieving a malaria positivity rate of less than 5% among cases of fever, fewer than one case per 1,000 people at risk per year, and zero cases of national origin. The plan also established "seuils indicatifs" or indicative thresholds for certification by the World Health Organization (WHO). The PSN identified four vulnerability criteria, including incidence, malaria lethality, utilization of health facilities, and poverty. Stratification of areas into high-transmission, low-transmission, pre-elimination, and pre-elimination zones was also implemented. The program recognized seven epidemiological profiles of malaria in Madagascar, including stable, unstable, and exempt zones. Characteristics of malaria endemism in Madagascar were identified, including stable malaria zones with perennial transmission, high premunition among the adult population, and vulnerability affecting the entire population. Unstable malaria zones were characterized by seasonal transmission, high incidence after the rainy season, and insufficient acquired immunity. Factors influencing malaria endemism in Madagascar included rainfall, temperature, altitude, and entomology. The program aimed to address these factors and reduce malaria morbidity and mortality through a comprehensive approach, including standardizing malaria prevention and treatment practices, improving access to healthcare, and enhancing community engagement and participation.