Climate change is worsening the malaria epidemic in Madagascar

Unusable roads cut off health care access

The peak of malaria season coincides with the cyclone and rainy season, which runs from October to May. During this period, the weather makes it extremely difficult for people to access health care, putting the lives of sick children at even greater risk. 

"When the rain is heavy, providing care for children becomes difficult,” said Dr. Nantenaina, a doctor at the intensive therapeutic feeding center run by MSF. “The roads become muddy, flooded, and unusable. It is a struggle for both health workers and patients to move around, making it hard for patients to access health centers or for us to send them back home."

In hard-to-reach areas like Ikongo, the distance between households and health care facilities is significant, and there is a lack of transportation. "After seeing my son's condition deteriorate, I decided to go to the nearest health center,” said Soanary, the mother of a 4-year-old boy suffering from malnutrition and malaria. “To get here, I had to walk for four hours and cross through water, carrying my son on my back.” Soanary isn't the only one facing this situation. As a result, people only seek medical care when their health has deteriorated to a critical condition.

Climate change is at the heart of the crisis

Madagascar has been severely affected by extreme weather events that challenge access to health facilities and threaten the overall state of health and nutrition. This situation has played a significant role in the rise of malaria and malnutrition.

According to the World Health Organization, the rates of malaria cases and deaths from malaria increased by 25 to 55 percent between 2015 and 2022. The 2023 World Malaria Report highlights that these rates surged by more than 100 percent between 2000 and 2022.

Changes in temperature and rainfall have resulted in floods and significant heat waves that impact the behavior and survival of anopheles mosquitoes which spread malaria, leading to increased disease transmission within communities. In Ikongo district, which already experiences a humid tropical climate, the effects of climate change are particularly severe: Many villages in Ikongo are surrounded by marshes and rivers, and heavy rains cause the flooding of plantations and rice fields, worsening the already precarious nutritional conditions in the area. "During the rainy season, our health centers receive a lot of malaria cases," explained Evelyne, a nurse at the Ikongo primary health center. 

Often, children with malaria also have malnutrition. "We have at least one new case of a malnourished child who also suffers from severe malaria every week during the rainy season," said Dr. Nantenaina, a doctor at the intensive therapeutic feeding center operated by MSF.

Our work in Ikongo

MSF has been present in Ikongo since 2022. Between then and March 2024, MSF medical teams collaborating with Madagascar health authorities and health promoters diagnosed and treated 2,205 children suffering from both malnutrition and malaria, including 256 cases this year. In response to food insecurity exacerbated by climate-related weather events such as cyclones, MSF teams have increased activities in the southern part of Madagascar, which has been the most affected. Currently, MSF is supporting seven primary health centers and two intensive nutritional clinics to diagnose and treat malnourished children in Ikongo district.