Madagascar African Region

I. Epidemiological profile Population (UN Population Division) 2017 % Parasites and vectors High transmission (>1 case per 1000 population) 22.4M 88 Major plasmodium species: P.falciparum: 96 (%) , P.vivax: 4 (%) Low transmission (0-1 case per 1000 population) 3.1M 12 Major anopheles species: An. funestus, An. gambiae, An. arabiensis Malaria free (0 cases) 0 - Reported confirmed cases (health facility): 800 661 Estimated cases: 2.3M [1.7M, 3M] Total 25.6M Confirmed cases at community level: 134 568 Confirmed cases from private sector: 50 623 Reported deaths: 370 Estimated deaths: 6K [189, 11.2K]

II. Intervention policies and strategies Yes/ Year Intervention Policies/Strategies Medicine Year adopted No adopted Antimalaria treatment policy ITN ITNs/LLINs distributed free of charge Yes 2004 First-line treatment of unconfirmed malaria AS+AQ 2006 ITNs/LLINs distributed to all age groups Yes 2009 First-line treatment of P. falciparum AS+AQ 2006 IRS IRS is recommended Yes 1993 For treatment failure of P. falciparum QN 2006 DDT is used for IRS No - Treatment of severe malaria QN 2006 Larval control Use of Larval Control No Treatment of P. vivax - - IPT IPT used to prevent malaria during pregnancy Yes 2006 Dosage of primaquine for radical treatment of P. vivax 0.25 mg/Kg (14 days) Diagnosis Patients of all ages should receive diagnostic test Yes 2006 Type of RDT used P.f + all species (Combo) Malaria diagnosis is free of charge in the public sector Yes 2006 Therapeutic efficacy tests (clinical and parasitological failure, %) Treatment ACT is free for all ages in public sector Yes 2006 Medicine Year Min Median Max Follow-up No. of studies Species is The sale of oral artemisinin-based monotherapies (oAMTs) 2006 AS+AQ 2012-2016 0 0 1.6 28 days 6 P. falciparum banned Single dose of primaquine (0.25 mg base/kg) is used as Yes 2015 Resistance status by insecticide class (2010-2017) and use of class for malaria vector control (2017) gametocidal medicine for P. falciparum Insecticide class Years (%) sites1 Vectors2 Used3 Primaquine is used for radical treatment of P. vivax No - Carbamates 2010-2017 9.8% (51) An. funestus s.l., An. gambiae s.l. No G6PD test is a requirement before treatment with primaquine No - Organochlorines 2010-2017 24.53% (53) An. gambiae s.l. No Directly observed treatment with primaquine is undertaken Yes 2015 Organophosphates 2010-2017 0% (52) - Yes System for monitoring of adverse reaction to antimalarials exists Yes 2008 Pyrethroids 2010-2017 25.86% (58) An. gambiae s.l. Yes Surveillance ACD for case investigation (reactive) Yes 1993 1Percent of sites for which resistance confirmed and total number of sites that reported data (n) ACD at community level of febrile cases (pro-active) Yes 1993 2Principal vectors that exhibited resistance Mass screening is undertaken Yes 2003 3Class used for malaria vector control in 2017 Uncomplicated P. falciparum cases routinely admitted Yes 2006 Uncomplicated P. vivax cases routinely admitted Yes 2010 Case and foci investigation undertaken Yes Case reporting from private sector is mandatory Yes 2008

III. Charts Sources of ﬁnancing Government expenditure by intervention in 2017 80M

60M

40M Contribution($USm) 20M

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Insecticides & spray materials ITNs Diagnostic testing Others WHO/UNICEF USAID/PMI Worldbank (USD) Antimalarial medicines Monitoring and evaluation Global Fund (USD) Government contribution Human resources & technical assistance Management and other costs

IV. Coverage Coverage of ITN and IRS Cases tested and treated in public sector 100 100

75 75

50 50 (%) Population

25 25

0 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Suspected cases tested Antimalarials distributed vs reported cases ACTs distributed vs reported P. f. cases % of households >= 1 ITN (Modelled) At risk protected with IRS Primaquine distributed vs reported P. v. cases % of the population who slept under an ITN the previous night (survey) % <5 fever cases who had a ﬁnger/ heel stick (survey) % of the population with access to an ITN (survey) ACTs as % of all antimalarials received by <5 (survey)

Source: DHS 2009, MIS 2011, 2013, 2016 Source: DHS 2009, ENSOMD 2013, MIS 2011, 2013, 2016, Other Nat.* V. Impact Cases treated Test positivity 100% 100%

75% 75%

50%

(%) 50% Tests (%)

25% 25%

0% 0%

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 % fever cases <5 seeking treatment at public HF (survey) Reporting completeness Slide positivity rate RDT positivity rate

Source: DHS 2009, MIS 2011, 2013, 2016

V. Impact Conﬁrmed malaria cases per 1000 and ABER Malaria admissions and deaths 50 10 25k 1200

40 8 20k 1000

30 6 15k 800 Deaths ABER (%)

10k 600 20 4 Admissions Cases per 1000 Cases

5k 400 10 2

0k 200 0 0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Admissions (all species) Admissions (P. vivax)) Deaths (all species) ABER Cases(all species) Cases (P. vivax) Deaths (P. vivax))

World Malaria Report 2018