DEMOGRAPHICS

Total population (000) Total under-five population (000) Births (000) Birth registration (%) Under-five mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) Total under-five deaths (000) Maternal mortality ratio (per 100,000 live births) Lifetime risk of maternal death (1 in N) Total maternal deaths 19,159 (2006) 3,142 (2006) 714 (2006) 75 (2006) 115 (2006) 72 (2006) 33 (2000) 82 (2006) 510 (2005) 38 (2005) 3,600 (2005)

Madagascar
Under-five mortality rate
Deaths per 1000 live births

MATERNAL AND NEWBORN HEALTH
Causes of maternal deaths
Regional estimates for Africa, 1997-2002

Causes of under-five deaths

200 160 120 80 40

168 115 56
MDG Target

Globally more than one third of child deaths are attributable to undernutrition Causes of neonatal Other Measles Injuries deaths 8% 5% Diarrhoea 3% 2% Diarrhoea Tetanus 4% HIV/AIDS Congenital 6% 17% 1% Other 7%
Infection 24%

Coverage along the continuum of care
Contraceptive prevalence rate Antenatal visit (1 or more) Haemorrhage 34% Skilled attendant at birth *Postnatal care Exclusive breastfeeding 67 59 27 80 51
Pre-pregnancy Pregnancy Birth Neonatal period Infancy

Unmet need for family planning (%) Antenatal visits for woman (4 or more visits, %) Intermittent preventive treatment for malaria (%) C-section rate (total, urban, rural; %)
(Minimum target is 5% and maximum target is 15%)

24 (2003-2004) 40 (2003-2004) --1,2,1 (2003-2004) 62 (2003-2004)

Obstructed labor Abortion Anaemia 4% 4% 4% Hypertensive disorders 9% Sepsis/Infections, including AIDS 16% Other causes 30%
Source: Khan, Khalid S., et al, Lancet 2006:367:1066-74

Malaria 20% Pneumonia 21%
Source: WHO, 2006

Neonatal 26%

Asphyxia 25%

Early initiation of breastfeeding (within 1 hr of birth, %)

0 1990
Source: UNICEF, 2006

Preterm 31%
Source: Lawn JE, Cousens SN for CHERG (Nov 2006)

Postnatal visit for baby (within 2 days for home births, %) ---

Measles

1995

2000

2005

2010

2015

0
Source: DHS, MICS, Other NS *See Annex for indicator definition

20

40

60

80 100

INTERVENTION COVERAGE FOR MOTHERS, NEWBORNS AND CHILDREN
NUTRITION
Stunting prevalence (moderate and severe, %) 53 (2003-2004) Wasting prevalence (moderate and severe, %) 15 (2003-2004) Complementary feeding rate (6-9 months, %) 78 (2003-2004) Low birthweight incidence (%) 17 (2003-2004)

Antenatal care
100 80
Percent

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

Skilled attendant at delivery
100

Percent live births attended by skilled health personnel

Neonatal tetanus protection
100 80

Percent of newborns protected against tetanus

78

77

71

80

80
Percent

67

Percent children < 5 years underweight for age*

Percent infants < 6 months exclusively breastfed

Percent children 6-59 months receiving vitamin A doses

47

100 80
Percent

100 80
Percent

100
67 38 48
Percent

94

At least one dose 73 58

Two doses 95 91 84

40 20 0
1992
DHS

40 20

46

Percent

Underweight prevalence

Exclusive breastfeeding

Vitamin A supplementation

60

60

57

51

60 40 20

89 87

95 95

80 60 40 20
38 0

60 40 20 0 1992
DHS

60 40 20

1997
DHS

2000
MICS

2003-2004
DHS

0

1992
DHS

1997
DHS

2000
MICS

2003-2004
DHS

1982
Source: WHO/UNICEF

1987

1992

1997

2002

2006

36

37

41

47 0

WATER AND SANITATION
Water
100 80
Percent

EQUITY
Sanitation
100
Rural Percent population using improved sanitation facilities Urban Total

2003-2004
DHS

0

1992
DHS

1997
DHS

2000
MICS

2003-2004
DHS

0

1999 2000 2001 2002 2003 2004 2005

Source: UNICEF

Percent population using improved drinking water sources Rural Urban 80 Total 77

Coverage gap by wealth quintile
100 80
Percent

*Based on 2006 WHO reference population

CHILD HEALTH
Immunization
Percent of children immunised against measles Percent of children immunised with 3 doses DPT Percent of children immunised with 3 doses Hib

80
Percent

Malaria prevention

Percent children < 5 years sleeping under ITNs

Prevention of mother to child transmission of HIV

60 40 20 0 1990 2004
40 27 35

50

60 40 20 0
10 27 26

48 34

60 40 20

Percent HIV+ pregnant women receiving ARVs for PMTCT

14

100 80
Percent

100
61 59
Percent

80 60 40 20
No data

1990

2004

0

Poorest

2nd

3rd 1997
DHS

4th 2000
MICS

Wealthiest
DHS

60 40 20 0 1990 1995 2000

Source: WHO/UNICEF JMP, 2006

Source: WHO/UNICEF JMP, 2006

2004

POLICIES
International Code of Marketing of Breastmilk Substitutes New ORS formula and zinc for management of diarrhoea Community treatment of pneumonia with antibiotics IMCI adapted to cover newborns 0-1 week of age Costed implementation plan(s) for maternal, newborn and child health available Midwives be authorised to administer a core set of life saving interventions Maternity protection in accordance with ILO Convention 183 Specific notification of maternal deaths Partial Yes Yes Yes No Partial No Partial

SYSTEMS
Financial Flows and Human Resources
Per capita total expenditure on health (US$) General government expenditure on health as % of total government expenditure (%) Out-of-pocket expenditure as % of total expenditure on health (%) Density of health workers (per 1000 population) Official Development Assistance to child health per child (US$) 29 (2007) 9 (2007) 21 (2007) 0.6 (2004) 6 (2005) Coverage gap (%) Ratio poorest/wealthiest Difference poorest-wealthiest (%)

Source: WHO/UNICEF

2005 2006

0

0.2

54 2.1 34

47 1.9 24

44 3.1 42

2000
MICS

Diarrhoeal disease treatment

Percent children < 5 years with diarrhoea receiving oral rehydration therapy or increased fluids, with continued feeding

Malaria treatment

Percent febrile children < 5 years using antimalarials

Pneumonia treatment

Percent children < 5 years with suspected pneumonia taken to appropriate health provider Percent children < 5 years with suspected pneumonia receiving antibiotics

100 80
Percent

100 80
Percent

100 80
61
Percent

60 40 20 0
19

47

47

60 40 20

60 40 20
42 20 37

34

47 38

48 35

Official Development Assistance to maternal and neonatal health per live birth (US$) 7 (2005) National availability of Emergency Obstetric Care services (% of recommended minimum) 30 (2002-2003)

Madagascar
Countdown to 2015
2008 Report

1997
DHS

2000
MICS

2003-2004
DHS

0

2000
MICS

2003-2004
DHS

0

1992
DHS

1997
DHS

2000
MICS

2003-2004
DHS

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