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Madagascar Public Health
Life expectancy at birth has gradually improved from an
average of 37.5 years for men and 38.3 years for women in
1966 to
an average of fifty-two years for men and fifty-five years
for
women in 1990 (for a combined average of fifty-four).
Malaria
remains the most serious tropical disease, although
eradication
campaigns against mosquitoes waged since 1948 initially
resulted
in spectacular declines in incidence and a dramatic
decrease in
the island's mortality rate during a twenty-year period.
Indeed,
in some regions, especially the central highlands, these
campaigns were almost completely successful, although
malaria
continues to be prevalent in the coastal regions,
especially the
east coast. As prevention practices faltered during the
late
1970s and throughout the 1980s, the mosquito staged a
comeback.
The effect on a population with a significantly reduced
resistance to malaria was devastating. For example, the
Malagasy
Ministry of Health reported 490,000 cases and 6,200 deaths
from
malaria in 1985, but these figures rose--to 760,000 cases
and
11,000 deaths--in 1987.
As of 1994, other serious diseases included
schistosomiasis,
tuberculosis, and leprosy. The prevalence of
schistosomiasis, a
parasitic ailment that spreads primarily through the
passing of
human wastes into ponds, irrigation canals, and
slow-moving
streams, reflects the continued lack of adequate sewage
facilities, especially in the rural areas. Occasional
outbreaks
of bubonic plague occur in urban areas, the most recent of
them
in 1990. Yet Madagascar has been spared many of the
diseases
common in tropical countries, such as trypanosomiasis,
cholera,
brucellosis, and yellow fever.
The occurrence of sexually transmitted diseases (STDs)
has
increased during the 1980s and the 1990s. It is estimated
that
287 of 100,000 inhabitants have gonorrhea, and 220 of
100,000
have syphilis. According to data collected from 9,574
inhabitants
treated for STDs in 1987, the breakdown by type of disease
was as
follows: gonorrhea (38 percent); syphilis (33 percent);
trichomoniasis (20 percent); and candidiasis (8 percent).
According to data compiled by the World Health
Organization, only
three cases of acquired immune deficiency syndrome (AIDS)
were
reported in the 1990-92 period, and six cases in 1993,
earning
Madagascar a 0.0 "case rate" (reported cases per 100,000
population).
The government has committed itself to the principle
that
good health is a right of each Malagasy citizen, and has
made
significant strides in the area of health care. A number
of new
hospitals and medical centers were built in various parts
of the
country during the 1970s and the first part of the 1980s.
However, about two-thirds of the population reside at
least five
kilometers from a medical center, resulting in the May
1993
finding of UNICEF that 35 percent of the population lacked
adequate access to health services.
Economic decline has led to a deterioration in medical
services during the late 1980s and the early 1990s. In
1976, of
the national budget, 9.2 percent was allocated to health
care;
this percentage dropped to 6.6 percent in 1981, 4.5
percent in
1990, and 2 percent in 1994. For example, as of 1993,
according
to UNICEF, the country had only one physician per 17,000
people.
Important regional differences also exist. For example, in
some
provinces the ratio was as low as one physician for 35,000
persons. For the entire island, in 1993 a total of 234
medical
centers were under the direction of one doctor, and the
remaining
1,728 centers were under the direction of paramedics,
midwives,
nurses, health aides, or sanitarians. For those unable to
obtain
modern medical treatment, traditional medicine--the use of
herbs
or the exorcism of malicious spirits--remains popular.
Additional factors contributing to health problems
include
overcrowding (in some areas five to eight persons live in
a room
fourteen meters square), contagious diseases such as the
plague,
and inadequate garbage disposal facilities. Infant
mortality has
risen from sixty-eight per 1,000 births in 1975 to 109 per
1,000
in 1980 and 150 per 1,000 in 1990. Malnutrition, diarrheal
diseases, respiratory infections, and malaria are major
causes of
infant deaths. Madagascar had a serious malaria epidemic
in 1990
causing the death of tens of thousands; efforts are
underway for
annual antimalarial campaigns, especially in the Hauts
Plateaux.
Data as of August 1994
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