Madagascar is a nation of 13.3 million people. Population growth was estimated to be 3.1% a year during the period 1985-92. It is a low income country with per capita GNP of U.S.$240 in 1993. Madagascar has an enormous resource endowment and a highly unequal income distribution with severe and widespread poverty. Its economy is primarily agricultural.
The nutrition situation up to 1987 was described in the ACC/SCN's Update on the Nutrition Situation, 1989, pages 69-73.
Recent Trends in Nutrition
Two national surveys were carried out in Madagascar in the last ten years. The earlier survey, in 1983/84, covered children from 0-23 months of age, while the latter survey, carried out in 1992 by DHS and the Centre Nationale de Reserches sur l'Environnement, covered children from 0-59 months. For examining trends, data for the 0-23 months age group in the 1992 survey were used in making comparisons with the 1983/84 period.
The results indicate that over the 9 year period, the prevalence of underweight children (0-23 months <-2 s.d. weight-for-age NCHS) remained nearly the same or increased slightly (34% in 1992 vs. 32% in 1983/84), but the prevalence of stunting (<-2 s.d. height-for-age NCHS) increased markedly from 27% to 34%. Population growth rates in Madagascar over that period have been very high (3.1%), which implies that the magnitude of problems has been rising in the last ten years. The actual number of underweight children, for instance, nearly doubled - from 520,000 preschool children in 1983 to about 950,000 in 1992, due to increases in both prevalence and population.
The 1992 data showed that there is variation in the underweight prevalence across the country. Some summary data are shown in Figure 1, by region and urban/rural. In Mahajanga/Antsiranana and Toliary provinces, the underweight prevalence (0-59 months old) was about 28%, compared to the problems in Antananarivo and Fianrantsoa provinces where the prevalence was between 44% and 47% respectively. Prevalences were somewhat higher in rural areas (40% underweight) compared to urban areas (33% underweight).
Figure 1. Madagascar: Undernutrition among Children under 5 years by Region and Residence, 1992
Note: Central region includes: (Antananarivo and Antsirabe provinces)
Southern region includes: (Toliary and Fianarantsoa provinces)
Northern region includes: (Antsiranana, Mahajanga, and Toamasina provinces)Source: CNRE/MRAD/DHS (1994).
MADAGASCAR
(Estimates in 1993)
|
Population |
: 13.3 million |
|
Population Density |
: 20 per sq. km. |
|
Population Growth Rate |
: 2.9% per annum |
|
Urban Population |
: 26% |
|
IMR |
: 100 |
|
GNP US$ (Per Capita) |
: 240 |
|
PPP estimates of GDP |
: 710 |
Underweight preschool children (Percent below -2 s.d. weight for age)
Infant mortality rate (Per 1,000 live births)
ECONOMICS
GDP per capita (1987 Mkt. prices, Malagasy Francs / capita)
Debt service ratio (Debt service/exports)
FOOD
Food production index (Per caput, 1979-81=100)
Dietary energy supply (Kcals/caput/day)
Consumer price index (1980=100)
FPI/CPI ratio (1980=100)
HEALTH
Immunization coverage (Percent)
Access to local health care (Percent)
PUBLIC EXPENDITURES
Education and health expenditures (US $ per capita)
Education and health expenditures (Percent of government expenditures)
Factors Affecting Trends in Nutrition
Economic Growth. The country faced serious economic difficulties throughout the 1980s. At the same time, population growth rates were 3.3% annually, giving rise to higher dependency ratios, which put a heavy burden on households. The annual growth rate of real GDP per capita during the period 1986-1993 was -2.1 percent.
Food Security. Per capita food production has been declining particularly in the late 1980s and early 1990s. Using 1979-81 as base=100, the per capita food production index is estimated at 86 in 1993, and is about the lowest point since 1980. Partly as a result of this poor performance in the agricultural sector, the estimated per capita calorie supply per capita declined from 2370 kcals in 1985 to 2135 in 1992. Greater than 80% of the population are dependent on agriculture for both consumption and for livelihood, which is the source of more than 80% of merchandise export earnings. It is estimated that 16% of the land is usable for cropping, of which 19% is currently under cultivation.
The basic staple is rice. Government plans to restore self-sufficiency in rice (between 2.8 million and 3 million MT of paddy) by 1990 were not realized. In 1990, rice imports rose to 103,000 MT, which is higher than in the late 1980s, but is lower than the 250,000 MT of imports in 1985. Part of these import requirements were met from food aid of roughly which accounted for 30% of all import requirements.
Inflation in the 1980s was estimated at about 10%. As a result of rice buffer stocking policy, food prices were relatively stable. The food price index did not increase as much as the overall CPI, so that the FPI/CPI ratio has been below 100 for most of the late 1980s and early 1990s.
Health, Education, Women's Status. The total fertility rate of 6.1 births per woman is extremely high. The high rates of population growth (3.1% in early 1990s, compared to 2.7% in mid 1980s) has increased the dependency ratios and, therefore, has added pressure to the growing labor force by reducing economic opportunities.
The government has a high priority for education. Government financial statistics indicate that the proportion of educational expenditures to total government budgets rose from 13% in 1988 to about 17% in 1991, despite the increasing fiscal constraints. This translates to roughly $6 per capita. Primary school enrollment in Madagascar is now extensive, up from 65% two decades ago. About 36% enrollment ratios were achieved in 1991 in the secondary school level, a figure that is higher than many countries in the Sub-Saharan region.
An important association of education with nutrition was found in the 1992 nutrition survey. Amongst mothers who had reached only a primary level of education, the prevalence of underweight children was about 42%, compared to 27% amongst those who had reached secondary education.
In terms of health services, about 80% of the population had access to public health services in 1988, and about 75% of mothers were reported to have access to antenatal care. Immunization coverage of 12-23 months old children was estimated in 1992 by the DHS survey as 43%, 58% in urban and 41% in rural areas. Malarial infection had again reached epidemic proportions in recent years, even in the central highland areas where malaria had previously been eliminated.
Infant mortality rates in Madagascar are higher than the Sub-Saharan Africa average, at 100 per 1000 live births. Some improvements were, however, observed in the last decade or so.
