Evaluation of the influenza sentinel surveillance system in Madagascar, 2009-2014.

PROBLEM: Evaluation of influenza surveillance systems is poor, especially in Africa. APPROACH: In 2007, the Institut Pasteur de Madagascar and the Malagasy Ministry of Public Health implemented a countrywide system for the prospective syndromic and virological surveillance of influenza-like illnesses. In assessing this system's performance, we identified gaps and ways to promote the best use of resources. We investigated acceptability, data quality, flexibility, representativeness, simplicity, stability, timeliness and usefulness and developed qualitative and/or quantitative indicators for each of these attributes. LOCAL SETTING: Until 2007, the influenza surveillance system in Madagascar was only operational in Antananarivo and the observations made could not be extrapolated to the entire country. RELEVANT CHANGES: By 2014, the system covered 34 sentinel sites across the country. At 12 sites, nasopharyngeal and/or oropharyngeal samples were collected and tested for influenza virus. Between 2009 and 2014, 177 718 fever cases were detected, 25 809 (14.5%) of these fever cases were classified as cases of influenza-like illness. Of the 9192 samples from patients with influenza-like illness that were tested for influenza viruses, 3573 (38.9%) tested positive. Data quality for all evaluated indicators was categorized as above 90% and the system also appeared to be strong in terms of its acceptability, simplicity and stability. However, sample collection needed improvement. LESSONS LEARNT: The influenza surveillance system in Madagascar performed well and provided reliable and timely data for public health interventions. Given its flexibility and overall moderate cost, this system may become a useful platform for syndromic and laboratory-based surveillance in other low-resource settings.

Assessment of Risk, Vulnerability and Adaptation to Climate Change by the Health Sector in Madagascar.

Madagascar is cited as one of the most vulnerable countries to the effects of climate change, with significant impacts to the health of its population. In this study, the vulnerability of Madagascar's health sector to climate change was assessed and appropriate adaptation measures were identified. In order to assess climate risks, vulnerability and identify adaptation options, the Madagascar Ministry of Public Health as well as the National Meteorological and Hydrological Service worked in close collaboration with a team of local experts to conduct a literature review, field surveys, and analyses of current and future climate and health trends. Four climate-sensitive diseases of primary concern are described in the study: acute respiratory infections (ARI), diarrhea, malnutrition, and malaria. Baseline conditions of these four diseases from 2000 to 2014 show acute respiratory infections and diarrheal diseases are increasing in incidence; while incidence of malnutrition and malaria decreased over this period. To assess future impacts in Madagascar, this baseline information was used with climate projections for the two scenarios-RCP 4.5 and RCP 8.5-for the periods 2016⁻2035, 2036⁻2070 and 2071⁻2100. Future climate conditions are shown to exacerbate and increase the incidence of all four climate sensitive diseases. Further analysis of the exposure, sensitivity and adaptive capacity to the climate hazards suggests that the health sector in four regions of Madagascar is particularly vulnerable. The study recommends adaptation measures to improve the monitoring and early warning systems for climate sensitive diseases, as well as to reduce population vulnerability.