Public health surveillance of tropical diseases in Madagascar: a scoping review of population burden, intervention strategies, and health system responses.

BACKGROUND

Madagascar faces unique challenges in tropical disease management due to its diverse geography, tropical climate, and socioeconomic factors. This review examines current challenges in tropical medicine in Madagascar and explores opportunities for improving public health outcomes, with a focus on six priority diseases.

METHODS

We conducted a comprehensive scoping review of literature published between January 2000 and December 2024, searching PubMed, Google Scholar, ScienceDirect, and Web of Science. Studies were included if they reported on tropical disease burden, interventions, health outcomes, or health system capacity in Madagascar. Studies were excluded if they were not available in English or French, lacked Madagascar-specific focus, did not discuss health systems or population-level disease control, focused solely on laboratory techniques without public health relevance, were conference abstracts or reports without full-text availability, or came from non-credible sources. Peer-reviewed literature was supplemented with grey literature. Data were extracted using a standardized form by two independent reviewers and analyzed thematically.

RESULTS

Madagascar shows divergent disease patterns compared to regional averages. Malaria represents the biggest concern, with cases up 132% and deaths up 278% by 2023, now exceeding regional rates. Conversely, lymphatic filariasis represented a remarkable public health success, achieving 93% prevalence reduction and slightly outperforming regional outcomes. Dengue control remained exemplary throughout the study period, with Madagascar maintaining rates approximately three times lower than regional averages. Leprosy burden persistently exceeded regional averages by threefold despite achieving 54% reduction, while tuberculosis and schistosomiasis follow continental reduction trends. Control strategies included integrated vector management, mass drug administration achieving 76.3% national coverage for lymphatic filariasis, seasonal malaria chemoprevention, and targeted treatment approaches. Disease spread is driven by poor infrastructure, poverty, water access issues, and favorable climate. Research gaps exist in disease interactions, economic impact, and intervention acceptance.

CONCLUSION

Addressing tropical disease burden in Madagascar requires strengthened public health infrastructure, increased domestic health financing, improved health workforce retention, and targeted interventions for remote communities. Building local research capacity, investing in innovative technologies, and implementing integrated disease control approaches are essential for improving population health outcomes.