Association between Proximity to a Health Center and Early Childhood Mortality in Madagascar

Objective: To evaluate the association between proximity to a health center and early childhood mortality in Madagascar, and to assess the influence of household wealth, maternal educational attainment, and maternal health on the effects of distance. Methods: From birth records of subjects in the Demographic and Health Survey, we identified 12565 singleton births from January 2004 to August 2009. After excluding 220 births that lacked global positioning system information for exposure assessment, odds ratios (ORs) and their 95% confidence intervals (CIs) for neonatal mortality and infant mortality were estimated using multilevel logistic regression models, with 12345 subjects (level 1), nested within 584 village locations (level 2), and in turn nested within 22 regions (level 3). We additionally stratified the subjects by the birth order. We estimated predicted probabilities of each outcome by a three-level model including cross-level interactions between proximity to a health center and household wealth, maternal educational attainment, and maternal anemia. Results: Compared with those who lived >1.5–3.0 km from a health center, the risks for neonatal mortality and infant mortality tended to increase among those who lived further than 5.0 km from a health center; the adjusted ORs for neonatal mortality and infant mortality for those who lived >5.0–10.0 km away from a health center were 1.36 (95% CI: 0.92–2.01) and 1.42 (95% CI: 1.06–1.90), respectively. The positive associations were more pronounced among the second or later child. The distance effects were not modified by household wealth status, maternal educational attainment, or maternal health status. Conclusions: Our study suggests that distance from a health center is a risk factor for early childhood mortality (primarily, infant mortality) in Madagascar by using a large-scale nationally representative dataset. The accessibility to health care in remote areas would be a key factor to achieve better infant health

Development of a multi-criteria evaluation of agroecological practices involving soil biodiversity, agronomic performance and farmer perception

International audienceAn experiment has been designed in the Highlands of Madagascar withthe aim to produce multi-criteria indicators of performance ofagroecological practices. In this experiment, different traditionaland innovative practices were tested in field conditions with theassumption that practices that enhance soil biodiversity and soilecological processes are the one that best promote plant production,yield and sustainability. Both ecological and agronomic performanceswere confronted with socio-economic performance defined by farmers inorder to propose innovative practices adoptable by farmers.A 2-year field experiment with 16 different practices, replicated 4times, was designed in the Highlands of Madagascar with upland riceas the main crop. Many soil and plant parameters were measured: 73parameters to describe soil biodiversity and soil ecologicalprocesses, 19 descriptors to measure rice production, nutrition andyield, and 8 socio-economic descriptors.This study led to the production of a useful indicator allowing toevaluate an agroecological practice on the way it promotes soil healthand especially soil biodiversity, crop yield and socio-economicalrequirements which are the main limits for practice adoption. Wemeasured interesting relations between soil ecological descriptorsand agronomic descriptors

Development of a multi-criteria evaluation of agroecological practices involving soil biodiversity, agronomic performance and farmer perception

International audienceAn experiment has been designed in the Highlands of Madagascar withthe aim to produce multi-criteria indicators of performance ofagroecological practices. In this experiment, different traditionaland innovative practices were tested in field conditions with theassumption that practices that enhance soil biodiversity and soilecological processes are the one that best promote plant production,yield and sustainability. Both ecological and agronomic performanceswere confronted with socio-economic performance defined by farmers inorder to propose innovative practices adoptable by farmers.A 2-year field experiment with 16 different practices, replicated 4times, was designed in the Highlands of Madagascar with upland riceas the main crop. Many soil and plant parameters were measured: 73parameters to describe soil biodiversity and soil ecologicalprocesses, 19 descriptors to measure rice production, nutrition andyield, and 8 socio-economic descriptors.This study led to the production of a useful indicator allowing toevaluate an agroecological practice on the way it promotes soil healthand especially soil biodiversity, crop yield and socio-economicalrequirements which are the main limits for practice adoption. Wemeasured interesting relations between soil ecological descriptorsand agronomic descriptors