The epidemiological transition in Antananarivo, Madagascar: an assessment based on death registers (1900–2012)

Background: Madagascar today has one of the highest life expectancies in sub-Saharan Africa, despite being among the poorest countries in the continent. There are relatively few detailed accounts of the epidemiological transition in this country due to the lack of a comprehensive death registration system at the national level. However, in Madagascar's capital city, death registration was established around the start of the 20th century and is now considered virtually complete. Objective: We provide an overview of trends in all-cause and cause-specific mortality in Antananarivo to document the timing and pace of the mortality decline and the changes in the cause-of-death structure. Design: Death registers covering the period 1976–2012 were digitized and the population at risk of dying was estimated from available censuses and surveys. Trends for the period 1900–1976 were partly reconstructed from published sources. Results: The crude death rate stagnated around 30‰ until the 1940s in Antananarivo. Mortality declined rapidly after the World War II and then resurged again in the 1980s as a result of the re-emergence of malaria and the collapse of Madagascar's economy. Over the past 30 years, impressive gains in life expectancy have been registered thanks to the unabated decline in child mortality, despite political instability, a lasting economic crisis and the persistence of high rates of chronic malnutrition. Progress in adult survival has been more modest because reductions in infectious diseases and diseases of the respiratory system have been partly offset by increases in cardiovascular diseases, neoplasms, and other diseases, particularly at age 50 years and over. Conclusions: The transition in Antananarivo has been protracted and largely dependent on anti-microbial and anti-parasitic medicine. The capital city now faces a double burden of communicable and non-communicable diseases. The ongoing registration of deaths in the capital generates a unique database to evaluate the performance of the health system and measure intervention impacts

Les changements ou les transitions démographiques dans le monde contemporain en développement

Etude comparative de l'évolution de la mortalité des pays développés et des pays en développement à partir d'indicateurs démographiques suivant deux axes : date du début de la mutation, son intensité, sa durée, sa portée géographique; nature des progrès réalisés, perceptibles à partir des structures par âge et causes de décès

Projections démographiques de la population âgée pour 1980 et 1985

Waltisperger Dominique. Projections démographiques de la population âgée pour 1980 et 1985. In: Population, 34ᵉ année, n°4-5, 1979. pp. 919-931

Economic Crisis and Mortality: The Case of Antananarivo, 1976-2000

In the past forty years, Madagascar’s GDP has shrunk more than 30%. The almost continuous deterioration in living conditions has been marked by extremely severe economic crises, most notably in the mid-1980s. Analysis of death registers in the capital, Antananarivo, provides a means to track changes in mortality and main causes of death since 1976. In the past twenty-five years, the rise in poverty has substantially counteracted the positive effects of preventive health initiatives: it has triggered the emergence of diseases thought to have been eradicated several decades ago (tuberculosis, malaria, cholera) in population groups hitherto regarded as less vulnerable (young adult males). The 1986 crisis had the most dramatic impact, particularly among children aged 1-4. The political and economic choices made at the time plunged the country into a state of nutritional deficiency so severe that, within one decade, more than ten years of life expectancy at birth were lost. Progress has been achieved in recent years and life expectancy has very recently returned to its mid-1970s levels. While the levels are comparable, the distribution of causes of death has been significantly modified. The share of acute and infant diseases has fallen, whereas that of chronic diseases has risen. Madagascar’s health outlook remains very uncertain however. In the current economic and political climate, it is by no means certain that the fragile decline in infectious mortality will be maintained and the rise of new pathologies kept in check

Crise économique et mortalité. Le cas d'Antananarivo 1976-2000

Au cours des quarante dernières années, le PIB de Madagascar s’est réduit de plus de 30 %. La dégradation quasi constante des conditions de vie a été ponctuée de crises économiques particulièrement graves, en particulier au milieu des années 1980. L’exploitation des registres de décès de la capitale, Antananarivo, permet d’y suivre l’évolution de la mortalité et des principales causes de décès depuis 1976. Au cours des vingt-cinq dernières années, la montée de la pauvreté a considérablement contrarié l’effet bénéfique des actions préventives de santé en provoquant l’émergence d’affections considérées comme éradiquées il y a plusieurs décennies (tuberculose, paludisme, choléra) sur des populations considérées jusque-là comme moins vulnérables (jeunes hommes adultes). L’effet de la crise de 1986 est particulièrement spectaculaire, notamment chez les enfants de 1-4 ans. Les choix politico-économiques de cette époque ont plongé le pays dans une situation de carence alimentaire telle qu’au total, plus de dix ans d’espérance de vie à la naissance ont été perdus en dix ans. Dans les années les plus récentes, les progrès ont repris et l’espérance de vie a retrouvé tout récemment les niveaux du milieu des années 1970. Si les niveaux sont comparables, la répartition des causes de décès s’est nettement modifiée. Le poids des maladies aiguës et infantiles s’est réduit tandis que celui des maladies chroniques s’accroissait. L’avenir sanitaire de Madagascar reste cependant très incertain. Il n’est en effet pas sûr que la situation économique et politique actuelle permette à la fois de consolider la baisse encore fragile de la mortalité infectieuse et de freiner la montée des nouvelles pathologies

Évolution de la mortalité des enfants et des mères à Madagascar : l’échéance 2015

Depuis plus de trente ans, la santé maternelle et infantile est au cœur des préoccupations des politiques internationales en matière de population. Dès 1978, la conférence d’Alma-Ata permet de définir une stratégie de « soins de santé primaires » (WHO, 1978) qui est ensuite renforcée par l’initiative de Bamako en 1987 (WHO, 1988). Des outils de collecte (recensements, enquêtes nationales, enquêtes démographiques et de santé ont alors été développés pour assurer le suivi et l’évaluation des pr..

Economic Crisis and Changes in Mortality Due to Infectious and Parasitic Diseases in Antananarivo, Madagascar

Madagascar was severely affected by the economic crisis that hit sub-Saharan Africa in the 1980’s. The crisis, exacerbated by a high degree of political instability, led to food shortages in the mid-1980s. The impact on, mortality is not well known, owing to a lack of statistics for the whole island. Systematics analysis of the registers of the Municipal Hygiene Office (Bureau municipal d’hygiène: BMH) in Antananarivo is used to show the trend of mortality by cause in the capital since 1976. The food crisis substantially reduced life expectancy, which did not return to its 1976 level until 2000. Nutritional deficiencies and infectious diseases played a prominent role in the reduction in life expectancy. Mortality due to nutritional deficiencies fell as soon as the food supply improved, but mortality due to infectious diseases remains high, particularly among males aged 10-50, who are also particularly vulnerable to the increase in man-made diseases, including road accidents and alcoholism