Madagascar: Cardiovascular Care and Treatment
Population: 25.57 million
Madagascar, the fifth-largest island in the world, faced a political crisis beginning in 2009 and finally concluding 2013. This continued from a history of chronic instability and strife that has characterized the country since it gained independence in 1960, with pronounced, detrimental social and economic impacts. The country has made some important improvements thanks to concerted public health initiatives and investment, including improved access to drinking water, intense malaria pre-elimination efforts and a campaign to improve children’s health. We applaud these gains while we also recognize that much remains to be done in order to reduce the many preventable deaths that still plague the country.
Remaining challenges include: Limited health coverage and access to care, particularly in rural areas where 35% of the population lives more than 10 km from a health facility. Low health-services utilization: Only 31.2% of the population attend basic health care centers as outpatients. Technical shortcomings limiting service quality, including lack of necessary technical competencies to provide quality care and proper medical equipment and material.
- There are an estimated 0.161 physicians per 1,000 people and 0.316 nurses and midwives per 1,000 people.
- Infant mortality rate (per 1,000 live births): 33
- Under-5 mortality rate (per 1,000 live births): 44
- An estimate of the number of congenital heart pathologies in Madagascar is around 3,600 annually for 720,000 births – or 5 in every thousand births.
*Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UN DESA Population Division)
USFC began working in Madagascar in July 2018 to continue the successful cardiac surgery that first began in 1994 by Doctors of the World.
Today, USFC’s pediatric surgery program is virtually the only option available for children with heart conditions in the country, making it an instrumental avenue of surgery and care for families in need.
In 2018, one medical mission took place:
- USFC performed 11 closed-heart operations on children in Madagascar.
- 388 children with cardiac complications received consultations, including 86 new cases
- USFC treated 135 children post-op.
- USFC also laid out ongoing medical monitoring plans for 167 children.
- 16 children who required open-heart surgery were brought to France for treatment.
USFC’s pediatric cardiac surgery program is designed for children under the age of 16 with congenital or acquired heart defects in Malagasy, Madagascar. In partnership with Soavinandriana Hospital of Antananarivo (CENHOSOA) and the Félix Guyon hospital of St. Denis (La Réunion, France), the program consists of bi-annual surgical missions. Volunteer teams of cardiac surgeons, anesthetists and pediatric cardiologists come from La Réunion for consultations and closed-heart surgeries performed in collaboration with the Malagasy medical team of CENHOSOA.
Children diagnosed as needing more complex surgery, including open-heart surgeries, are brought back to La Réunion or metropolitan France for care. More recently, the program has been geared towards strengthening the capacities within CENHOSOA through:
- Empowerment of Malagasy medical teams through refined screening and diagnosis trainings to better determine the treatment for each child.
- Training of the teams in simple cardiac surgeries with an opportunity for growth in the future to more complex surgeries.
- Upgrading equipment in the cardiac surgery operating theaters.
In 2019, USFC intends to continue this progress. Once the CENHOSOA pediatric heart surgery unit has been properly rehabilitated and equipped they will begin open-heart operations and training.