Climate Change and Malaria in Madagascar

Madagascar, while only contributing less than 0.01% of annual global carbon emissions,¹ is ranked as the third most vulnerable country to climate related change due to its geographical location.² It is also reported to have among the lowest adaptative capacity to mitigate climate change.³ This unfortunate situation is only worsened when you consider that Madagascar is ranked 151^st on the Human Development Index,⁴ and over 66% of the population is malnourished.⁵ As social vulnerability is directly linked to climate change resilience,³ the Malagasy people are among the most vulnerable people to climate change in the world. 

Risks and Impacts of Climate Change in Madagascar

Madagascar’s geographical vicinity to the equator means it is situated almost entirely in the tropical zone.² Due to this location in the tropical Indian Ocean and the varying altitudes across the island, Madagascar experiences a large range of microclimates,⁶ including thriving rainforests along the east coast, compared to the west which is home to dry deciduous forests, or the south which showcases dry spiny forests.⁷ 

Madagascar is known to experience extreme weather events like cyclones, floods, and droughts; however, these weather events are predicted to intensify with climate change.⁶ The effects of climate change in Madagascar were first reported in 1950 with the first reports of temperatures warming.² However, in 1961 researchers began an in-depth daily analysis of Madagascar’s temperature using 21 observation stations across the island which are still in use today and report detectable anthropogenic influences.⁶ Of the 21 observation stations, 17 of them have reported a statistically significant increase in minimum daily temperatures. The researchers also discovered that the most consistent changes to Madagascar’s climate were due to changes in rainfall during winter and spring along the east coast and throughout central Madagascar.⁶Between 1961 and 2005, rainfall was consistently decreasing every year in both regions and seasons. As a result, Madagascar has experienced an increased number of days where these regions experience prolonged dry spells, followed by episodes of less heavy rainfall and a decrease in the number of days where rainfall exceeds 10mm.⁶ By 2050, the southeast coast is projected to be drier compared to every other region of Madagascar which is projected to be wetter,⁶and by 2030 the average temperature is projected to increase by more than 2 degrees Celsius.²

These results are significant because they have contributed to Madagascar experiencing an increase in droughts and floods. Researchers have reported that in 1981 droughts had impacted over one million people in Madagascar, but in 1988 over 200 deaths had occurred as a result of the droughts.² Furthermore, the World Food Program note that the droughts in Madagascar between 1980 and 2009 had caused widespread crop failures, particularly affecting maize crops which are one of the main food sources for farmers in the southern region of the country.⁸ These crops failures impacted over 230,000 children and worsened the existing food insecurity issues in the country.²

Over the same 30-year period from 1980-2010, Madagascar experienced over 30 significant flood events that have impacted thousands of people and killed hundreds.² However, the most severe flooding events have been caused by cyclones. Between 1990 and 2015, Madagascar recorded over 50 major climate related cyclones, many of which were associated with significant flooding events.⁹ Currently, cyclones and flooding events in Madagascar cost the country an average of US$40-50 million per event.⁹ Some of the worst recorded cyclones in Madagascar were the 2004 cyclones of Gafilo and Elita which affected over one million people, caused over 360 deaths, and an estimated loss to GDP of 2.3%,^9,10 and cyclone Enawo, which affected over half the countries regions and cost approximately US$400 million, which is equal to approximately 4% GDP.⁹ This grim reality is worsened by the knowledge that the destructive force of cyclones is projected to increase steadily over the next century.⁶ 

Despite the crippling economic effects and devastating death toll that Madagascar experiences from climate change induced cyclone and flooding events, cyclones are also responsible for the destruction of crops, especially in regions that have high rates of deforestation.¹¹ Since the 1950’s, Madagascar agricultural sector is responsible for significant deforestation across the country, with a total decrease of almost 40% in forest cover and high land degradation in the remaining forest lands.¹² Cyclones and associated flooding events leave a layer of sand behind that renders plot cultivation futile for the areas that are suitable for farming.¹¹ Furthermore, the heavy rainfall that accompanies cyclones exacerbates soil nutrient depletion that is related to the agricultural slash-and-burn practice typical to Madagascar.¹³

The impacts of climate change in worsening droughts, floods, and cyclones, and in reducing the production of the agricultural sector all have serious implications for the overall health of Madagascar’s people. Reduced agricultural production as a result of climate change events has led to malnutrition and undernourishment in over 1.14 million people, 665,000 of which experienced severe food insecurity.^2,14 Malnutrition is known to increase the susceptibility of the population to diseases, which is already the leading cause of morbidity and mortality in Madagascan adults and children.¹⁵ Currently, over 50% of the diseases recorded in Madagascar are attributed to the effects of climate change, with this rate increasing every year.² The diseases of primary concern in Madagascar are acute respiratory infections, malnutrition, malaria, and diarrhea, all of which are climate sensitive and projected to increase in incidence and severity as the extreme weather events in Madagascar continue to worsen in line with future climate projections.¹⁶ Madagascar’s ability to respond to the worsening health crisis is also reduced with basic health centres and hospital infrastructure being repeatedly damaged during these severe weather events.¹⁷

Madagascar’s Climate Change Mitigation and Adaptation Strategies

Although climate change has been recorded in Madagascar from as early as the year 1950, the first apparent national adaptation strategies were only developed in 2003. Perhaps non-incidentally, this is the same year that Madagascar ratified the Kyoto Protocol.^18,19 The National Strategy for Disaster Risk Management was passed in 2003 with the aim of guaranteeing Madagascar’s people and environment protection from natural disasters and boosting the countries resilience to catastrophic events.²⁰ The main mechanisms to achieve this were through the implementation of preventative warning measures and recovery and reconstruction development assistance. However, currently this strategy is outdated and there is no recent documentation to verify that the organisational structures implemented to support this strategy are still operational.²⁰ Furthermore, current literature notes that there are no warning signals for extreme weather events on the island,²¹ and over 89% of farmers reported that they had to rebuild their own homes after the most recent cyclone.¹⁴ This demonstrates that the original National Strategy for Disaster Risk Management ultimately failed its original purpose. There is however an updated National Disaster Risk Management Strategy that covers 2016-2030,²² whose current success is yet to be documented. 

In 2006, the National Adaptation Program of Action (NAPA) was implemented in Madagascar and financed by the Least Developed Countries Fund, the Adaptation Fund, and the Global Environment Fund.²⁰ Allegedly these funds were financing the implementation of four NAPA projects, however details of these projects are not available in English but do not appear to have progressed past the planning stage.²³ In 2010, the National Climate Change Policy was developed to promote climate change adaptation and mitigation and integrate climate change at every level of government so that climate change is a driving force behind all future decisions.^20,24 The National Action Plan that was developed in 2007 was meant to drive the implementation of the National Climate Change Policy, however further information about the National Action Plan post 2012 is sparse.^11,25 The National Climate Change Policy and National Action Plan were also meant to be integrated with NAPA, yet the Madagascan government never communicated on the relationship between these plans.²⁰ In 2013, Madagascar implemented the 2012-2025 National Strategy to Face Climate Change in Agriculture-Livestock-Fishery which was developed in alignment with the goals of the National Climate Change Policy.²⁰Similarly to the above policies, further details of this policy are not in English and reports of this strategies success are yet to be seen. 

Despite Madagascar’s ratification of the Paris Agreement in 2016,¹⁸ most of the literature relating to legislative climate adaptation and mitigation in Madagascar is outdated, and the ongoing verve of these government initiatives seem to dwindle years before the end of the policy’s implementation lifespan. The most successful climate change initiatives in Madagascar have been those that have been initiated from other global agencies. 

USAID has partnered with Madagascar since 1985, and since 2013 has contributed over $56 million towards programs that improve protection of Madagascar’s natural resources.²⁶ The Conservation and Communities Project (CCP) is the most recent and current ongoing project that is funded by USAID Madagascar.²⁴ The CCP has two flagship activities, one of which is called Hay Tao and is notable due to its community-led approach. Hay Tao is still in progress and so its success cannot yet be commented upon, however this project emulates local laws called a dina which have proven to be successfully in local conservation management in Madagascar previously.²⁷ A dina are an example of a bottom-up adaptation initiative, created, agreed upon, and enforced by local stakeholders in response to climate change.³ The success of a dina and, hopefully, Hay Tao were stimulated by the 1996 implementation of the GELOSE (Gestion Locale Securisé) legislation²⁰ which allowed for decentralised natural resource management and community-led conservation initiatives. 

In February of 2021, Madagascar signed a US$50 million agreement with the World Bank’s Forest Carbon Partnership Facility, whose activities to decrease carbon emissions resulting from deforestation and enhance forest carbon stocks are often referred to as REDD+.²⁸ This agreement was signed under Madagascar’s Emissions Reductions Program that aims to reinforce forest conservation.²⁸ However, in August of 2021, the REDD+ carbon program in Madagascar was halted due to President Andry Rajoelina wanting to nationalise carbon credits, for which a decree is currently in progress.²⁹Despite this, Madagascar is continuing a standard World Bank carbon credit agreement whereby Madagascar will sell 10 million carbon credits at $5 each.²⁹

Madagascar’s use of renewable energy to help mitigate the effects of climate change are also still in progress. Whilst there are reports that the Ministry of Energy was updating the countries energy policy in collaboration with the European Union,²⁰ and a 2018 article from the World Bank that states it granted $65 million in support of reforming the energy sector,³⁰ the only documented Malagasy legislation on renewable energy is the Reform of the National Fund of Electricity (FNE) that set up a National Sustainability Energy Fund to finance renewable energy infrastructure.³¹ 

Although it is apparent that global agencies have had more success in implementing climate change mitigation and adaptation strategies, they too suffer seemingly due to Madagascar’s want for national control. Further attempts to combat climate change in Madagascar should focus on supporting country-led initiatives. 

Climate Change and Malaria in Madagascar

Malaria is one of the leading causes of morbidity and mortality in Madagascar and climate change impacts in Madagascar have created favourable conditions for the multiplication of the malaria transmission vector, mosquitoes.² Malaria is a disease that is vector-borne, meaning that it is transmitted to humans through the bite of a mosquito that carries the disease.^32,33 The female Anopheles mosquitoes is responsible for all cases of malaria transmission to humans, and the female Anopheles mosquito itself acquires the disease if it is infected by Plasmodium parasites.³² There are 5 types of Plasmodium parasites that can cause malaria disease in female Anopheles mosquitoes, of which P. falciparum and P. vivax cause the greatest concern for malaria disease risk.³² P. falciparum is the deadliest malaria parasite and is most prevalent in Africa.³²

Malaria is both treatable and preventable, although it can lead to death if left untreated.³² Once a human becomes infected with malaria, the transmitted malarial parasites multiply and attack red blood cells in the liver, which causes the infected person to experience initial symptoms of headache, fever, chills, and eventually death if malaria is left to progress untreated.³³ In particular, if P. falciparum is left untreated, the infected person is at risk of severe illness and death within 24 hours.³² 

In 2015, malaria prevalence in Madagascar was between 1-15% across the population, and up to 6% for children under 5.³⁴ In 2018, malaria prevalence increased on average to impact over 2.16 million people, or approximately 12.5% of the population, and led to over 5000 deaths.³⁵ Whilst everyone is at risk of contracting malaria in Madagascar due to the high prevalence of Anopheles mosquitoes, persons who are malnourished are at an increased risk of severe illness and death if infected with malaria.² Malnourishment compromises the body’s natural immune system and weakens the ability of a person to fight disease and infection.³⁶ Additionally, some studies suggest that if children under 5 contract malaria, they have a higher risk of becoming malnourished, stunted, and underweight.³⁶ 

There are several factors that impact the prevalence of malaria in Madagascar. Mosquitoes are sensitive to the impacts of climate change, and their ability to reproduce and mature is impacted by temperature changes. Madagascar’s average annual temperatures are projected to increase from roughly 24 degrees to above 30 degrees Celsius this century.¹⁶Unfortunately, in temperatures around 30-32 degrees Celcius, the vectoral capacity of mosquitoes increases substantially because this temperature range reduces the incubation time period for mosquitoes.³⁷ Additionally, global warming is contributing to warmer water temperatures which allows mosquito larvae to mature in shorter periods of time, which allows more mosquitoes the opportunity to produce more larvae, ultimately contributing to larger populations of mosquitoes and higher risks of malaria transmission to Malagasy people.^16,37

Another key climate factor influencing the prevalence of malaria in Madagascar is the increase in incidence of cyclones and flooding events, which are accommodated by heavy rainfall. Heavy rainfall, floods, and cyclones result in large quantities of water being brought onto the island, which often take weeks after the event to clear.³⁸ This is significant because in the immediate days after such a climate event, mosquito larvae that were laid in uninhabitable soil will hatch, creating large populations of Anopheles mosquitoes.³⁸ Additionally, due to the humanitarian and impacts of climate events, people typically spend more time outdoors in the weeks following a natural disaster, which further increases their risk of being bitten and infected with malaria. Lastly, as heavy rainfall, cyclones, and flooding create more breeding sites for the Anopheles mosquitoes who have just matured, compounding the ability of the vector to reproduce and increase the risk of malaria transmission.³⁹ 

Anopheles mosquitoes in Madagascar are most prevalent in the agricultural lands and villages surrounding forested areas, however prevalence slightly decreases for Anopheles mosquitoes in forested areas.⁴⁰ Considering over 63% of the Malagasy population lives in rural areas and farming communities,⁴¹ we can postulate that more than 63% of the country are now at an increased risk of malaria infection due to the ideal climate conditions provided for Anopheles mosquitoes to breed. In fact, a WHO study reiterated that in the next four decades the Malagasy people are at an increased risk of malaria disease,³² and others have estimated that over 46 million people could be at risk of malaria by 2070.¹¹

As previously mentioned, each climate event in Madagascar costs the country an average of US$40-50 million per event,⁹however, the increased risk of malaria is not only a population health issue but also creates a concerning future in regards to increased economic and social burden for the Malagasy people. Today, over 40% of Madagascar’s rural population live more than 5km away from a health facility,¹¹ and less than 15% of farmers own a bicycle as means of transportation.¹⁴ In these instances, assuming that access roads are open and stable, most of Madagascar’s rural population have very limited access to health facilities in the event that they do contract malaria. To exacerbate matters, increased frequency of climate events often causes roads to collapse or become blocked.¹¹ This has the potential of blocking rural access to healthcare altogether, and also impacts the ability for health centres to replenish their medical supplies.¹¹ Furthermore, extreme climate events in Madagascar continually damage homes and farms¹⁴ and have significant mental health effects on the people who survive climate disasters.⁴² These same people now need to find the extra money to repair their homes, worry about increased risk of contracting malaria, and know that even if they could reach health centres, it is likely their stocks are in high demand and replenishments are delayed. 

Combating Malaria in Madagascar

There are a number of activities that Madagascar can undertake to prevent and reduce the burden of malaria resulting from climate impacts. These are presented in order of implementation ease. 

Educate the population on the risks of standing water and symptoms of malaria:

Previous studies have shown a positive correlation between farmers education levels and willingness to adopt agricultural adaptation measures.¹⁴ Farmers primary reason for low uptake of agricultural adaptation practices was due to their concern over impacting already scarce crop quantities.¹⁴ Although education and changing agricultural practices would both help to mitigate and adapt to the impacts of climate change, a smaller impactful initiative should focus on increasing rural populations education on the risks of standing water for malaria and to recognise the symptoms of malaria. Community leaders would be able to share this information during community or council meetings, as most rural farmers do not own a mobile phone.¹⁴ It would be relatively easy for community leaders to access government advice on malaria, and simply minimising the amounts of standing water around farms and having the ability to quickly identify when to seek medical attention to stop malaria progressing to death would decrease both the morbidity and mortality rates of Malaria in Madagascar. Although it is recognised that there are limitations to this approach in the wake of natural disasters, this approach will generally help to mitigate the incidence and impact of malaria.

Provide mosquito nets and larvicide to rural Madagascar: 

The provision of mosquito nets would provide protection against malaria by limiting the ability of an Anopheles mosquito to bite a human and can also help reduce mosquito populations by killing mosquitoes if the bed nets contain chemical agents.⁴³ If the initial cost of acquiring and distributing large quantities of mosquito nets are not feasible, it is recommended that the Madagascan government first concentrate providing mosquito nets to the West Coast region which is currently at the highest risk of malaria infection.⁴⁰ Additionally, there is an opportunity for the Malagasy government to provide larvicide to rural populations to combat the increasing availability of mosquito breeding grounds.⁴⁴ Distribution of larvicide can also be staggered to minimise initial costs by concentrating first in the South East and South West regions of Madagascar, where breeding sites are projected to become more prevalent.⁴⁰

Increase operational collaboration within the Malagasy Government:

The national budget for malaria decreased post the 2009 coup,¹¹ however Madagascar recently received US$89 million in funding to strengthen health systems, including against malaria, from the Global Fund.⁴⁵ It is recommended that the Malagasy government inspire a community-led approach in strengthening its health systems wherever possible and work in close collaboration with the Global Fund during implementation. History has shown that national policies and initiatives have failed due to lack of operational collaboration.²⁰ Maintaining operational collaboration with the Global Fund could be achieved by creating a specific taskforce linked to the Global Fund. Additionally, some of the most successful initiatives in Madagascar have been due to dina,²⁷ and this dedicated taskforce could assist in providing a community-led lens to the Global Fund and encourage the implementation of dina to prevent risk of malaria. 

Invest in partnerships to introduce Wolbachia mosquitoes: 

Wolbachia-based malaria control strategies are a relatively recent discovery. Wolbachia is a naturally occurring bacterium that, when introduced to Anopheles mosquitoes, inhibits the ability of the mosquito to transmit Plasmodium parasites and reduces reproductive capacity of Anopheles mosquitoes.⁴⁶ A Wolbachia-based control approach to vector-borne diseases has proven effective in other countries,⁴⁷ and recent research suggests this approach is a promising opportunity to combat malaria transmission from Anopheles mosquitoes.⁴⁸ It is recommended that the Malagasy government sponsor a field trial for Wolbachia in partnership with local universities. If such research is sponsored in Madagascar, local universities will not only be exposed to novel malaria control strategies, but increase their global university connections, and directly contribute towards reducing the risk of malaria disease. 

Concluding remarks

Whilst Madagascar’s economic position and social capacity limits the country’s ability to directly mitigate climate change and its disastrous effects, there are a number of adaptation initiatives that can be taken to support the Malagasy people fight against the increased risk of malaria disease. As Madagascar is projected to experience climate events (temperature rises, cyclones, floods) that encourage the increase in Anopheles mosquito populations, and consequently malaria risk, it is imperative that Madagascar act swiftly.

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