Malaria is a major public health problem in Madagascar where it is endemic in approximately 90% of the country. But, the entire population is considered to be at risk for the disease. Measures to control malaria in Madagascar are being scaled up thanks to the increased funding from multiple sources. It is essential that the National Malaria Control Programme and Roll Back Malaria Partners closely monitor the trends in malaria morbidity and mortality and evaluate the coverage and impact of interventions. Moreover, with the Madagascar National Strategy for Malaria Control, 2008-2012, has been designed with the goal of moving the country towards malaria pre-elimination and eventually elimination. High quality, effective and prompt surveillance is needed to monitor progress towards these goals. The epidemiology of malaria, intervention strategies and health sector development vary considerably among geographical regions of Madagascar. In 2007 an integrated fever sentinel surveillance system was begun in 13 initial geographically distinct sites and expanded yearly to a total of 31 operational sites as of January 2011. The surveillance system sites were chosen based on various criteria including diversity in terms of malaria epidemiology and malaria intervention coverage in order to track RBM indicators in various settings. The sentinel surveillance network currently reports daily febrile disease surveillance information using clinical case definitions and standard reporting methodology (ref. Randrianasolo et al). Since it's inception, data from the sentinel surveillance system have been used to regularly monitor disease trends and have identified several outbreaks in a timely manner, including chikungunya, rift valley fever and malaria. Since calendar year 2009, the President's Malaria Initiative (PMI), has supported the initial 13 sentinel surveillance sites and in 2010 began supporting 2 additional sites bringing the total to 15 total sites supported by PMI. In March 2010, PMI conducted a quality assessment of the IPM's fever sentinel site network to evaluate the quality and periodicity of data collected, to assess how the data is used in country by the MoH and partners and to assess the overall management of the system. Reported malaria cases and deaths through the national HMIS system have shown decreasing trends in morbidity and mortality between 2003 and 2009. Overall, hospital deaths attributed to malaria decreased from 17% in 2003 to 6% in 2009 (National Malaria Control Program, April, 2010). In 2009, malaria was responsible for an estimated 4% of all reported outpatient visits and 14% of all children under five years of age admitted to a hospital were diagnosed with severe malaria (INSTAT, 2010). In spite of this, malaria remains a leading cause of under-five mortality and, according to UNICEF, kills approximately 20,000 Malagasy children every year. Unfortunately, as in many countries, especially in Africa, the quality and reliability of information generated by the routine health information system is poor and the health information system rarely provides information on the burden of malaria at the community level (ref : REMMEJHF et al). The only option for monitoring trends in malaria mortality in Africa may be through demographic surveillance systems in specific sites. Fortunately such demographic surveillance system is just beginning in the district of Moramanga. The objectives of this work include: 1. Identify the burden and monitor trends of malaria in Madagascar through sentinel surveillance, network 2. Identify entomological activities and methodologies to link entomological data with human malaria case data in order to more accurately monitor the progress of the malaria control program. 3. Evaluate malaria program activities especially but not limited to assessing the effectiveness of integrated community case management in reducing malaria associated morbidity and mortality.
