Madagascar's Anemia Crisis: New Data Reveals Scale of Health Threat to Millions

Madagascar carries one of the world’s heaviest anemia burdens, and for years the country lacked the precise data needed to fight it effectively. That gap has now closed, at least in part, thanks to a sweeping national survey conducted in 2024 that examined the health profiles of approximately 8,000 women and children across the country.

The stakes for ordinary Madagascans are immediate. Anemia, a deficiency in hemoglobin, the protein that carries oxygen through red blood cells, causes intense fatigue, dizziness, and headaches. In young children, severe cases can impair cognitive and motor development, with consequences that follow them for life. Globally, the condition affects roughly half a billion women of reproductive age and approximately 269 million children under five, according to the World Health Organization.

The 2024 survey, whose findings were published in June in The Lancet Regional Health - Africa, was built on a North-South research partnership that brought together Madagascar’s Ministry of Public Health and national institutions alongside the Institute of Research for Development (IRD), the Swiss public health organization GroundWork, and UNICEF, which provided technical and financial support. The investigation examined vitamin levels, micronutrient status, malaria prevalence, and dietary patterns, among other indicators.

What the data revealed is a disease with many faces. Iron deficiency remains the leading cause overall, accounting for 17 percent of anemia cases among young children and 23 percent among women of reproductive age. But those national averages obscure sharp regional divides. In central Madagascar, iron and vitamin A deficiencies explain virtually all severe childhood anemia cases. In the south, malaria and inflammatory conditions drive the disease. Similar disparities appear among different groups of women, depending on age and menstrual status.

Frank Wieringa, research director at the IRD and a physician specializing in malnutrition in developing countries, put the complexity plainly: iron deficiency is only one possible cause among many. Blood loss, inflammation that suppresses red blood cell production, genetic disorders, and malaria can all trigger the condition. He pointed to a 2014 national survey in Cambodia, where anemia rates reached approximately 40 percent among women and children despite iron deficiency affecting only 5 to 10 percent of the population. Genetic factors turned out to be the primary driver there, a finding that reshaped the country’s response entirely.

To make sense of Madagascar’s own data, researchers used a statistical tool called population attributable fraction, which calculates what share of anemia cases in each group and region could be prevented by eliminating specific risk factors. The method does not just identify causes; it maps where each cause predominates and in whom, giving policymakers a practical guide for targeting interventions.

Zeinab Annan, a UNICEF Madagascar consultant who coordinated the survey’s data analysis, described how the partnership took shape from 2021 onward, with partners establishing roles, selecting target populations, and agreeing on biomarkers before the 2024 fieldwork began. The resulting dataset now underpins multiple scientific publications addressing calcium deficiency, iodine deficiency, and anemia as separate threads of the same public health challenge.

By contrast, the path from data to policy is rarely swift. Following Cambodia’s 2014 findings, authorities introduced prenatal supplements enriched with 14 vitamins and minerals in several regions and identified problems with iodine supplementation in salt supplies. Those adjustments took years to implement fully. Madagascar faces a similar timeline.

Miary Toky H. Rajoelina, director of the Family Health Department at Madagascar’s Ministry of Public Health, announced plans to develop a national anemia control strategy grounded in the survey results. The ministry has secured preliminary approval from the WHO and is awaiting a new funding cycle. In the meantime, existing interventions will be reinforced. Rajoelina noted that iron supplementation for children and adolescents deserves greater emphasis than current food policies provide, a gap the 2024 survey made impossible to ignore. Dietary questions will receive particular attention in Antananarivo, where nutritional deficiencies appear concentrated, possibly reflecting urban eating patterns that combine more processed foods with greater dietary variety.

Both Rajoelina and Wieringa stressed the value of sustained North-South partnerships, especially among francophone nations, in generating the kind of precise, regionally specific data that health policy actually requires. The collaboration that produced this survey has itself become a model worth examining. Whether Madagascar can move from diagnosis to scaled intervention before the next funding cycle closes is the question that now hangs over the work.