Jointly conducted by UGB and IRD [Île-de-France], this research highlights the dynamics of infectious diseases in Madagascar.
Jean Marius Rakotondramanga, researcher at UMMISCO; MIVEGEC (Université Gaston Berger de Saint-Louis Sénégal).
Thesis defended in 2023 at the doctoral school École doctorale Pierre Louis de santé publique : épidémiologie et sciences de l'information biomédicale (Paris ; 2000-....).
This research is the result of an international co-supervision between several partner institutions.
Referenced in the ABES/STAR network, this thesis meets the rigorous criteria of French higher education.
In Madagascar, infectious diseases, notably malaria and COVID-19, pose major challenges for public health. These diseases not only affect individual health but also have profound repercussions on the healthcare system, the economy, and social well-being. The COVID-19 pandemic has exacerbated an already critical situation, testing epidemiological surveillance systems and disease control programs. The figures speak for themselves: between 2015 and 2020, malaria cases increased alarmingly, and deaths related to this disease also saw a significant rise. This thesis by Jean Marius Rakotondramanga, defended at the Université Gaston Berger de Saint-Louis, aims to analyze these dynamics through biostatistical and biomathematical modeling approaches, thus offering a scientific perspective on crucial public health issues.
The author conducted in-depth studies, including an analysis of exposure factors to malaria in the highlands of Madagascar, using data from a randomized study involving 6,293 children. This approach allows for the identification of the most vulnerable groups and more effective targeting of interventions. At the same time, he assessed the impact of COVID-19 in Antananarivo based on 45,959 death records. These works highlight the crucial importance of disaggregated data and optimal surveillance systems to improve infectious disease control programs.
The results of this research raise several essential questions. How can policymakers use this data to strengthen public health systems? What strategies should be implemented to avoid a new health crisis? Non-pharmaceutical interventions, while necessary during the pandemic, had unintended consequences on the fight against malaria, leading to millions of additional cases. For example, lockdown measures and social distancing disrupted malaria prevention campaigns, such as the distribution of treated mosquito nets and preventive treatments. This underscores the need for an integrated and coordinated approach to managing infectious diseases, where each intervention is carefully planned to avoid undesirable side effects.
It is imperative that policymakers take these spatio-temporal dynamics into account when developing public health policies. Surveillance systems must be strengthened to enable a rapid and effective response to epidemics. This involves not only collecting accurate and up-to-date data but also training health personnel in the analysis and interpretation of this data. Data should be used not only to understand current trends but also to anticipate future health threats.
Collaboration between research institutions and health authorities is essential to implement sustainable solutions tailored to local realities. For example, partnerships between universities, NGOs, and governments can facilitate the sharing of knowledge and resources, thus enabling a collective response to the challenges posed by infectious diseases. Furthermore, it is crucial to involve local communities in the design and execution of health programs, as their participation can improve adherence to interventions and ensure that they meet their specific needs.
Finally, epidemiological modeling, such as that proposed by Rakotondramanga, offers a valuable tool for predicting the evolution of epidemics and assessing the potential impact of different interventions. By integrating environmental, social, and economic data, these models can provide realistic scenarios that help policymakers plan effective responses. In summary, the fight against malaria and COVID-19 in Madagascar requires a multidimensional approach, where science, policy, and community converge to build a healthier future.
Key Facts
- 211 millions à 234 millions : augmentation des cas de paludisme entre 2015 et 2020
- 542 000 à 593 000 : hausse des décès liés au paludisme sur la même période
- 13,4 millions : cas supplémentaires de paludisme signalés entre 2020 et 2021 en raison des interventions liées au COVID-19
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Sources and Access
Jean Marius Rakotondramanga. Modélisation épidémiologique de la dynamique spatio-temporelle des maladies infectieuses à Madagascar : cas du paludisme et du COVID-19. Santé publique et épidémiologie. Sorbonne Université, 2023. Français. ⟨NNT : 2023SORUS615⟩. ⟨tel-04606499⟩