Understanding inequities in the malaria landscape of Madagascar: a scoping review of current evidence

BACKGROUND: Malaria remains a significant public health challenge in Madagascar, affecting vulnerable populations including children under five and pregnant women. Despite global progress in reducing malaria cases and deaths, Madagascar continues to experience a high burden due to inequities in access to prevention, diagnosis, and treatment. METHODS: A comprehensive literature review was conducted using major academic databases including PubMed, Web of Science, and Google Scholar. A comprehensive search of literature was conducted in PubMed, Web of Science, Google Scholar, and EBSCOhost. The search focused on studies published between 2015 and 2024, supplemented by online reports. The literature was assessed for quality and relevance to malaria prevention, diagnosis, treatment interventions, and socioeconomic factors in Madagascar. RESULTS: Disparities in malaria prevention and treatment between urban and rural areas are evident, with remote regions experiencing a higher disease burden. Geographic diversity leads to varied transmission patterns, necessitating region-specific interventions. Rural healthcare infrastructure is insufficient for timely diagnosis and treatment. Key interventions include insecticide-treated nets (ITNs), indoor residual spraying (IRS), and seasonal malaria chemoprevention (SMC). Case management primarily uses Artemisinin-based Combination Therapies (ACTs) and rapid diagnostic tests (RDTs). Social and behavior change communication (SBCC) has improved awareness but faces cultural barriers. SMC has shown promise, though logistical challenges remain. Drug resistance and diagnostic failures, along with socioeconomic inequalities, hinder effective malaria control. CONCLUSION: To reduce malaria's burden in Madagascar, strengthening healthcare systems, improving supply chains, and expanding prevention efforts in underserved areas are critical. Recommendations include targeting vulnerable groups, enhancing healthcare access, and fostering international collaboration for resource allocation and equitable intervention access. Strategies should emphasize scaling up IRS, ITNs distribution, and SBCC to effectively combat malaria.