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Online dating south africa in antananarivo madagascar

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Madagascar today has one of the highest life expectancies in sub-Saharan Africa, despite being among the poorest countries in the continent. There are relatively few detailed accounts of the epidemiological transition in this country due to the lack of a comprehensive death registration system at the national level. Online dating south africa in antananarivo madagascar provide an overview of trends in all-cause and cause-specific mortality Online dating south africa in antananarivo madagascar Antananarivo to document the timing and pace of the mortality decline and the changes in the cause-of-death structure.

Death registers covering the period — were digitized and the population at risk of dying was estimated from available censuses and surveys. Trends for the period — were partly reconstructed from published sources. Over the past 30 years, impressive gains in life expectancy have been registered thanks to the unabated decline in child mortality, despite political instability, a lasting economic crisis and the persistence of high rates of chronic malnutrition.

Progress in adult survival has been more modest because reductions in infectious diseases and diseases of the respiratory system have been partly offset by increases in cardiovascular diseases, neoplasms, and other Online dating south africa in antananarivo madagascar, particularly at age 50 years and over. The transition in Antananarivo has been protracted and largely dependent on anti-microbial and anti-parasitic medicine.

The capital city now faces a double burden of communicable and non-communicable diseases. The ongoing registration of deaths in the capital generates a unique database to evaluate the performance of the health system and measure intervention impacts.

The theoretical Online dating south africa in antananarivo madagascar of the epidemiological transition describes a long-term shift from a regime of high and fluctuant mortality, dominated by infectious diseases, to a regime of low mortality where deaths are predominantly due to non-communicable diseases NCDs linked with population aging and changes in lifestyles such as increasing fat and calorie consumption, decreasing exercise, and tobacco use 1.

In western countries, there has been considerable debate over the chronology of this transition and the contribution of better nutrition, rises in living standards and advances in medical science to the decline in mortality 23.

The relevance of this model for Latin America and Asia has also been widely debated 4 — 7. In SSA, the epidemiological transition started only after the World War II, Online dating south africa in antananarivo madagascar thanks to public health measures that were internationally supported It has progressed at a much slower pace than in other developing regions.

For instance, although life expectancy was around 36 years in SSA and India in —, it had reached 65 years in India in —, against only 53 in SSA Over the past 30—40 years, child mortality has declined dramatically in most African countries, but conspicuous stalls were observed in the s and early s.

These setbacks were related to the HIV epidemic, temporary declines in immunization rates Online dating south africa in antananarivo madagascar upsurges "Online dating south africa in antananarivo madagascar" malaria-related mortality Declines in child mortality have not been matched by sustained improvements in adult survival either. Since the s, most countries in eastern and southern Africa have witnessed enormous surges in adult mortality because of AIDS.

Progress in adult survival has been limited even in countries whose HIV epidemics have been small. Madagascar is an exception in this regard, because adult and child mortality rates have evolved in concert toward a regime of low mortality, as they have in Ethiopia or Senegal.

According to estimates from the Demographic and Health Surveys DHSthe probability that a newborn would die before reaching age 5 5 q 0 in Madagascar was 0. The probability that a person aged 15 would die before reaching age 60 45 q 15 was around 0. As a result, no country in SSA had a higher life expectancy than Madagascar during the period — 62 yearsexcept for small islands such as Cape Verde and Mauritius This disconnection between health and economic progress calls for a detailed examination of the epidemiological transition occurring in Madagascar.

Although this low coverage is a feature of most countries in SSA, the vital registration system is atypical in Madagascar because it was established relatively early, inby the Merina Kingdom, which ruled over most of the island at that time. The system only covered areas controlled by this Kingdom, however, and also did not include the slave population.

The French colonial administration officially abolished slavery in and enforced vital registration throughout the island.

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Vital registration offices were set up in all districts, and Antananarivo, the capital city, was considered an administrative unit on its own, with its own offices Since then, the coverage of death registers has always been very high in the city, in contrast to other parts of the country.

In this paper, we take advantage of this wealth of data and describe the epidemiological transition that occurred in city over the period — We first provide some historical background and introduce our data sources and our methods, and then we explore the changes in patterns of mortality by age groups and cause. Antananarivo, formerly known as Tananarive, is located in the central highlands of Madagascar at an altitude of 1,—1, m.

It is spread across 90 km 2. Epidemics were frequent; Antananarivo Online dating south africa in antananarivo madagascar hit by smallpox epidemics in — and —, a flu epidemic in and "Online dating south africa in antananarivo madagascar" typhoid epidemic in 17 The incidence of infectious diseases apparently increased when the Merina Kingdom reinforced its coercive policies from the s. Massive movements of units of forced labor contributed to the spread of malaria over the central highlands inin conjunction with the resettlement in the valleys of populations that previously lived in fortified centers located over the hills.

After the French takeover, the colonial administration acted quickly to implement measures to increase the health of the indigenous workforce and promote population growth.

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Online dating south africa in antananarivo madagascarthe city had a hospital and a medical school to train local doctors and midwives. The Indigenous Medical Assistance was established the following year and provided health care to the population free of charge.

A Pasteur Institute was founded in to produce locally the treatment for rabies and the smallpox vaccine. Routine immunization campaigns were organized and smallpox was considered well controlled in Unfortunately, these measures were partly offset by the expansion of malaria. This is apparent Online dating south africa in antananarivo madagascar the mortality data routinely collected in Antananarivo that we describe below.

This expansion of malaria was linked to a broad set of factors, including large movements of population induced by infrastructure projects, changes in the methods used for rice cultivation rice plants were no longer dried out after Online dating south africa in antananarivo madagascar harvestand the settlement of some populations closer to the rice fields The French administration established quinine depots, but malaria nonetheless became endemic in the central highlands.

The colonial administration also developed the city by clearing some marshland, setting up a public lighting system in and installing the first standpipes in The BMH worked under the supervision of the mayor to deliver free consultations, conduct immunization campaigns, provide malaria prophylaxis, and isolate patients affected by highly infectious diseases such as the plague.

The plague reached Antananarivo inand up to deaths were reported in when the city had 73, inhabitants. The introduction of sulfonamides and streptomycin helped reduce the incidence of the plague and no human cases were notified between andwhen it reemerged in the city.

Penicillin and other antibiotics were introduced in Antananarivo in the late s and early s, but little is known on the timing of their dissemination and their use in medical facilities. The importance of chloroquine in the fight against malaria is more documented Beginning inthe BMH launched a massive anti-malaria program, based on the indoor spraying of DDT and chemoprophylaxis administered on a weekly basis to school-age children and preschoolers.

Malaria was considered under control in the central highlands inwhen Madagascar gained its independence, and the DDT spraying was ceased. The Expanded Program of Immunization EPI was launched instarting with diphtheria, tetanus, pertussis, and tuberculosis. The polio vaccine was included in the immunization schedule in and the measles vaccine in The beneficial effects of these programs were stymied by a major economic crisis that began as early as GNI per capita then began a steep decline that lasted until the mids Fig.

The shift toward economic insularity under the socialist-Marxist regime of Didier Ratsiraka — contributed to this disastrous situation. The regime took control over Online dating south africa in antananarivo madagascar agricultural production and marketing system and nationalized foreign-owned trading and industrial companies.

The import trade was also put under state control. The price paid to rice producers fell and many smallholders withdrew Online dating south africa in antananarivo madagascar subsistence farming.

Inrice had to be imported to feed the population, despite Madagascar having been a net exporter of rice 5 years earlier. Inthe country removed subsidies on rice and started to implement a series of structural adjustment programs.

Rice imports remained controlled by the state untileven though controls Online dating south africa in antananarivo madagascar the prices paid by the consumers had been lifted.

A parallel market blossomed, where rice was sold at about twice the price of the state-controlled market To make things worse, malaria resurged in Antananarivo inat a time when many treatment and prophylaxis centers had closed after their funding was cutoff by the central administration The resumption of chemoprophylaxis with chloroquine in and the reintroduction of indoor DDT spraying in —95 brought malaria back under control.

Today, cases of autochthonous malaria are very rare in Antananarivo, but seroprevalence remains high because inhabitants come into contact with the parasite while travelling outside the city Madagascar was forced Online dating south africa in antananarivo madagascar introduce a series of structural reforms and move away from state intervention in the late s.

Didier Ratsiraka lost the elections in but he was voted back into power in and he moved further toward economic and financial liberalization. The economic recovery was short lived as a controversy over the presidential election gave rise to violent clashes Online dating south africa in antananarivo madagascar and resulted in a 6-month standoff.

GNI per capita plunged, rose again but dropped in when the president Ravalomanana was ousted from power during a coup Fig. Restrictions on aid from foreign governments and other donors, which resulted in severe cuts in public spending, followed this unconstitutional change of power.

The economic decline and the recurrent political instability have not prevented Madagascar from achieving significant health improvements.

Other Antananarivo Cities:

Empirical evidence from four DHS surveys indicate both the substantial decline in under-five mortality in Madagascar over the past three decades, and a consistent advantage of Antananarivo over rural areas and other cities Table 1 25 — This urban advantage has been observed in several African countries from the 19th century, because of higher incomes, higher education levels, and a disproportionate provision of modern sanitation and health care 29 Under-five mortality rates for the year period preceding each DHS survey conducted in Madagascar, according Online dating south africa in antananarivo madagascar type of place of residence.

In the case of Antananarivo, the lower Online dating south africa in antananarivo madagascar rates can be attributed to a variety of advantages. The capital has benefitted from a favorable location with a lower prevalence of malaria than in endemic coastal areas, although the region has been prone to epidemics.

The city is better equipped with health facilities compared to the rest of the country; it has three university teaching hospitals that correspond to the highest level of the health delivery system.

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In addition, large differences are found in educational attainment: These differences are a remnant of the early establishment of the school system in the central highlands by the Merina Kingdom. Our assessment of the epidemiological transition in Antananarivo is based on three types of data sources: We accessed the reports for the period — They provide a breakdown of deaths by age, sex and cause, but without cross-tabulation.

From this first type of data source, we will only extract the ranking of categories of causes of deaths and estimates of the crude mortality rate CDR.

Second, starting inthe BMH took over responsibility for the registration of deaths in the city and for regular reporting on mortality. Some published estimates of the CDR are available for the years — Third, all death registers maintained at the BMH for the period — were digitized, that is, aboutrecords.

For deaths occurring in hospitals or clinics, the reports are filled in by the medical personnel and transmitted to the BMH by the relatives. A high coverage Online dating south africa in antananarivo madagascar deaths is maintained because cemeteries are guarded and reporting the death at the BMH is required to obtain a burial permit or to move the corpse.

Based on data for the period —, Waltisperger et al. For this analysis, we retained only the deaths of residents of Antananarivo. The same physician was in charge of recoding all deaths that had not been previously coded in hospitals or clinics. Causes were later consolidated into seven broad categories: The complete list of corresponding ICD-9 codes is provided elsewhere Sincethe percentage of deaths whose cause was unknown or ill-defined including senility has ranged from 7.

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Changes in the rankings of the leading causes of deaths — To investigate changes in the cause-of-death structure, we distinguish three periods: Substantial changes in health and disease patterns occurred only from the s.

This decline continued until the end of the s, with the CDR reaching 8. The system only covered areas controlled by this Kingdom, however, and also did not include the slave population. Finally, we detail changes in the standardized mortality rates by causes — and estimate the contribution of age groups and causes of deaths to changes in life expectancy, based on the algorithm developed by Andreev et al.

The percentage of children aged less than 5 years with moderate and severe stunting was However, the steep decline in the proportion of deaths due to pneumonia, bronchitis, influenza and tuberculosis between the years — and — indicates that they played a significant role.

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