Strengthening of the Community Health Centre’s (CSBs)

In Madagascar, CSBs are the main point of access to healthcare services. However, due to a lack of funding, the healthcare system is under-resourced and only 60–70% of the population has access to basic primary healthcare [13]. Additionally, there are 86 district hospitals and 18 regional referral hospitals that provide more advanced diagnostic services, but the availability is limited. Healthcare services as well as trained manpower are more accessible in urban areas but are not evenly distributed, leading to limited access and affordability for those in disadvantaged neighbourhoods. There is a lack of trained healthcare staff and equipment resulting in inaccurate diagnoses and poor treatment outcomes, as well as shortage of medicine at healthcare centre’s [14]. Voluntary training of local leaders, healthcare providers as well as encouraging and sensitising them to actively participate and provide services in rural areas can significantly bring down the number of cases through early diagnosis and treatment.

Robust vector, reservoir and pest control

Rodent populations and distribution may rise as a result of agricultural practises, deforestation, and wildfires, with a particular influence on migrants who are farming new acreage and are residing in substandard circumstances [9]. Low-income and marginalised people in Madagascar are disproportionately impacted by the illness and much more prone to come into encounter with rodents and fleas. The underlying socioeconomic causes of the plague’s spread must be taken into account for effective control methods. This entails tackling problems at the household and societal levels, such as poverty, subpar housing, and poor sanitation. Additionally, methods for reducing human-rodent interaction should be devised, such as secure food and granary storage and preventing animals from entering inhabited areas.

Need for diversified animal surveillance and disease monitoring

The National Plague Control Program (NPCP) carries out regular monitoring for plague in human populations, examining all reported cases deemed suspicious. However, no corresponding program for monitoring plague in animals is in place. Studies have shown that small mammal species Suncus murinus, an invasive shrew species which does not develop plague disease, is a known reservoir of Yersinia pestis [7]. A 3-month-old domestic dog from the village of Ampanalana, which is located near a former plague quarantine hospital (Lazaret) in Toamasina, showed the presence of antibodies for Yersinia pestis infection. However, there is no evidence that the dog had developed symptoms of plague [15]. Emphasizes the possibility of utilizing animal surveillance to detect the potential transmission of plague in both endemic and non-endemic areas, for the purpose of targeted prevention and control measures.

Need to address the research lacunae regarding the plague

There exist several scarcities in the literature that need to be addressed to gain a more comprehensive understanding of crucial contextual elements and to enhance the efficacy of community involvement and communication strategies pertaining to plague in Madagascar. It is imperative to investigate the healthcare seeking behaviour and the impact of funeral and burial customs on the transmission of plague. So that co-creative policies can be made keeping in mind the customary believes but also tracks the preparedness for outbreaks, which includes examination of protocols for body handling, initial interment, and practices that are deemed appropriate by the community.

Need to implement One Health concept (OHC) for effectively managing the plague

Zoonotic diseases collectively have a significant impact on livestock production, food security, livelihoods, and environmental conservation. The broad-reaching effects and the interconnectedness of human, animal, and environmental health make it crucial for public health systems to employ a multi-disciplinary “One Health” approach that fosters coordination in order to better understand and manage the risks associated with these diseases.

Importance of OHC (i)

The reduction of catastrophe risk, the mitigation of antibiotic resistance, and the improvement of outbreak preparation planning may all be achieved through a “One Health” strategy. It can also enhance the assessment of sensitivity to the effects of climate change.

(ii)

Early involvement of all stakeholders improves project success by promoting shared understanding, joint solutions, risk anticipation, gap addressing, redundancy reduction, and relevant coordination.

(iii)

Consistent and effective communication, risk management, greater efficiency, and credibility maintenance during disease occurrences are ensured by good planning and strong collaboration across sectors.