Miller A.C. auteur aut IRD Ramananjato R.H. auteur aut IRD Garchitorena Andres auteur aut IRD Rabeza V.R. auteur aut IRD Gikic D. auteur aut IRD Cripps A. auteur aut IRD Cordier L. auteur aut IRD Rananiraka Razanadrakato H.T. auteur aut IRD Randriamanambintsoa M. auteur aut IRD Hall L. auteur aut IRD Murray M. auteur aut IRD Safara Razanavololo F. auteur aut IRD Rich M.L. auteur aut IRD Bonds M.H. auteur aut IRD text journalArticle eng text/pdf reformatted digital access Background: A model health district was initiated through a program of health system strengthening (HSS) in Ifanadiana District of southeastern Madagascar in 2014. We report population health indicators prior to initiation of the program. Methods: A representative household survey based on the Demographic Health Survey was conducted using a two-stage cluster sampling design in two strata-the initial program catchment area and the future catchment area. Chi-squared and t-tests were used to compare data by stratum, using appropriate sampling weights. Madagascar data for comparison were taken from a 2013 national study. Results: 1522 households were surveyed, representing 8310 individuals including 1635 women ages 15-49, 1685 men ages 15-59 and 1251 children under age 5. Maternal mortality rates in the district are 1044/100,000. 81% of women's last childbirth deliveries were in the home; only 20% of deliveries were attended by a doctor or nurse/midwife (not different by stratum). 9.3% of women had their first birth by age 15, and 29.5% by age 18. Under-5 mortality rate is high: 145/1000 live births vs. 62/1000 nationally. 34.6% of children received all recommended vaccines by age 12 months (compared to 51.5% in Madagascar overall). In the 2 weeks prior to interview, approximately 28% of children under age 5 had acute respiratory infections of whom 34.7% were taken for care, and 14% of children had diarrhea of whom 56.6% were taken for care. Under-5 mortality, illness, care-seeking and vaccination rates were not significantly different between strata. Conclusions: Indicators of population health and health care-seeking reveal low use of the formal health system, which could benefit from HSS. Data from this survey and from a longitudinal follow-up study will be used to target needed interventions, to assess change in the district and the impact of HSS on individual households and the population of the district. specialized MADAGASCAR 050 10 art. no 1329961 [10 en ligne] 2017 1654-9880 https://www.documentation.ird.fr/hor/fdi:010077250 10.1080/16549716.2017.1329961 1654-9880 [F B010077250] https://www.documentation.ird.fr/hor/fdi:010077250 https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers19-12/010077250.pdf IRD - Base Horizon / Pleins textes 2019-12-18 2023-07-11 fdi:010077250 fre