Anger over handling of Madagascar's cholera epidemic

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More than 1100 people have died as result of a cholera epidemic that started almost a year ago in Madagascar, one of the world's poorest countries. As of Feb 29, more than 19,500 cases had been reported in the Indian Ocean island's population of 14·8 million.

But "the death toll is far higher and there are no signs of let-up", said Médecins Sans Frontières (MSF) Swiss section, which last week abandoned its cholera-related operations in Madagascar, alleging that the government was actively hindering its work. More than of a third of Madagascar's cholera-related deaths have been in the past 6 weeks. And the disease is progressing at an alarming rate, with a mortality rate of 8­15%, according to MSF. "Any and all measures taken by the government to control the epidemic have up to this time been unsuccessful", said Thierry Durand, Operations Director of MSF's Swiss office.

But Madagascar's health officials refute MSF's accusations. They allege that MSF behaved in a dictatorial manner by treating Madagascar like a war-torn country unable to handle disease. Health Ministry official, Armand Ralaidovy said: "The worst of epidemic is over and the disease is well under control." But on Feb 28, WHO warned that the severity of the epidemic is likely to worsen at the end of the rainy season, which continues until March or April.

The epidemic started in the Mahajanga province in March 1999, but spread to neighboring Antananarivo and Antsiranana later in the year. Last month, the disease had spread to Toliary.

Source: Ahmad K. Policy and People, The Lancet 355 (9206), 4 March 2000.