Public health challenges in Madagascar: Trends in the 25 most common diseases across 22 regions from 2015 to 2024

This study aims to provide an overview of the 25 most commonly encountered diseases in district reference hospitals (CHRD) across Madagascar's 22 regions from 2015 to 2024, with the goal of better guiding public health policies and improving healthcare delivery. The originality of this study lies in the use of aggregated clinical data from the Health Information System (HIS), centralized through the DHIS2 platform, and validated by data committees at multiple levels (services, hospitals, districts). The methodology relies on the analysis of data collected from CHRDs, gathered both manually and digitally, and validated at different hierarchical levels before being centralized in DHIS2. The geographic and socio-demographic profile of Madagascar, the health pyramid, and the data collection and validation mechanisms are also considered to contextualize the results. Preliminary analyses reveal that the most recurrent diseases include malaria, acute respiratory infections, diarrheal diseases, tuberculosis, and severe malnutrition, with significant regional disparities. For instance, the fatality rate for severe malaria remains high (6%), while neonatal mortality stands at 26‰. Consultation rates remain low (37.2% in 2022), especially in rural areas. This study highlights the weaknesses of the Malagasy healthcare system, particularly in terms of prevention and healthcare coverage. It suggests the need for better resource allocation, strengthening regional health infrastructure, and rigorous data monitoring to support Universal Health Coverage (UHC).