Crise économique et mortalité. Le cas d'Antananarivo 1976-2000

In the past forty years, Madagascar?s GDP has shrunk more than 30%. The almost continuous deterioration in living conditions has been marked by extremely severe economic crises, most notably in the mid-1980s. Analysis of death registers in the capital, Antananarivo, provides a means to track changes in mortality and main causes of death since 1976. In the past twenty-five years, the rise in poverty has substantially counteracted the positive effects of preventive health initiatives: it has triggered the emergence of diseases thought to have been eradicated several decades ago (tuberculosis, malaria, cholera) in population groups hitherto regarded as less vulnerable (young adult males). The 1986 crisis had the most dramatic impact, particularly among children aged 1-4. The political and economic choices made at the time plunged the country into a state of nutritional deficiency so severe that, within one decade, more than ten years of life expectancy at birth were lost. Progress has been achieved in recent years and life expectancy has very recently returned to its mid-1970s levels. While the levels are comparable, the distribution of causes of death has been significantly modified. The share of acute and infantile diseases has fallen, whereas that of chronic diseases has risen. Madagascar?s health outlook remains very uncertain however. In the current economic and political climate, it is by no means certain that the fragile decline in infectious mortality will be maintained and the rise of new pathologies kept in check.