Editing Madagascar (section)

===Health===
{{main|Healthcare in Madagascar}}
Medical centers, dispensaries, and hospitals are found throughout the island, although they are concentrated in urban areas and particularly in Antananarivo. Access to medical care remains beyond the reach of many Malagasy, especially in the rural areas, and many recourse to traditional healers.<ref>{{cite journal|last1=Legrip-Randriambelo|first1=Olivia|last2=Regnier|first2=Denis|title=The place of healers-diviners (ombiasa) in Betsileo medical pluralism|journal=Health, Culture and Society|volume=7|issue=1|pages=28–37|url=http://hcs.pitt.edu/ojs/index.php/hcs/article/viewFile/188/219|doi=10.5195/hcs.2014.188|year=2014|doi-access=free|access-date=21 July 2016|archive-date=29 August 2016|archive-url=https://web.archive.org/web/20160829070004/http://hcs.pitt.edu/ojs/index.php/hcs/article/viewFile/188/219|url-status=live}}</ref> In addition to the high expense of medical care relative to the average Malagasy income, the prevalence of trained medical professionals remains extremely low. In 2010, Madagascar had an average of three hospital beds per 10,000 people and a total of 3,150 doctors, 5,661 nurses, 385 community health workers, 175 pharmacists, and 57 dentists for a population of 22&nbsp;million. Fifteen percent of government spending in 2008 was directed toward the health sector. Approximately 70 percent of spending on health was contributed by the government, while 30 percent originated with international donors and other private sources.<ref name=WHO2011/> The government provides at least one basic health center per commune. Private health centers are concentrated within urban areas and particularly those of the central highlands.<ref name=INSTAT/>

Despite these barriers to access, health services have shown a trend toward improvement over the past twenty years. Child immunizations against such diseases as [[hepatitis B]], [[diphtheria]], and [[measles]] increased an average of 60 percent in this period, indicating low but increasing availability of basic medical services and treatments. The Malagasy fertility rate in 2009 was 4.6 children per woman, declining from 6.3 in 1990. Teen pregnancy rates of 14.8 percent in 2011, much higher than the African average, are a contributing factor to rapid population growth.<ref name=WHO2011>{{cite book | title = World Health Statistics 2011 | publisher = World Health Organization | year = 2011 | location = Paris | url = http://www.unfpa.org/sowmy/resources/docs/main_report/en_SOWMR_Full.pdf | isbn = 978-92-4-156419-9 | access-date =21 January 2012| archive-url = https://web.archive.org/web/20111125020623/http://www.who.int/whosis/whostat/EN_WHS2011_Full.pdf | url-status=live | archive-date = 25 November 2011 }}</ref> In 2010, the maternal mortality rate was 440 per 100,000 births, compared to 373.1 in 2008 and 484.4 in 1990, indicating a decline in perinatal care following the 2009 coup. The infant mortality rate in 2011 was 41 per 1,000 births,<ref name=BGNote/> with an under-five mortality rate at 61 per 1,000 births.<ref name="SOWMY">{{cite web|url=http://www.unfpa.org/sowmy/report/home.html|title=The State of the World's Midwifery|publisher=United Nations Population Fund|date= August 2011 |archive-url = https://web.archive.org/web/20111225024306/http://www.unfpa.org/sowmy/report/home.html |access-date =22 January 2012 |url-status=live|archive-date = 25 December 2011 }}</ref> [[Schistosomiasis]], [[malaria]], and sexually transmitted diseases are common in Madagascar, although infection rates of [[HIV/AIDS|AIDS]] remain low relative to many countries in mainland Africa, at 0.2 percent of the adult population. The malaria mortality rate is also among the lowest in Africa at 8.5 deaths per 100,000 people, in part because of the highest frequency use of insecticide treated nets in Africa.<ref name=WHO2011/> Adult life expectancy in 2009 was 63 years for men and 67 years for women.<ref name=WHO2011/>

Madagascar had [[21st century Madagascar plague outbreaks|outbreaks]] of the [[bubonic plague]] and [[pneumonic plague]] in 2017 (2575 cases, 221 deaths) and 2014 (263 confirmed cases, 71 deaths).<ref>{{Cite news |url=https://www.theguardian.com/global-development/2017/oct/19/madagascar-plague-death-toll-reaches-74 |title='It is a dangerous moment': Madagascar plague death toll reaches 74 |first=Peter |last=Beaumont |work=The Guardian |date=19 October 2017 |access-date=21 October 2017 |language=en-GB |archive-date=19 May 2020 |archive-url=https://web.archive.org/web/20200519165330/https://www.theguardian.com/global-development/2017/oct/19/madagascar-plague-death-toll-reaches-74 |url-status=live }}</ref> In 2019, Madagascar had a [[2018 Madagascar measles outbreak|measles outbreak]], resulting in 118,000 cases and 1,688 deaths. In 2020, Madagascar was also affected by the [[COVID-19 pandemic in Madagascar|COVID-19 pandemic]]. Undernourishment and hunger rates were at 42% in 2018.<ref>{{cite report |date=February 2021 |title=WFP Madagascar Country Brief |url=https://docs.wfp.org/api/documents/WFP-0000125015/download/?_ga=2.216094418.577338328.1616525997-700118633.1616525997 |publisher=World Food Programme |access-date=23 March 2021 |archive-date=30 March 2021 |archive-url=https://web.archive.org/web/20210330034436/https://docs.wfp.org/api/documents/WFP-0000125015/download/?_ga=2.216094418.577338328.1616525997-700118633.1616525997 |url-status=live }}</ref> According to the United Nations, more than one million people in southern Madagascar are struggling to get enough to eat,<ref>{{cite web|date=2021-10-21|title=Madagascar: Severe drought could spur world's first climate change famine|url=https://news.un.org/en/story/2021/10/1103712|access-date=2022-02-09|website=UN News|language=en|archive-date=8 February 2022|archive-url=https://web.archive.org/web/20220208102451/https://news.un.org/en/story/2021/10/1103712|url-status=live}}</ref> due to what could become the first [[2021–2022 Madagascar famine|famine]] caused by climate change.<ref>{{cite news |title=How climate change is turning once green Madagascar into a desert |url=https://www.euronews.com/green/2022/03/20/how-climate-change-is-turning-once-green-madagascar-into-a-desert |work=Euronews |date=20 March 2022 |access-date=23 October 2022 |archive-date=23 October 2022 |archive-url=https://web.archive.org/web/20221023215848/https://www.euronews.com/green/2022/03/20/how-climate-change-is-turning-once-green-madagascar-into-a-desert |url-status=live }}</ref>