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Background: Madagascar

Madagascar has a population of approximately 20 million, 17% of whom are children under five years of age. One of the poorest countries in the world, the average per capita income is only $255 (World Bank 2005); 46% of the population is illiterate; 70% of the population lives below the poverty line; and 49% of children under age five are malnourished (DHS 2004).

The most common causes of death among children under five are malaria, diarrheal diseases, respiratory infections often associated with malnutrition. Life expectancy is around 55 years.

 This difficult social and medical situation springs from several factors: a weak health system, poor economic growth, and a high population growth rate of 2.8%, although the last decade has witnessed marked health improvements in Madagascar, especially among children. 

Madagascar has already shown some success in reducing child mortality, though much remains to be done. Iin 2006 there were 58 deaths in the first year of life per 1,000 live births, compared with 98 in 1993 and 74 in 2003, according to the WHO.

"Mothers and children are the most precious members of our society," Madagascar's prime minister, Charles Rabemenanjara, said at the launch of the health week on 20 Octobe 2008r. "Mothers because they are the source of life, and children because they are the future."

In her book Madagascar Travels (ISBN 1590481429) Christina Dodwell explores this exotic tropical country's least accessible corners and makes friends with its people. Her four-month journey began in the highlands where, travelling by horse-drawn stagecoach, she encounters a healer, a village poet and families who perform bone-turning rites for their ancestors.

Christina’s great courage, open mind and unbounded curiosity enable her to go to places few would dare visit, and she almost invariably finds kindness and hospitality wherever she travels.

Taboos, fetishes and astrology weave through her travels among wood-carvers and lead to a royal meeting. Christina paddles her canoe on the south-east coastal rivers and makes plans to enter the capital’s Grand Prix horse race.