HEALTH PROMOTION IN

MADAGASCAR
Lindsay Johnson, Andrea
Crapsey,
Katie Helms, Charissa Deur

Get to know Madagascar

Total Population = 22,925,000
Languages are Malagasy and French
Average life expectancy for Males=62 and for Females=65
The legal drinking age is 16
Major health risk factors include Alcohol and Tobacco
Majority of the country earns a very low income
Top 4 noncommunicable diseases are cardiovascular

disease, cancer, chronic respiratory disease, and diabetes

Prevalent diseases are Yellow Fever and Malaria
Unsanitary water consumption is a problem for children

HEALTH PROBLEMS IN
MADAGASCAR

Contaminated Water
Diarrhea
Malaria
Alcohol/Tobacco Use

CONTAMINATED WATER
10.9 million people in Madagascar dont have access to

safe water Nursing Diagnosis:

The people of Madagascar are at risk for

contamination related to chemical contamination of

water, poor personal hygiene practices, and playing
outdoors where environmental contaminants are used;
as evidenced by the amount of people without
adequate, clean water and the mortality rate of
children who die from diarrhea.
Nursing Outcome:
Within one year, community will reduce negative

health associated effects by 50%.

NURSING INTERVENTIONS
Teach and utilize appropriate universal precautions

hand washing for children.

Contact a program to teach adult community members

how to properly clean water for cooking and drinking

purposes.
Teach signs and symptoms associated with contamination

due to ingesting contaminated water.

TEACHING
Ingesting contaminated water can lead to many diseases

including intestinal worms, chronic diarrhea, cholera,

malaria, and typhoid
Signs and symptoms include diarrhea, cramps, nausea,

and possibly jaundice, and any associated headaches and

fatigue
https://www.youtube.com/watch?v=zxlQn7KaCNU
https://www.pinterest.com/pin/505388389409232096/
http://www.oici.org/programs/clean-water-sanitation/

DIARRHEA
Nursing Diagnoses:
The people of Madagascar area at risk for deficient fluid volume as

evidenced by excessive loss of fluids in liquid stools.

Treatment consists of restoring fluid volume and correcting any electrolyte
imbalances.
Elderly patients are more likely to develop fluid imbalances
Defining Characteristics:
Decreased urine output
Output is greater than the intake
Thirst
Decreased skin turgor
Weakness
Weight gain is possible
Over 4,000 children die each year from diarrhea caused by unsafe water

NURSING INTERVENTIONS
Observe for symptoms of:

Dry tongue

Dry mucous membranes

Longitudinal tongue furrows

Actions by the health care provider:

Get daily weights of the patient

Watch for any sudden decreases in weight

Observe carefully for a sudden decrease of urine output or signs of

active fluid loss

OUTCOMES
Patient experiences adequate fluid volume and

electrolyte balance as evidenced by urine output of >30

ml per hour

Normative BP, HR, consistency in weight, and normal skin turgor

In six months be able to explain measures that can be

taken to treat or prevent fluid volume loss.

In one year be able to describe symptoms that indicate

the need to consult with health care provider.

TEACHING
Teach causes of fluid loss

Parent education

Explain and reinforce rationale and intended treatment

plan
Explain the importance of maintaining proper nutrition
Teach interventions to prevent future episodes of

inadequate intake:

Importance of drinking clean water, and how to obtain clean water

Increase their intake of fluid when diarrhea, fever, or other

conditions occur that cause fluid loss

MALARIA
Malaria is a mosquito-borne infectious disease of humans

and animals caused by parasitic protozoans.

Symptoms include fever, fatigue, vomiting, and

headaches. In severe cases, it can cause yellowing of the

skin, seizures, coma, or death.
Nursing Diagnosis: The people of Madagascar have a

readiness for enhanced immunization status as

evidenced by the large number of the population who are
affected with malaria, related to the desire to enhance
behavior to prevent infectious disease and express desire
to enhance knowledge of immunization standards.

NURSING INTERVENTIONS
Assess cultural or religious beliefs that may relate to

either the decision-making process.

Employ culturally sensitive educational strategies to

maximize the individual, family, or community response.

Assess barriers to immunizations, such as, anxiety related

to immunization side effects.

OUTCOMES
Patient will ask questions about the benefits and risks of

immunizations prior to scheduled immunizations.

Provide evidence of an understanding of the benefits of

community immunizations during peak infectious disease

seasons.

TEACHING
Main target: Adults
It is important for the people of Madagascar to know how severe

Malaria can be. It is widely spread throughout third world

countries and it is important for them to take all the precautions
necessary to keep the disease away.
If immunizations are against their cultural or religious beliefs,

then we will teach them about secondary precautions such as,

covering their skin as much as possible, especially at nighttime.
Children can sleep under mosquito nets to keep them away.

ALCOHOL AND TOBACCO

Legal drinking age in Madagascar = 16 years old - BAC =

0.08%
Children as young as 12 years old drink frequently
14.3% of the population are considered heavy drinkers
Tobacco is one of the main crops in Madagascar easy to

grow
Smoking is allowed everywhere, except healthcare

facilities
Nursing Diagnosis: The populations in Madagascar show

an increase in Risk-prone health behavior as evidenced

by the extensive use of Alcohol and Tobacco in the
country, related to an abundance of tobacco/alcohol
available in the country

NURSING INTERVENTIONS
Perform physical assessment for deterioration of body

from usage of alcohol and tobacco

Provide patient education about smoking cessation,

decreased tobacco usage, decreased alcohol usage

Give patients alternative options to using tobacco/alcohol

OUTCOMES
In 3 months, clients will have understanding of the

dangers of excessive alcohol and tobacco use.

Clients will understand how to use these products in

moderation, or will stop using them completely as a

result of proper education.

TEACHING
Show patients the difference between a Smokers lung

and a Non-smokers lung

https://www.youtube.com/watch?v=GOZvDrLP-pw
Teach patients about the idea of trading/selling tobacco,

not using it for themselves

Teach about liver failure and how it can affect the well-

being of the patient

CITATIONS

Davis, A. B. (2013). Tobacco production and trade in

Madagascar : (Malagasy Republic). In U.S. dept. of agriculture.

Ladwig, B. (2011). Mosby's guide to nursing diagnosis. 3rd Ed.

Elsevier ISBN: 9780323071727

Madagascar (2010). In WaterAid.

Razanamihaja, N., Befinoana, M. (2013). Alcohol consumption

by school-going adolescents in Madagascar: Prevalence and
associated risk factors. Journal of Alcoholism and Drug
Dependence, 2(145).

World Health Organization. (2015). Madagascar. In World

health organization.