Stop measles : Vaccinating the hardest-to-reach children in Madagascar

By Jeremiah Kariuki and Anna Balint

This month the World Health Organization (WHO) reported that the numbers of measles cases around the world had risen by 300% in the first three months of the year in comparison with 2018. Save the Children’s Emergency Health Unit (EHU) has already responded to three measles outbreaks this year, in South Sudan, Kenya and Madagascar. This is more than in any previous year.

Measles is a highly contagious disease. At its simplest it can cause fever, rash and a cough. However, complications are relatively common and can have severe, even lethal, implications, including pneumonia, blindness and brain inflammation. Children under 5 years have a particularly high risk of getting serious complications, and the risks are even more pronounced in countries with high malnutrition rates and poor healthcare. In Madagascar, one of the poorest countries in Africa, the most recent measles outbreak has seen over 118,000 infections and 1,700 deaths so far.

Vaccines are highly effective in preventing the spread of measles. In Madagascar, Save the Children supported the Ministry of Health and the WHO with a national mass vaccination campaign to stop the outbreak from spreading further. We focused on providing supervision, operational and logistics support in the northeast, Sava region, of the country.

Overcoming challenges to reach all children

Compared with our previous measles responses, the campaign in Madagascar provided a unique set of challenges around resource mobilisation, community resistance and accessibility. Some vaccination sites were so remote that it was impossible to reach them by vehicle, leaving teams to trek through mountainous and forested regions for two days in order to get to them – with another two days to come back. This meant dealing with challenges in communicating with the teams in the field, as there was no mobile network, and in maintaining the cold chain. The remoteness also meant that the vaccines and other materials had to be transported on canoes and carried by human porters to the sites before the campaign started. Despite these challenges, our dedication ensured the materials made it to all the vaccination sites, travelling to sites that even the district’s medical inspectors had never visited, helping to reach the hardest-to-reach children.

While most parents were keen to get their children vaccinated and engaged with the campaign, the vaccination teams faced community resistance from some parents and schools. Community mobilisation played a crucial role in dispelling misinformation and convincing parents of the benefits of vaccinating their children. Local community leaders had an active role in informing people of the campaign, the necessity of vaccination to prevent the spread of measles, and the risks posed to the community by not vaccinating children.

Despite challenges, the campaign was successful with more than 180,000 children vaccinated in the two districts where we worked. The Ministry of Health has already reported a drop in the number of measles cases in the vaccinated areas, demonstrating the immediate impact of the campaign on the epidemic in Madagascar and its children, even in the hardest-to-reach areas.


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  • Daniel Iraguha

    For sure this was a big achievement for the EHU team.
    Big thank for all the team involved, especially those who managed to reach even where the medecin Inspecteur never arrived.