Acute diarrhea: an alarming situation

Infectious diseases above all affect disadvantaged populations, and especially the young. In Madagascar, 51% of children under five have acute diarrhea. Of viral, bacterial or parasitic origin, acute diarrhea is the third cause of mortality in the country, after respiratory illnesses and malaria.
Until the present, no specialist structure existed in the country to care for these patients. The population being 80% rural, few children were hospitalized for diarrhea. But if care is provided quickly enough, their lives can be saved.

A specialized pediatric unit

It was thus an urgent matter to create a medical center for these little Malagasy children. The objective is to learn more about infantile diarrheas and to provide better care, and thus lower the mortality rate linked to these pathologies.

After having studied the causes of diarrhea in 14 districts, Moramanga, located in the central western part of the island, was selected by the Institute Pasteur teams as the site for the new unit. This region is representative of the urban and rural situation in the country as a whole. 
A veritable diagnosis, care and prevention center has been created at the hospital. The unit includes:

• pediatricians trained in France,
• nursing staff,
• a pediatrics department (11 beds, including 2 intensive care beds),
• a laboratory,
• workspace for researchers,
• an administrative area independent from the patient care zone.
  
  

For the population of Madagascar, the center represents considerable progress. The Malagasy now have a hospital with a pediatric unit and highly qualified health personnel. What remains to be done is to make this structure known to everyone. “The fact that such installations exist at present should create the demand. The job at hand is to spread the news of the Moramanga site's existence to the villages,” explains Vincent Richard.

A site that has become a pilot project

Moramanga thus constitutes an advanced research structure focused on the complications of serious diarrhea cases. Doctors and scientists work together at the center, sharing knowledge and feedback. By observing the local population, they perform demographic and epidemiologic surveys. Diagnoses and treatment serve as models that can be utilized in other regions.
In the second half of 2011, Moramanga was expanded to become a multi-disciplinary research center. The program of research has now been extended to cover other:

• viruses and bacteria,
• pathologies (respiratory affections),
• populations (adults),
• topics (cultural and social).
  
  

Solid and actively-involved partners

At the initiative of this project, the Institute Pasteur of Madagascar is the first African Institute Pasteur specialized in observing and treating tropical viruses. Together with the Institute Pasteur of Bangui (Central African Republic), it is dedicated to research work on infantile diarrheas.
A partner of the Institute Pasteurfor many years now, the Total Foundation is co-directing the project via its outreach entity, Total Madagasikara. The program comes within the scope of the Foundation's action focused on combating infectious diseases: raise the awareness of the population, support research and train local medical teams. “The projects provided with funding concern countries with limited resources, and they are conducted in close collaboration with local scientists. The idea is to transfer capabilities and develop local expertise where these are lacking,” points out Françoise Barré-Sinoussi, researcher and winner of the Nobel Prize in medicine in 2008.

The Moramanga project benefits from solid financial backing, including 1.7 billion Ariary (600 000 euros) contributed by the Total Foundation. The other providers of funds include the Ministry of Health, local authorities, and the teams of the Institutes Pasteur of Madagascar and Paris.

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