• The districts of Bekily, Beloha and Amboasary Atsimo are classified as in IPC "Serious" Malnutrition for the period March to May 2017; they will risk staying there until September 2017 with the exception of Bekily. Action will be needed to reduce urgently the high levels of malnutrition recorded in these areas.
• The other districts analyzed namely Betioky, Ampanihy, Tsihombe, Ambovombe, Taolagnaro are in IPC "alert" phase. For the projected period (June to September 2017), no phase change is foreseen for these five districts as the beginning of this period coincides with the post-harvest period when improved food availability and accessibility is expected. At the same time, treatment programs for cases of acute malnutrition are under way although they deserve to be strengthened to avoid a further deterioration of the situation. These should contribute to maintaining or even achieving a slight improvement in the current situation.
• Inadequate food intake, inadequate access to food, and high exposure to diseases such as diarrhea, malaria, fever, acute respiratory infection (ARI) of the studied areas.
• Education and literacy of heads of households and the adaptability of families to unusual shocks are also major causes of the situation currently prevailing in the areas studied and deserving special attention.

Recommendations and next steps for analysis and decision making

The current food and nutritional situation of the districts remains very fragile. Answers should focus on:

• Continuation of food distributions and / or transfers of funds to populations suffering from insecurity severe food (IPC food security classification, June 2017);
  
  
• Strengthening the acute malnutrition management program in terms of coverage to increase access to on the other hand, especially in the districts of Amboasary, Ambovombe, Ampanihy and Taolagnaro in which more than 4,000 malnourished children are expected in the third quarter of 2017:
  Regular community screenings by Community Agents (CAs) and Community Nutrition Officers (ACN) and references in nutrition centers,
  Severe Acute Malnutrition (MAS): CRENI in hospitals; CRENAS in the basic health centers (CSB) and teams in the pockets of malnutrition identified,
  Moderate acute malnutrition: CRENAM in community nutrition sites
  
  
• Community nutrition program support to increase access and quality of services: monitoring and promotion of growth, follow-up of CRENI / CRENAS counter-referred children, nutrition and health education, home visiting of children presenting problems;
  
  
• Support to the efforts of the Ministry of Public Health for the strengthening of the health system and, in particular, the taking into integrated burden of childhood illnesses (malaria, diarrhea and respiratory infections), the Expanded Program on Immunization, Mother and Child Health Week (MHW) and the alignment of the Community Health Program;
  
  
• Support to the efforts of the Ministry of Water, Energy and Hydrocarbons to improve access to drinking water, sanitation and hygiene practices, improving access to water for livestock and agriculture, and agricultural diversification, especially diversified and high-value crops, small-scale livestock farming, small-scale processing and preservation of products (Ministry with the Presidency in charge of Agriculture and Livestock);
  
  
• Under the aegis of the ONN and in a concerted manner with all stakeholders in sensitive and specific nutrition, the implementation of the intervention package of PNAN III (2017-2021) in order to increase the population's resilience to shocks and accelerate the reduction of chronic malnutrition;
  
  
• Reflection with the partners of the nutrition cluster and the cluster food security and livelihoods for the establishment a nutritional monitoring system in the regions