Between June 2023 and April 2024, the acute malnutrition situation in Madagascar is likely to worsen significantly. Approximately 458,700 children under the age of five are likely to suffer acute malnutrition. Among them, over 121,000 children are expected to suffer from Severe Acute Malnutrition (SAM) and nearly 338,000 children are expected to experience Moderate Acute Malnutrition (MAM). In the Grand Sud Est region, an estimated 196,451 cases are projected, with 57,973 children in SAM and 138,478 children in MAM. Meanwhile, in Grand Sud, nearly 262,208 children are susceptible to acute malnutrition, including 63,199 children in SAM and 199,009 children in MAM. The districts likely to be most severely affected are Nosy Varika and Ikongo in Grand Sud Est, as well as Amboasary, Betroka, Betioky, and Beloha in Grand Sud.

By December, districts likely to be most affected are Nosy Varika and Ikongo in Grand Sud Est, and Amboasary, Betroka, Betioky, and Beloha in Grand Sud. The nutritional situation (June - September 2023) is projected to slightly improve before worsening during the lean season (January - April 2024). Notably, Nosy Varika and Ikongo are expected to be in IPC Phase 4, Critical, while Befotaka, Vangaindrano, Vondrozo, Manakara, Vohipeno, Ifanadiana, Mananjary, Ambovombe, Tsihombe, Beloha, Toliara II, Betioky Atsimo, Ampanihy Ouest, Amboasary, and Betroka are likely to be in IPC Phase 3, Serious.

Enhance community-based nutrition and screening: Strengthen community-level coverage and quality of early prevention and screening efforts to reduce acute malnutrition among children and pregnant and lactating women. Expand preventive interventions for children and pregnant/breastfeeding women, such as Infant and Young Child Feeding (IYCF) practices, micronutrient supplementation, and distribution of fortified foods, prioritizing the most inaccessible areas with critical malnutrition rates.

Strengthen cross-sectoral coordination and resilience: Integrate multisectoral interventions such as supporting agricultural activities, promoting crop diversification, providing nutrition education; diversifying household economic activities to secure resources and reduce dependency on aid; enhancing WASH infrastructure and improving road infrastructure to reduce the isolation of certain areas.

Improved access to health services: Formalize new (level II) health centers or establish facilities in remote regions, integrate malnutrition treatment education into medical, nursing, and midwifery training, and recruit and train sufficient qualified healthcare staff for all levels, including for complex cases.

Livelihood support: Provide access to services and inputs that allow farmers to use agricultural inputs that increase crop yield through subsidies and government programmes. Agricultural inputs include sustainable mechanization services and climateresilient seed varieties resistant to pests and diseases.