In the areas analysed in the Grand South and Grand South-East, it is estimated that nearly 479,000 cases of Global Acute Malnutrition (severe and moderate) are expected from May 2022 to April 2023. Of these cases, the Grand South-East of the country is expected to account for nearly 123,000 cases of acute malnutrition based on the weight/height prevalence from the SMART (Standardised Monitoring and Assessment of Relief and Transitions) survey. Based on comprehensive screening data from July 2022, there are 39,000 cases of Severe Acute Malnutrition expected and nearly 355,000 cases of acute malnutrition in the Grand South – with an incidence factor of 8.5, and 53,000 cases of Severe Acute Malnutrition. The districts most affected, as December 2022 approaches, will be Nosy Varika and Befotaka for the Grand South-East and Bekily and Ampanihy for the Grand South. The situation is likely to deteriorate during the lean season which also coincides with the peak of malnutrition. The following districts will likely be in Phase 3, Crisis: Ikongo, Farafangana, Vangaindrano, Betroka, Betioky Atsimo, Beloha, Tsihombe, Ambovombe and Amboasary Atsimo.

Immediate/short-term response objectives:

• In order to avoid the deterioration of the nutritional situation of children, it is important to raise awareness on infant and young child feeding (IYCF) practices with parents at community sites and maintain a close watch on the health of children. These interventions should be immediately scaled in the communities and districts most at risk of moving from Minimal to Serious. These communities include Bekily and Ampanihy in the far south and Befotaka and Nosy Varika in the Grand South-East.

• For the most vulnerable households, actions to improve food security through food assistance for cash transfers must be continued, and accompanied by distributions and advice aimed specifically at early childhood nutrition (all districts). Monitoring of children’s food consumption will also require special attention in Ikongo.

• Community interventions in water, sanitation and hygiene (WASH) – especially those related to sanitation and control of open defecation in districts in Androy and Mananjary/Nosy Varika should also be prioritised. Ongoing water supply should be maintained in high-risk areas (Androy).

For medium and long-term response objectives:

• Strengthen the assessment and periodic analysis of the nutrition situation in districts by strengthening management and data sharing at the Public Health District Services level. This requires improving the data collection and analysis system, both at the community level and at the public health level, capacity building of health workers for the compilation and analysis of data from health center, advanced strategies, mobile, and community activities. In the medium term, digitalisation could enable the establishment of a simplified system of surveillance and nutritional monitoring at community level.

• Improve coordination of nutrition activities (review, coordination meetings, alignment of activities).

• Focus on the prevention of acute malnutrition through the integration of multi-sectoral interventions for nutrition, with a view to resilience and development.