Between May 2025 and April 2026, the acute malnutrition situation in Grand Sud and Ikongo (located in the Fitovinany Region of Grand Sud-Est) is projected to worsen significantly. An estimated 558,000 children under five are either currently suffering or at risk of suffering from acute malnutrition. Of these, approximately 155,600 are expected to face Severe Acute Malnutrition (SAM), while 402,400 are likely to experience Moderate Acute Malnutrition (MAM). In addition, around 38,500 pregnant and breastfeeding women (PBW) are expected to be affected during the same period.

Amboasary and Ikongo districts are already classified as IPC AMN Phase 3 (Severe) between May and September 2025. This severity is expected to intensify, with five additional districts projected to enter Phase 3 between October 2025 and January 2026. Notably, Ikongo could escalate to IPC AMN Phase 4 (Critical) during this period. By February to April 2026, Amboasary is also projected to reach Phase 4. The residual effects of harvests may temporarily obscure the full extent of the crisis between May and September, but underlying vulnerabilities persist.

Key drivers of acute malnutrition include very low food consumption, soaring food prices, limited market access, high child morbidity (notably from diarrhea and malaria), inadequate healthcare practices, and a fragile health system. These factors are compounded by climatic and socioeconomic shocks, deepening household vulnerability. Without urgent intervention, child survival is at serious risk across several districts.

• Enhance community-based nutrition and screening: Expand the coverage of prevention of acute malnutrition (PREVMA) by deploying a comprehensive package of nutritional interventions. This includes the distribution of PREVMA rations and micronutrients to children and pregnant and breastfeeding women, as well as the promotion of good practices for Emergency Infant and Young Child Feeding (IYCF-E), screening by parents or MUAC (Mid-Upper Arm Circumference), and early detection of malnutrition.
• 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: Improve vaccination coverage and disease management at the community level. Preposition nutritional supplies and medications for common illnesses. Given the isolation of the Greater South-East, these life-saving activity packages will have to be deployed as close as possible to the villages.
• 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 mechanisation services and climate-resilient seed varieties resistant to pests and diseases.