Geographic and socioeconomic barriers to COVID-19 healthcare access in rural Madagascar: a population-based cohort study
1
Thematic Doctoral School "science, culture, society and development", University Of Toamasina, ANTSIRANANA, Madagascar
Popul. Med. 2026;8(Supplement Supplement 1):A1209
ABSTRACT
INTRODUCTION:
Madagascar experienced severe health inequities during the COVID-19 pandemic, with 60% of the population living over 5 kilometers from healthcare facilities and only 15% having access to clean water. This study examined geographic and socioeconomic barriers affecting COVID-19 healthcare seeking behavior and vaccination uptake in rural Madagascar, where underreporting was estimated to be ninefold higher than official figures.
METHODS:
We conducted a longitudinal cohort study in rural districts of Madagascar between January 2020 and December 2022, utilizing data from 1600 representative households. We assessed healthcare utilization patterns for fever and respiratory symptoms during the pandemic compared to 2018 baseline data. Geographic accessibility modeling combined satellite imagery, digital elevation maps, and travel time calculations to healthcare facilities. Vaccination uptake was tracked through 12 rural health centers. Poisson regression models identified sociodemographic determinants of healthcare access and vaccine acceptance.
RESULTS:
Healthcare utilization for febrile illness decreased by 47% during the pandemic compared to pre-COVID baseline despite similar disease prevalence. Only 9% of the rural population received at least one COVID-19 vaccine dose by November 2023, far below WHO's 70% target. Distance to health facilities emerged as the strongest barrier, with populations living beyond 5 kilometers showing 65% lower healthcare utilization. Economic constraints increased catastrophically, with 78% of households experiencing poverty compared to 75% pre-pandemic. Healthcare seeking was 52% lower among women and poorest wealth quintiles. Infrastructure limitations included inadequate cold chain equipment, shortage of trained personnel, and only 3% access to improved sanitation facilities.
CONCLUSIONS:
Geographic isolation and socioeconomic inequities created critical barriers to COVID-19 healthcare access in rural Madagascar, exacerbating pre-existing health disparities. Achieving health equity requires targeted interventions including mobile health services, community health worker programs, infrastructure investments in rural areas, and culturally adapted health communication.
Madagascar experienced severe health inequities during the COVID-19 pandemic, with 60% of the population living over 5 kilometers from healthcare facilities and only 15% having access to clean water. This study examined geographic and socioeconomic barriers affecting COVID-19 healthcare seeking behavior and vaccination uptake in rural Madagascar, where underreporting was estimated to be ninefold higher than official figures.
METHODS:
We conducted a longitudinal cohort study in rural districts of Madagascar between January 2020 and December 2022, utilizing data from 1600 representative households. We assessed healthcare utilization patterns for fever and respiratory symptoms during the pandemic compared to 2018 baseline data. Geographic accessibility modeling combined satellite imagery, digital elevation maps, and travel time calculations to healthcare facilities. Vaccination uptake was tracked through 12 rural health centers. Poisson regression models identified sociodemographic determinants of healthcare access and vaccine acceptance.
RESULTS:
Healthcare utilization for febrile illness decreased by 47% during the pandemic compared to pre-COVID baseline despite similar disease prevalence. Only 9% of the rural population received at least one COVID-19 vaccine dose by November 2023, far below WHO's 70% target. Distance to health facilities emerged as the strongest barrier, with populations living beyond 5 kilometers showing 65% lower healthcare utilization. Economic constraints increased catastrophically, with 78% of households experiencing poverty compared to 75% pre-pandemic. Healthcare seeking was 52% lower among women and poorest wealth quintiles. Infrastructure limitations included inadequate cold chain equipment, shortage of trained personnel, and only 3% access to improved sanitation facilities.
CONCLUSIONS:
Geographic isolation and socioeconomic inequities created critical barriers to COVID-19 healthcare access in rural Madagascar, exacerbating pre-existing health disparities. Achieving health equity requires targeted interventions including mobile health services, community health worker programs, infrastructure investments in rural areas, and culturally adapted health communication.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
