自1960年以来,马达加斯加经历了重大的环境变化,特别是通过森林砍伐以扩大农业规模。马达加斯加的气候模式也在发生变化,随着温度的升高,干旱,和气旋活动。这些环境和气候变化的影响将对粮食供应构成威胁,创收,和当地的生态系统,对疾病负担的时空分布具有显著的潜在影响。本研究旨在通过多种临床测量来描述大量地理和社会多样化的马达加斯加社区的健康状况,详细的社会调查,以及当地生态区域变化的配对数据。随着人们对当前人类健康和营养变化模式的理解,未来的研究将能够更好地识别与气候的关联,并预测和减轻更大的负担,长期变化。我们的混合方法方法包括观察性横断面研究。研究对象是男性,女人,1125个家庭的儿童平均分布在马达加斯加四个生态和社会人口学上不同的地区的24个社区。对于这1125户家庭,所有性别和所有年龄的人(共6,292人)被纳入研究,共5,882人被纳入.通过反复的社会调查回忆和焦点小组会议,我们获得了社会和人口数据,包括广泛的季节性运动,并以创收的波动为特征,食品生产和饮食消费。通过收集临床和生物样本进行现场护理诊断和实验室分析,我们获得了微量营养素营养的详细发生(重要的是共现)数据,传染病,和非传染性疾病状况。我们的研究强调了高度可变的社会,文化,以及马达加斯加健康状况的环境背景,以及巨大的区域间,社区间,以及营养和疾病状况的社区内变化。超过30%的被调查人群患有贫血,而14%的人群目前患有疟疾感染。这种与一系列生物样本以及营养和疾病结果数据相关的丰富元数据应该可以解开马达加斯加不断变化的景观中一些健康不良的潜在驱动因素。
Madagascar has experienced significant environmental change since 1960, particularly through forest clearing for agricultural expansion. Climatic patterns are undergoing change in Madagascar as well, with increasing temperatures, droughts, and cyclonic activity. The impact of these environmental and climatic changes will pose threats to food availability, income generation, and local ecosystems, with significant potential effects on the spatial and temporal distribution of disease burden. This study seeks to describe the health status of a large sample of geographically and socially diverse Malagasy communities through multiple clinical measurements, detailed social surveys, and paired data on regional variation in local ecologies. With an increased understanding of the current patterns of variation in human health and nutrition, future studies will be better able to identify associations with climate and anticipate and mitigate the burdens expected from larger, longer-term changes. Our mixed-method approach included an observational cross-sectional study. Research subjects were men, women, and children from 1,125 households evenly distributed across 24 communities in four ecologically and socio-demographically distinct regions of Madagascar. For these 1,125 households, all persons of both sexes and all ages therein (for a total of 6,292 individuals) were recruited into the research study and a total of 5,882 individuals were enrolled. Through repeated social survey recalls and focus group meetings, we obtained social and demographic data, including broad categories of seasonal movements, and characterized the fluctuation of income generation, food production and dietary consumption. Through collection of clinical and biological samples for both point-of-care diagnoses and laboratory analyses, we obtained detailed occurrence (and importantly co-occurrence) data on micronutrient nutritional, infectious disease, and non-communicable disease status. Our research highlights the highly variable social, cultural, and environmental contexts of health conditions in Madagascar, and the tremendous inter-regional, inter-community, and intra-community variation in nutritional and disease status. More than 30% of the surveyed population was afflicted by anemia and 14% of the population had a current malaria infection. This type of rich metadata associated with a suite of biological samples and nutritional and disease outcome data should allow disentangling some of the underlying drivers of ill health across the changing landscapes of Madagascar.