Linkages Programme - Madagascar

The Linkages Project in Madagascar worked to reinforce breastfeeding, complementary feeding, and women’s nutrition messages through the mass media. This included working with media, for example facilitating journalist's participation in Groupe d'Action Intersectoriel pour la Nutrition (GAIN – a nutrition working group) workshops, technical updates, and special events such as World Breastfeeding Week. Messages were conveyed through local radio broadcasts, national radio and television spots, traditional singers, and songs by pop singer "Poopy", Madagascar’s musical celebrity and breastfeeding/nutrition ambassador. The pop singer wrote 7 songs with nutrition messages and sang them during 60 concerts attended by over 300,000 people. She also promoted nutrition during press conferences, local community festivals, and World Breastfeeding Week.

Local radio announcers also received training to improve their ability to talk about Essential Nutrition Actions (ENA), child survival, and reproductive health issues during their broadcasts. In addition, audio music tapes containing key messages were distributed to drivers of public transport vehicles. Radio and television spots were widely disseminated with approximately 33,000 broadcasts by 20 radio stations and 2,500 broadcasts by televisions stations.

Linkages has regional links across the world. The Madagascar programme was characterised by four phases:

• Phase 1: National Policy Activities - For the first two years (1997–1999), Linkages provided support to the Ministry of Health (MOH) for national policy activities, particularly the establishment and coordination of an intersectoral nutrition action group, GAIN.
• Phase 2: District and Community Activities - In 1999 Linkages’ focus expanded to the district level, with activities in ten districts in Antananarivo and Fianarantsoa. The programme also raised awareness about the lactational amenorrhea method (LAM) as a family planning method.
• Phase 3: Provincial Focus - In mid-2002, Linkages adapted to changes in the health sector and refocused its efforts at the provincial level. The project provided support for provincial nutrition action groups; promotion of self-learning ENA training modules; mass media, especially radio and television; baby-friendly hospitals, clinics, and workplace initiatives; pre-service medical and paramedical training; and training of private doctors. In early 2003, with co-funding from USAID and the Global Forum for Health Research, Linkages expanded this “provincial package” to three districts of the two coastal provinces of Tulear and Mahajanga.
• Phase 4: Added Emphasis on Complementary Feeding - In the final two years of the programme (2005–2006), Linkages worked to strengthen achievements made in breastfeeding, while intensifying the focus on complementary feeding. In addition to the provincial approach, Linkages carried out activities in eight districts of the two original provinces, updated complementary feeding messages, tested new complementary feeding indicators, and supported implementation of the national nutrition policy.

Health, Nutrition, Children

According to the organisers, one in 10 children die before reaching their first birthday and one in six dies before the age of 5. Malnutrition is an underlying cause in 54% of all under-five deaths. Among 19 sub-Saharan African countries for which Demographic Health Survey data are available, Madagascar has the highest proportion of children under the age of three years who are stunted (low height for age). Almost half of Malagasy children in this age group suffer from malnutrition. A major cause of death and malnutrition is sub-optimal breastfeeding practices and poor complementary feeding practices with foods inadequate in quality, quantity, and/or density.

The Linkages Programme, which had projects in Africa, Asia and Latin America, ended December 2006.