Catholic University of Madagascar

We analyze Madagascar's structural dependence on energy imports using annual and quarterly data spanning 2007 to 2024. Our methodological framework integrates the Tapio decoupling index, Logarithmic Mean Divisia Index (LMDI) decomposition, Autoregressive Distributed Lag (ARDL) modeling, and Granger causality testing. The results show persistent expansive negative decoupling throughout the sample period, which demonstrates that economic expansion drives a disproportionate rise in energy import volumes relative to GDP growth. The LMDI decomposition reveals a systematic inverse symmetry between price and intensity effects. During periods of low international prices, the economy temporarily improves efficiency, yet these gains prove unsustainable. When prices surge, energy intensity simultaneously increases. This pattern reflects structural rigidity in Madagascar's energy system, as the economy fails to sustain efficiency gains during price shocks and instead reverts to more import-intensive production methods. The ARDL estimates confirm this dependency and yield long-run and short-run GDP elasticities of 1.043 and 1.256, respectively. Granger causality tests support the energy-led growth hypothesis and reveal unidirectional flows from energy prices and imports to economic growth in the long run. In the short run, positive shocks in energy prices cause positive changes in GDP, while negative shocks in energy prices cause negative changes in GDP. Short-run GDP shocks, however, cause fluctuations in energy imports of the opposite sign, providing further evidence of the decoupling status. These empirical findings demonstrate that Madagascar's economy remains locked into a high-dependency trajectory where growth is constrained by external energy market volatility.

Climate change has an increasing physical and mental health toll on young people globally. In this Perspective, we suggest that the extent of mental health impacts is likely to be underestimated in the low- and middle-income countries which are most vulnerable to the effects of climate change. We highlight a strong global inverse relationship between internet connectivity and climate vulnerability, which poses significant challenges for understanding climate change’s worldwide mental health impacts and for developing effective mitigation strategies. Inclusive methodologies that enable engagement with offline but climate-vulnerable communities are therefore needed. Such locally grounded mental health research is essential to ensure that climate policies are informed by the lived experiences of populations on the frontlines of the crisis, many of whom remain digitally disconnected and excluded from much current research.

OBJECTIVES:To assess whether the magnitude of immune responses measured by tuberculosis infection tests is associated with short-term risk of microbiologically confirmed tuberculosis. METHODS:Between December 2020 and December 2022, we conducted a prospective observational cohort study in Madagascar and Cameroon among household contacts recently exposed to pulmonary tuberculosis. Baseline analyses estimated the prevalence of tuberculin skin test and/or interferon-γ release assay positivity in the screening cohort. Participants were followed for 18 months. Prognostic analyses were performed in a prespecified analytic dataset including participants aged ≥5 years without symptoms at screening, not receiving tuberculosis preventive treatment at baseline, with complete baseline immunological data and complete follow-up. Associations between baseline immune-response magnitude and incident tuberculosis were evaluated using multivariable Poisson and Cox proportional hazards models adjusted for age, sex, and country. A decision-analytic model was used to explore the health and economic implications of threshold-guided preventive strategies in Madagascar. RESULTS:Among 1659 household contacts enrolled, 1089 were included in prognostic analyses. During follow-up, 30 participants developed symptomatic, microbiologically confirmed tuberculosis, corresponding to an incidence rate of 18.4 per 1000 person-years. Qualitative test positivity showed limited prognostic discrimination. In contrast, higher baseline immune-response magnitude was associated with increased short-term risk. A tuberculin skin test induration ≥14 mm was associated with progression (adjusted hazard ratio, 4.00; 95% CI, 1.58-10.11). Elevated T-SPOT.TB panel A responses (≥130 spots) were also associated with increased risk (adjusted hazard ratio, 5.86; 95% CI, 2.40-14.35). Cost-effectiveness analyses showed that threshold-guided strategies modified both the number of individuals eligible for preventive treatment and economic outcomes. CONCLUSIONS:Immune-response magnitude measured by tuberculosis infection tests was associated with short-term progression risk but did not distinguish infection from early disease at the individual level. Magnitude-informed interpretation of existing tests may improve risk stratification and support more efficient tuberculosis prevention strategies in high-incidence settings.

INTRODUCTION: Globally, adolescent pregnancy affects around 21 million girls in low- and middle-income countries (LMICs) annually, leading to 12 million births. Family planning education, sexual abstinence, and contraception utilization, mainly for married adolescent girls, are essential to prevent adolescent pregnancy. Although the role of civil society organizations (CSOs) in advancing family planning has been increasingly recognized within the global health, there was lack of systematic documentation of its unique contribution and limited knowledge on its conceptualization and operation on sustainability. This study critically evaluating CSO members in nine carefully selected Asian and African nations involved in Adolescent and Youth Sexual and Reproductive Health (AYSRH) programs, with an emphasis on community involvement, collaboration, and cultural and religious program adaptation. METHOD: This critical review study analyzed sustainability factors for adolescent family planning (AFP) programs across nine Asian (Bangladesh, India, Indonesia, Myanmar) and African countries (Cameroon, Kenya, Madagascar, Malawi, Nigeria) through structured review submissions from CSOs practitioners, based on their perspectives. Using thematic analysis, the study identified three key sustainability pillars: (1) community participation, (2) multi-stakeholder partnerships, and (3) cultural-religious adaptation of programs. RESULTS: This study highlights the crucial role of CSOs in sustaining AFP programs across nine countries in Asia and Africa. Despite an unsupportive situation in the studied countries, such as sociocultural, political, and resource constraints, CSOs provide benefits. Three theme were reflected from the thematic analysis; community engagement and participation (youth empowerment, local ownership, grassroots mobilization, hybrid digital–community models, culturally sensitive advocacy); partnerships and collaboration (government–CSO alliances, joint implementation, cross-sector engagement, data-driven accountability); and cultural and religious adaptation (integrating local values, engaging gatekeepers, addressing barriers through dialogue and innovation). CONCLUSION: According to this multi-country study, community engagement, strategic partnerships, and cultural-religious adaptation are the three main pillars that support the effectiveness of family planning programs. The findings of this study advocate for scaled-up collaboration among governments, CSOs, and global health actors to institutionalize contextually grounded solutions. Strengthening CSOs through targeted investments, inclusive program designs, and institutionalizing these strategies within health systems is essential to ensure lasting acceptance, effectiveness, and community ownership.