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This study provides the first empirical diagnosis of organizational culture among SMEs in five major urban centers of Madagascar, assessing its compatibility with the work-related values of Generations Y and Z. Structured questionnaires based on the Competing Values Framework (CVF) and the Harvard Business Review (HBR) cultural profile model were administered to 309 managers from 309 companies and compared with data from a parallel survey of 810 Generation Y/Z employees. Hierarchy culture emerged as dominant (38.83%), followed by Clan (29.13%) and Market (28.80%), while Adhocracy was virtually absent (3.24%); CVF culture type was strongly associated with HBR value profile, χ²(21, N = 309) = 59.38, p < .001. Managers valued the role clarity (63.4%) it affords but identified limited flexibility (67.6%) as its foremost constraint, matching employee priorities: 93.4% favor collaborative management and 87.8% expect transparent communication. This misfit constitutes a strategic vulnerability, motivating a three-phase transition toward a hybrid model grounded in the Malagasy values of fihavanana (relational solidarity) and fahendrena malagasy (ethical wisdom). By integrating indigenous constructs into a validated Western framework, the study extends organizational culture theory to an underexplored sub-Saharan African setting and offers a practical roadmap for engaging younger talent.
Background:International recommendations for the management of hepatocellular carcinoma (HCC) are often difficult to apply in low-resource settings. This study aimed to describe the epidemiological, clinical, diagnostic and therapeutic characteristics of HCC patients managed at Analankininina University Hospital in Toamasina, Madagascar. Methods:This retrospective, descriptive cross-sectional study was conducted from January 1, 2017 to December 31, 2021. Diagnosis of HCC was based on histological confirmation or non-invasive radiological criteria (arterial enhancement with washout on dynamic imaging) and/or elevated alpha-fetoprotein >500 ng/ml in cirrhotic patients. Serological, radiological and therapeutic data were analysed. The Child-Pugh score was used to assess liver function and the Barcelona Clinic Liver Cancer (BCLC) classification was used for staging and therapeutic guidance. Alcoholism was defined as documented chronic excessive alcohol consumption recorded in medical files. Results:Forty-three patients were included. Mean age was 52.57 ± 19.74 years. The male-to-female ratio was 2.31. Most patients were diagnosed at advanced stages (BCLC C/D: 39/43). Alpha-fetoprotein was >500 ng/ml in 33/43 patients. Liver ultrasound was performed in all cases, CT scan in 9/43 and histological confirmation was obtained in 9/43. Symptomatic palliative care was administered in 33/43 patients. Conclusion:HCC is frequently diagnosed at an advanced stage in our setting, limiting curative treatment options. Limited access to dynamic imaging, histopathology and systemic therapies contributes to suboptimal management. Strengthening hepatitis B virus birth dose vaccination, early screening of at-risk populations and improving access to diagnostic tools are essential priorities.
Background: Episiotomy remains one of the most frequently performed obstetric procedures worldwide, especially among primiparous women. Despite recommendations promoting restrictive use, the practice remains common in low-resource settings. This study aimed to identify factors associated with episiotomy among primiparous women delivering at the University Hospital of Gynecology and Obstetrics of Befelatanana, Madagascar. Methods: A retrospective case-control study was conducted at the University Hospital of Gynecology and Obstetrics of Befelatanana from January 2018 to December 2019. Primiparous women who underwent vaginal delivery were included. Cases were women who received episiotomy and controls were women without episiotomy. Data were collected from medical records and analyzed using Epi Info and Microsoft Excel. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Results: Among 2,903 primiparous women, the prevalence of episiotomy was 34.51%. A total of 855 cases and 1,710 controls were analyzed. Factors significantly associated with episiotomy were maternal age ≥35 years (OR=2.90; 95% CI: 1.89-4.02), uterine height ≥34 cm (OR=1.48; 95% CI: 1.25-1.76), gestational age >42 weeks (OR=4.10; 95% CI: 1.81-20.39), labor duration ≥12 hours (OR=9.03; 95% CI: 7.48-10.89), prolonged second stage of labor, breech presentation (OR=4.04; 95% CI: 1.51-10.80), instrumental delivery, occipito-sacral delivery, and birth weight >3500 g. Conclusions: Episiotomy prevalence among primiparous women remains high in Madagascar. Restrictive use of episiotomy, improved intrapartum monitoring, and enhanced antenatal preparation may reduce unnecessary procedures and maternal morbidity.
Introduction: Blood transfusion is a common and essential therapeutic intervention in intensive care units (ICUs), particularly for managing anemia and hemorrhagic conditions. This study aimed to evaluate transfusion practices, requirements, and outcomes in the ICU of Analankininina University Hospital, Toamasina, Madagascar. Methods; A monocentric descriptive cross-sectional study was conducted over a 12-month period. All patients who received at least one blood transfusion during their ICU stay were included. Data were collected from medical records and analyzed using standard statistical methods. Results: Among 562 ICU admissions, 11.6% (n=65) of patients received transfusions. The mean age was 40 ± 16.9 years, with a female predominance (sex ratio M: F = 2: 3). Hemorrhagic syndromes were the leading indication (41.5%). A total of 135 blood units were requested, of which 79.3% were available. The mean delay between prescription and transfusion was 1h53 ± 1h42. Adverse reactions occurred in 6.2% of patients. Conclusion: Blood transfusion needs in this setting were moderate but constrained by limited availability. Strengthening coordination with blood banks and promoting voluntary donation could improve transfusion efficiency and patient outcomes.
