Considered by the westerners as a mere past chapter of their History, Plague is an ancient flea-borne disease with a case fatality rate of 50-60% if left untreated. Nowadays, plague still represents a public health concern in affected countries in Africa, Asia and Americas.

Despite the surveillance and the prevention measurements implemented, according to WHO over the past 3 years the number of cases in Madagascar has steadily increased, making it the country most severely affected by plague worldwide. Regular outbreaks have been recorded every year since 1983.

Plague is considered a “neglected tropical disease”, whose term refers to a group of infectious diseases that affect more than a billion people, living in poverty, without adequate sanitation and in close contact with infectious vectors.

The explanation for the persistency of plague in Madagascar has to be found besides the biological factors: socio-economical causes appear to be key determinants. Plague is considered to be the “disease of the poor”, affecting those living in poorer, insalubrious, underserved, peripheral areas. This is related to the deep-rooted social stigma associated to the disease, to the patients and to their families. The shame is causing severe delays in the beginning of an effective treatment, as people hide and deny the disease, escape from quarantine areas and illegally unearth the bodies from the mass grave.

 

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