Burden and Co-Occurrence of Anemia, Micronutrient Deficiencies, Inflammation, and Malaria Among Women, Adolescents, and Children in Madagascar: A National Cross-Sectional Survey

Background: Madagascar faces persistently high rates of anemia and undernutrition, yet limited nationally representative data on micronutrient (MN) deficiencies impede evidence-based interventions. MN deficiencies and infections such as malaria are known to interact and jointly contribute to this burden. Objectives: To estimate the prevalence and co-occurrence of malaria, anemia, inflammation, and MN deficiencies among preschool children (PSC), adolescent boys and girls, and non-pregnant women. Methods: The 2024 National Micronutrient Survey used a 2-stage probabilistic design across 23 regions. Venous blood and urine were analyzed for malaria, anemia, inflammation, iron, zinc, iodine, fluoride, vitamins A, D, and B12, folate, riboflavin, and thiamine biomarkers. Results: Malaria was detected in 4% to 14% of participants, and inflammation in 21% to 46% of participants. Anemia affected 42% of PSC and about one-third of the older groups. Iron deficiency was most common in PSC (26%) and less frequent in adolescents and women (6%–16%). Zinc deficiency affected one-third of all groups. Riboflavin deficiency was highly prevalent, affecting 75% of PSC and nearly 90% of older groups. Vitamin A deficiency prevalence was 12% among PSC but rare in older groups, while folate deficiency affected 12% of adolescent girls and 21% of non-pregnant women. Other deficiencies were uncommon (iodine, vitamins B12 and D, and thiamine). Multiple conditions co-occurred frequently, particularly in PSC, although co-occurrence did not exceed levels expected by chance. Conclusions: Findings underscore the need for integrated national strategies combining fortification, supplementation, dietary diversification, biofortification, and infection control to address the multiple drivers of anemia and MN deficiencies.