Community-based health screening in Madagascar reveals a potential underestimation of non-communicable and infectious disease burden: a cross-sectional study

Abstract

To assess the prevalence of selected communicable diseases and cardiometabolic risk factors in adults from underserved inland and coastal communities in Madagascar. A community-based cross-sectional study was conducted in two underserved peripheral communities settings (inland and coastal). Participants underwent standardized health screening, including testing for HIV, hepatitis B and C, and syphilis, as well as measurements of anthropometric parameters, blood pressure, fasting glycemia, and total cholesterol. Descriptive analyses, between-group comparisons, and multivariable logistic regression analyses adjusted for age, sex, and study cohort were performed using Stata version 17, with statistical significance set at p < 0.05. A total of 256 participants (mean age 45.2 ± 17.4 years) were included. HIV infection was detected in 3.1% of participants. Hypertension was present in 28.1%, and elevated fasting glycemia (≥ 7 mmol/L) in 15.6%. The prevalence of HIV, hepatitis C, and syphilis was significantly higher in the coastal community, which also showed a higher proportion of elevated total cholesterol. After adjustment for age and sex, elevated total cholesterol remained the only cardiometabolic indicator independently associated with the coastal community. This study demonstrates the feasibility and value of integrated community-based health screening in underserved communities in Madagascar. The findings indicate a considerable burden of both communicable diseases and cardiometabolic risk factors and reveal important geographical differences between inland and coastal communities. Although not nationally representative, the results provide valuable contemporary epidemiological data and support the expansion of integrated community-based surveillance and preventive health programmes in resource-limited settings.