# Multimorbidity and mortality trends in the COVID19 syndemic in Madagascar covering 180 diseases 2015 2024

## TL;DR

The paper examines how multiple diseases and the impact of the COVID-19 pandemic have affected health outcomes in Madagascar, highlighting regional disparities and the need for integrated health strategies.

## Contribution

The study provides new insights into multimorbidity and mortality trends in Madagascar, linking stroke, hypertension, and diarrhea with the effects of the COVID-19 syndemic.

## Key findings

- Stroke is the leading cause of death with extreme regional disparities in case-fatality rates.
- Strong correlations were found between stroke, hypertension, and diarrhea, indicating interconnected health vulnerabilities.
- The post-COVID period saw a decline in disease incidence but persistent regional health inequalities.

## Abstract

Multimorbidity and mortality shape population health in Madagascar, where chronic and infectious diseases interact across regions. Using surveillance data covering 180 diseases across 22 regions from 2015 to 2024, we quantified geographic disparities, dominant contributors to disease burden, and shifts associated with the COVID-19 syndemic. Stroke was the leading cause of death, with regional case-fatality rates often exceeding 45% and reaching nearly 99% for cardiac arrest in some urban areas. Stroke also showed strong correlations with hypertension (r = 0.97) and diarrhea (r = 0.98), highlighting interconnected vulnerabilities. During the COVID-19 period, overall disease frequency increased by 6.12% on average, though responses varied widely across conditions. Post-lockdown, incidence declined substantially (MRD = −90.17%), and mortality decreased slightly (MRD = −3.93%), yet disparities persisted. Groups with cardiovascular and mental health disorders exhibited the greatest instability. These findings illustrate how interacting epidemics reshape population vulnerability and underscore the importance of integrated strategies to strengthen health-system resilience.

•Stroke is the leading cause of death with extreme regional disparities•Strong syndemic links found between stroke, hypertension, and diarrhea•COVID-19 period shows a 6.12% rise in overall disease frequency•Post-COVID decline in incidence, but major regional health inequalities persist

Stroke is the leading cause of death with extreme regional disparities

Strong syndemic links found between stroke, hypertension, and diarrhea

COVID-19 period shows a 6.12% rise in overall disease frequency

Post-COVID decline in incidence, but major regional health inequalities persist

Health sciences; Public health; Environmental health