The Republic of Madagascar is a large island country located about 400 kilometers off the coast of East Africa, in the Indian Ocean. The population of 27.5 million lives in predominantly rural areas and is made up of various ethnic groups, including Malayo-Indonesian, Cotiers, French, Indian, Creole, and Comoran. Malagasy, French, and English are all spoken, as are local languages. The people practice various forms of Christianity, Islam, and local indigenous religions. The country has diverse animal life, most notably 40 species of indigenous lemurs unique to Madagascar.

Madagascar gained independence from France in 1960 and has since experienced several bouts of political turmoil and instability. A coup in 2009 resulted in a five-year political deadlock; in 2019 the election of a new president ended a decade of political uncertainty. Despite political issues, the country as a whole has made positive economic progress, and the agriculture sector, with crops such as rice, coffee, and vanilla, is the nation’s leading employer. Over 70 percent of the young Malagasy population lives in poverty.

Health challenges include chronic malnutrition; nearly half of children under five years of age suffer from stunting. The country also experienced a measles outbreak in 2018 that infected tens of thousands of people. The leading causes of death include diarrheal diseases, lower respiratory infections, neonatal disorders, tuberculosis, malaria, and protein-energy malnutrition. Non-communicable diseases such as stroke, ischemic heart disease, hypertensive heart disease, and cirrhosis have notably increased and are increasingly among the top causes of death in Madagascar.