[Rice: source of life and death on the plateaux of Madagascar].

Since the 17th century, Europeans travelling in Madagascar described the contrast between the fever-free Plateau and the fever-ridden coasts. The former were inhabited by people of Asiatic origins and the latter by African migrants. At the end of the 18th century, "Merina" kings developed land irrigation and rice cultivation, using manpower from the coasts. Since then, rice has become a monoculture covering most of the arable lands of the Highlands. The first malaria epidemic occurred in the Tananarive area in 1878, and rapidly spread throughout the Plateau. The mortality rate was high. A second epidemic in 1895 may have been a resurgence of the previous one. Subsequently, malaria became meso-epidemic despite control measures, mainly consisting of larvivorous fishes, quinine treatment and prophylaxis. In 1949, an eradication program was launched based on DDT house-spraying and chloroquine prophylaxis in children. It was very successful on the Highlands where malaria disappeared, in 1962. Spraying was cancelled and only three small foci remained under surveillance. In 1987 and 1988, a malaria outbreak devastated the plateau. Subsequently, intensive spraying operations brought the situation under control by 1993. The main malaria vector on the Madagascar Highlands is An. funestus. More than 95% of its breeding sites are in the rice fields just before the harvest and afterwards in the fallow lands. The vector peak and the corresponding peak of malaria cases occur between February and May, depending on the farming calender. The second but less important vector, An. arabiensis, breeds in the rice fields just after seeding when the surface water is sunlit. Although rice fields remain the main source of this vector, it also breeds in rainwater pods and borow-pits. Malaria vectors on the plateau are products of human activities of rice cultivation, which is the basis of the economy. The epidemiological importance of rice fields varies greatly from one country to another. In Southeast Asia, the rice fields harbor several anopheline species most of which are only vectors of P. vivax. In West Africa where malaria is holoendemic, they produce large populations of An. gambiae; however, the malaria pattern is unaltered and remains at peak levels. In the dry areas of southern Madagascar, the vector An. funestus and meso-hyperendemic malaria are restricted to areas of cultivated rice. In West and Central Africa, An. funestus is never found in rice fields even though it is common in marshes. In Madagascar, this vector breeds in irrigated rice fields. Because it is practically impossible to control anophelines in rice fields by chemical, biological and ecological methods on the Highlands of Madagascar, house-spraying remains the best method for mass malaria control. Bed-nets impregnated with pesticides may offer an alternative, but their use is resisted by the local population.