Practical infection prevention and control in Madagascar: initial assessment via IPCAF

Abstract Background Healthcare-associated infections represent a major public health challenge, particularly in low and middle-income countries where infection prevention and control systems remain underdeveloped. In Madagascar, despite the recent establishment of a national infection prevention and control programme, baseline data on the level of implementation in healthcare facilities remain limited. Methods This cross-sectional analytical study aims to assess the initial level of implementation of this programme in 24 healthcare facilities covering communal, district, and regional levels, which are distributed according to health zones (entry and non-entry points). Data were collected via IPCAF via the ODK® platform, and the overall score (0–800) and the scores per component were analysed according to the World Health Organization’s classification. Results The mean overall score was 359, corresponding to a “basic” level, with 83.3% of facilities situated at the basic or intermediate levels. District hospitals generally achieved an “advanced” level, whereas regional‑level facilities were mostly classified as “basic” or “intermediate”, and communal‑level facilities included establishments rated as inadequate (17.6%). Surveillance of healthcare‑associated infections (12.5/100) and monitoring of practices (15.6/100) were the most critical components, whereas workload and staffing received the highest scores (61.3/100). Disparities emerged according to health zones, with “inadequate” categories observed exclusively in entry‑point zones. Conclusion The results show that infection prevention and control in Madagascar remain at basic to intermediate levels globally, with major deficiencies in the surveillance of healthcare‑associated infections and audit mechanisms. They provide an important baseline to guide national priorities, particularly the strengthening of surveillance, training, and multimodal strategies tailored to the different levels of the health system.