specific policy interventions and increasing their impact since health and nutrition budget allocations are sent to the commune level basic health centers.

# 4. Application of the Small Area Estimation Approach

Data description The 2018 census marked the third census undertaken in Madagascar, following the most recent one in 1993. The census enumeration process spanned from May 18 to June 25, 2018, encompassing the entirety of the country. During the 2018 census, Madagascar's population was estimated to be approximately 25,674,196 individuals residing in a total of 6,079,876 households. While most households live in rural areas (80.7%), the gender composition is slighted tilted toward women as they represent 50.7% of the population.

In parallel, the Enquête Permanente Aupres des Menages 2021-2022 (EPM21-22) represented a living standards measurement survey (LSMS) conducted between 2021 and 2022, encompassing all nine provinces and 22 regions. With the exception of one district (Mitsanjo), the survey covered all districts. The EPM is representative at both the national and regional levels. This means that we can use the data to draw inferences at the sub-regional level. A key objective of the EPM21-22 survey was to generate monetary poverty estimates, defined based on per capita consumption, using a national poverty line set at approximately 1.57 million ariary per year per person. Based on those estimates, 75.2 percent of the national population was poor (79.9 percent for rural and 55.5 percent for urban areas). This is a slight (non-statistically significant) increase from the 72.9 percent estimated for 2012. Rural poverty decreased from 80.6 percent in 2012 to 79.9 percent in 2022 (a statistically insignificant change), while average consumption among the rural poor increased by 1-percent per year.<sup>2</sup> At the same time, poverty significantly increased in urban areas, from 42.2 percent in 2012 to 55.5 percent in 2022.

The Demographic and Health Survey, carried out in 2021, spanned all nine provinces and 22 regions. Similarly to the EPM survey, we can use the DHS data to draw inferences at the sub-regional level. It entailed the surveying of a total of 20,510 households, comprising 5,146 in urban areas and 15,364 in rural areas. All women aged 15-49 living in the selected households or present the night before the survey were eligible for interviews. Additionally, a subsample of every other household included the weighing and measuring of all children under 5 years to assess their nutritional status (including wasting, underweight, and stunting). In this subsample, all children aged 6-59 months were eligible for anemia and malaria (RDT) tests. Furthermore, anthropometric measurements and anemia testing were also conducted for all women aged 15-49 in this subsample. Finally, in the other subsample of every other household, all men aged 15-59 were eligible for interviews, and gender-based violence questions were administered to one woman per household, randomly selected.

The 2021 DHS shows a modest improvement of stunting rate at 40% compared to 41.6% in 2018. In rural areas stunting declined from 42.6% to 40.5%, and in urban areas it also dropped from 37.7% to 35.5%. This suggests a positive trend in reducing child malnutrition, though there is still a considerable disparity between rural and urban regions, highlighting the need for continued efforts in addressing this issue, particularly in rural areas.

> 2 Approximately 80 percent of Madagascar’s population dwells in rural areas.

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