This article is based on the results of 3 anthropological studies on malaria conducted between 2012 and 2016 in 10 districts of Madagascar by the Institut Pasteur de Madagascar (IPM) and the Institut de Recherche pour le Développement (IRD). The 10 study areas covered the 5 main malaria facies and 10 of the 18 ethnic groups. The following data collection tools were employed: (i) semistructured interviews with various categories of individuals (villagers and representatives of village authorities, health workers, traditional healers and traditional birth attendants), (ii) direct observations (e.g., living conditions, installation and use of mosquito nets, environment, water supply point, hygiene, queuing for consultation at the HC, health worker availability) and (iii) informal interviews.
Determinants of access to malaria control methods and their impact (MEDALI) - qualitative component – 2012–2013 
MEDALI is a study of the impact of the interventions deployed as part of the Global Fund and National Malaria Control Programme (NMCP) funding in Madagascar. Carried out between 2012 and 2013, this multidisciplinary study covers all of Madagascar's epidemiological profiles. It includes a quantitative component focused on evaluating the effectiveness of PCS, complemented by sociodemographic and behavioral components. A second qualitative component (on which this article is based) aims to explore the sociobehavioral factors that interact with malaria control interventions, hindering or facilitating their effectiveness. Specifically, this section focused on the reasons for using HCs in cases of fever and the acceptance of the proposed PCS (LLINs and IRSs). Surveys by semidirective interviews and observations were conducted in 4 zones located in various epidemiological contexts: Moramanga, Antsohihy, Fianarantsoa and Mananjary. These districts cover the Bezanozano, Tsimihety, Betsileo and Antambahoaka ethnic groups. To ensure a diversified panel of health care utilization behaviors, the selected hamlets include both those that house the HC and others more distant from it (between 1 and 1.5 hours of travel time). Data collection was conducted from August to October 2012. A total of 70 semistructured interviews were conducted with 7 doctors/nurses, 8 CHWs, 3 traditional healers, 26 women and 26 men. The interviews explored three themes: perceptions and usual practices in case of fever (in adults and children); malaria prevention practices; knowledge and access to treatment. A qualitative article has already been published from the results of this study .
PALEVALUT (operational evaluation of integrated malaria control) - anthropology of malaria control–2014 [32–34]
PALEVALUT is a multidisciplinary operational research program, whose objective was to evaluate the effectiveness of malaria control strategies in real conditions. It aims to identify the factors that interfere with strategies, whether they are psychological, social, cultural, organizational or economic in nature. This large-scale program, funded by the 5% Initiative, was implemented in 5 sub-Saharan African countries, including Madagascar, in 2014. The socio-anthropological component aims to analyze the social and cultural determinants of the use of control strategies (intrahousehold spraying and LLINs). The survey was carried out in the districts of Brickaville and Ankazobe. The choice of these two areas was guided by the diversity of implemented control strategies, the diversity of cultural (Betsimisaraka and Merina/Betsileo ethnic groups), linguistic, geographical and climatic contexts, and epidemiological profiles. Two communes per district were selected; within each selected commune, two fokontany were drawn at random: one close to the CSBs and markets and the other more than 5 km away. The data collection, carried out in February and March 2014, included 58 semidirective interviews with 4 doctors/nurses, 7 CHWs, 3 traditional healers, 10 administrative and political leaders, 9 regional health officials and people from civil society who are actors in the fight against malaria: 16 women and 9 men. The themes investigated such concerns as popular representations of fever; popular discourse and perceptions of malaria PCS; the involvement of biomedical care providers, health actors (CHWs and traditional healers), and political and administrative leaders active in the fight against malaria.
Qualitative study on malaria: ownership and use of long-lasting insecticidal nets in Madagascar– 2015 
In light of the approximately 21 million LLINs distributed in Madagascar between 2005 and 2011 , USAID funded a qualitative study following the 2015 LLIN distribution in which the goal was to identify factors within households that affect net ownership and use. Four zones (Ambovombe, Farafangana, Sambava and Morondava) were selected: because of their diverse sociocultural contexts (Antandroy, Antaifasy, Betsimisaraka and Sakalava ethnic groups, respectively) and, in particular, the presence of factors likely to hinder LLIN use. One fokontany per area was selected. The selection criterion was based on the effectiveness of LLIN distribution and the extent of malaria incidence in fokontany. Regarding the choice of households, the aim was to observe a diversified cross-section of LLIN practices throughout different life phases. Thus, based on census data, the study targeted nuclear families with a primiparous pregnant woman, families with at least one child under 5 years old, families with at least one child between 10 and 18 years old, and families whose children had already left the parental home. The data collection was carried out between March and June 2016, 6 to 10 months after the 2015 distribution campaign. A total of 64 semistructured interviews and 64 direct observations of households benefiting from LLINs were conducted. The participatory Photovoice data collection methodology was employed to capture images associated with the perceptions of the local population on malaria and LLINs . Eight participants were equipped with cameras during the stay (4 men and 4 women) and given instructions to capture (four photos per participant) images associated with the following two questions: "In your opinion, what is malaria? "and "How can we protect ourselves against the disease transmitted by mosquitoes?" Focus groups were held with the participants to discuss their photo choices . The topics covered in the individual interviews included malaria knowledge, its causes and prevention, images associated with LLINs, and the advantages, disadvantages, efficacy, risks; frequency, reasons and modalities of LLIN use. In addition, the prioritization and spatial organization of sleeping spaces was documented through direct observations, and constraints on the installation and maintenance of LLINs and the use of LLINs for other purposes were noted.
The 3 studies were conducted using the same analysis methodology. All the interviews were recorded, transcribed and translated into French. They were then subjected to a thematic analysis using analysis grids designed for each category of persons surveyed. This method made it possible to highlight recurrences and divergences in the participants' discourses according to the themes addressed. The analysis of these recurrences and divergences forms the basis of the results presented in the reports of the three studies. These report results were, in turn, analyzed by following the same principles of thematic analysis to compare the results over the 10 study areas. The aggregated analysis of these three studies, comprising a total of 192 semistructured interviews, was used to provide a holistic sociocultural description in terms of epidemiological profiles, ethnic groups and age groups beyond 5 years of age. The analyses looked for the influence of pre-2009 LLIN distributions and focused on pregnant women and children under 5 years of age for the pivotal period of 2012–2015, during which the free and universal LLIN distribution strategy was adopted [22, 27]. In addition, data from the quantitative components of MEDALI and PALEVALUT were used to enrich the discussion.