The Grand Sud, where 1.8 million people reside, is the least developed part in the country. Madagascar has the fourth highest stunting rates in the world. Nearly 10 per cent of all children suffer from acute malnutrition nationally, and nearly 20 per cent of children in drought-affected districts (nutrition screening, April 2016). Under-five and infant mortality in the Grand Sud is already 42 per cent and 47 per cent higher than the national average respectively. The most vulnerable groups are the estimated 267,000 women of childbearing age, including 51,000 pregnant women, and 205,000 children under the age of 5 (WHO rapid assessment, May 2016). Access to water and sanitation is also a major concern.