Antananarivo is the capital and largest city of Madagascar, located centrally, in the highlands. It has a sprawling metropolitan area with population approaching 3 million. Rice and other crops are still grown in irrigated fields in the depressions between the hills.

Infrastructure throughout Madagascar is poor and the inadequacy thereof in Antananarivo is notable. For example, the narrow streets are shared by walkers (many carrying heavy loads), bicycles, motor bikes, zebu-pulled carts, cars, vans, buses and trucks. We did not see any attempt at "traffic control" (not a single stop sign or traffic light or officer-in-charge). Congestion brings traffic to a stand-still at peak hours, reminiscent of the worst we experienced in India and China.

The majority of homes are without running water, electricity, or means of sanitation. and charcoal fires are still used for cooking and heating. Rapid population growth, increasing migration from rural areas to urban centers, and squatter shantytowns exacerbate the problems.