Cyclone Ivan, the worst to hit Madagascar in several years, has claimed at least 44 lives, and left 145,000 people homeless. VOA's Delia Robertson reports from our southern Africa bureau in Johannesburg.

The National Office for Natural Disasters Preparedness (BNGRC) and humanitarian organizations in the cyclone-prone country say that the full extent of the damage caused by high winds and flooding is being revealed now that the torrential rains which followed Cyclone Ivan in Madagascar have lifted.

In addition to the cost in human lives and damage to private homes, the cyclone and flooding have damaged roads, communications and other infrastructure, and caused contamination to water supplies. UNICEF Emergency Specialist Edouard Libeau, says the major concern right now is prevention of water-borne and other diseases such as malaria.

"Urgent action is crucial to prevent outbreak of diseases actually... outbreak of diseases is of great concern at the onset of such a crisis - especially among the children," he said.

Libeau says that emergency packs that include water purification tablets, soap and medications to combat diarrhea are being distributed across the country. Where there is no access by road, helicopters and boats are being used.

Relief agencies say the damage to the rice crop has been severe and will result in food shortages in the coming months. In addition, says UNICEF'S Libeau, seeds will be needed next month to ensure the next harvest.

"And then you have to think about distributing seeds and this should be before the the end of March, because otherwise you miss the next planting season," he said. "And you are going to start to have a food insecurity lasting and lasting without having any capacity for the population to recover."

Libeau notes that in recent years the government of Madagascar has built cyclone response into its development plans and that this year the country was well prepared having pre-positioned short-term emergency and relief supplies.

But he notes that in the long term, Madagascar will need to look at building and other technologies that will much more significantly cushion the population against cyclone damage.