Health officials say 32 people have died as a result of an outbreak of bubonic plague in the African island state of Madagascar.

Some 84 cases of bubonic plague, 60 of them suspected of being pneumonic or pulmonary plague, a more virulent strain, have been reported in five of the island’s 112 districts in the past month. Last year, Madagascar reported 60 deaths from bubonic plague. Poor hygiene and declining living standards as a result of a protracted political crisis since a coup in 2009 are cited as the primary causes of the spread of the disease.

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