A virulent flu-like illness has killed at least 283 people on the giant Indian Ocean island of Madagascar and the death toll is likely to rise.
"We have a total of 3,857 cases, and 283 deaths," a health ministry spokesman said.
The southern province of Fianarantsoa is the worst affected by the illness, which causes severe headaches followed by neck and chest pains, along with a dry cough, but the virus appears to be spreading.
It is unclear exactly when the outbreak started, but increasing numbers of cases have come to light in the last few weeks.
Most of those who have died have been unable to reach a hospital or health center, or relied on traditional health remedies that have failed to cure them.
Health experts say most of the victims are poor and undernourished, which makes them more vulnerable.
Madagascar has only just emerged from six months of political crisis, which devastated the already shaky economy on the island of 16 million off southeast Africa.