Patients infected with the plague are escaping from hospital because they are afraid of needles - sparking fears the disease could spread across ten countries.

Doctors in Madagascar are currently treating people suffering from the highly contagious disease.

However, many people are not used to hospitals with reports some are scared of needles.

Security guards at the Central Anti-Plague Hospital Ambohimindra in the island's capital, Antananarivo, have been stopping patients from running away.

In October, one was forced back into an ambulance after managing to escape.

Jean Benoit Manhes, deputy representative of UNICEF, told the Irish Times: "People here are not used to the hospital.

A doctor helps a little girl put on a protective mask
The health centre where patients are kept

"The problem of plague is not just a medical response. You can have hospitals but if people don't come it isn't enough."

So far, since October 4, 907 people have died and 12,621 people have become infected.

Two thirds of cases have been caused by the airborne pneumonic plague, which can spread through coughing, sneezing or spitting and kill within 24 hours.

Alarmingly, doctors and nurses who are supposed to be looking after the sick have already been struck down with the disease.

An employee of the Plague Triage and Treatment Center in charge of disinfection and sanitation entering the centre
A woman in quarantine as she recovers from the plague

There are now concerns hospitals will soon baulk under the pressure if it continues to spread.

They also fear it will mutate and become resistant to antibiotics

Others worry it will hit the western world such as the US, Europe and Britain, leaving millions more vulnerable due to how quickly it can spread.

Melle Marie Flrencia, 22, playing cards with other patients at the Plague Triage Treatment Centre in Toamasina
Cleaning piles of garbage, to deter rats which carry the plague

South Africa, the Seychelles, Kenya, Ethiopia, La Reunion, Tanzania, Mauritius and Comoros have all been warned they are at risk of an outbreak.

The ancient ritual of Famadihana, which sees people dig up the tombs of their loved ones, could be fuelling the outbreaking.

As a result, officials have enforced a rule which says plague victims cannot be buried in a tomb which can be reopened.

Willy Randriamarotia, the Madagascan health ministry's chief of staff, said: "If a person dies of pneumonic plague and is then interred in a tomb that is subsequently opened for a Famadihana, the bacteria can still be transmitted and contaminate whoever handles the body."