A diversity of ethnic groups are found in the province, including Anjoaty, Sakalava, Antakarana, Tsimihety, Antemoro, Betsimisaraka, Antandroy, etc.

On 29 May, Japanese submarine I-10 surfaced off the coast and launched a Nakajima A6M2-N reconnaissance aircraft over the port.

The province has been described as being "virtually isolated", because of Mt Tsaratanana, the highest peak, being situated in it at 2,800 metres (9,200 ft) above sea level.

[3] With an average annual rainfall of about 2,000 millimetres (79 in),[3] the underlying rocks are susceptible to erosion, thereby producing caves and underground rivers—a karst topography.

The rugged relief and the dense vegetation have helped protect the region from human intrusion.

[8] An unusual percentage of children in the province have been reported to be suffering from anemia, as high as 70% in some parts.