The resistance of Xenopsylla cheopis from urban area to pyrethroids, to DDT, and their susceptibility to carbamate are known. We have evaluated the susceptibility of X. cheopis collected from three rural localities: Ambodisiarivo (district of Antananarivo Avaradrano), Mandoto (district of Betafo), Analaroa (district of Anjozorobe) in the province of Antananarivo and in Besoa (district of Ambalavao) in the province of Fianarantsoa. The standard WHO protocol was used and four insecticides were tested: deltamethrin 0.025%, cyfluthrin 0.15% (pyrethroids), DDT 4% (organochlorine), propoxur 1% and bendiocarb 0.1% (carbamate). X. cheopis has been shown resistance to DDT 4%, to deltamethrin 0.025% but was susceptible in the rural area around Antananarivo City. They were tolerant to deltamethrin 0.025% and cyfluthrin 0.15% but susceptible to propoxur 0.1% and bendiocarbe 1% in the districts of Betafo and Anjozorobe. In Besoa, X. cheopis was resistant to DDT 4%, tolerant to deltamethrin 0.025% and cyfluthrin 0.15% but susceptible to propoxur 0.1% and bendiocarbe 1%. These results indicate that DDT and pyrethroids can not be recommended any more for the vector control in the rural area around the capital. The use of pyrethroids in the other districts of the central highland must be joined with a X. cheopis susceptibility control. In case of resistance to pyrethroids, carbamates would be proposed to control plague vector in the rural area. The high level of resistance to DDT and pyrethroid in the rural area around the capital confirms the importance of studying the flea population in different area of Madagascar and the possibility of the gene resistance propagation.