They line the charming cobbled streets and terraced shop entrances. Children in tattered rags scour the alleyways begging for spare change.
Teenage mothers carrying infants wrapped in tea-towels walk barefoot, pleading with the well-dressed to buy postcards, fresh flowers or vanilla sticks.
"Sir, if you don't buy something, my baby won't eat," cries one woman as a tourist impatiently brushes her aside.
Outside French restaurants serving foie gras and champagne, old beggars sleep rough and prostitutes solicit on every street corner, hoping to get lucky with a meal or a taxi fare.
Just a short walk down dusty alleyways from here, is Isotre, one of the city's burgeoning slums where the really privileged are those with enough to eat.
For the three quarters of people in the huge Indian Ocean island of Madagascar who live on less than a dollar a day, the challenge to survive is getting tougher amid spiralling prices.
A surge in living costs has worsened the plight of many in the already desperately poor country, with prices soaring for even the most basic staples such as rice.
Analysts say a combination of record high oil prices, cyclone damage to domestic and export crops and a collapse in the Malagasy franc fuelled runaway inflation averaging between 5 and 6 percent in the six months to June.
Cyclones Elita and Gafilo, which hit the island in January and March, left 300,000 homeless and ravaged rice plantations. Cash crops like cocoa, coffee and vanilla were also damaged, hurting the country's predominantly rural export economy.
In Antananarivo's dusty roadside markets, a kilo (2.2 lb) of rice, the basic food for the vast majority of people, is on sale for 3,500 francs, up 75 percent since January.
The price hikes have sparked big street demonstrations.
"It's really making us suffer," said Charlene Rasoarimalala, who ekes out a living sifting through rubbish dumps for scrap she can sell. "We have the same money, but since the cyclones everything is double."
The 21-year-old supports four children and her unemployed husband, all living in a tin-roofed shack. "We used to have enough but now just to get a cup of rice every day is a hard thing. But we have to just face it. What can we do?" she said.
Analysts say Madagascar's inflationary crisis could get worse before it get better.
"The price rises will not stop immediately," said Joseph Rakotomanga, director of research at the central bank.
"But at least the franc has stabilised after being under pressure. This was a big part of the problem. Inflation should now come under control with time."
Economists say Madagascar's growth remains robust despite the inflationary shocks, and the central bank puts annualised gross domestic product growth at 5.3 percent this year.
But they said the vast island's poorest have yet to benefit from the expansion.
"The problem they're now having is translating that growth into poverty reduction," one leading economist told Reuters.
Tsilavo Randrianjafy, who hammers scrap metal into crude household items, is one of many in Antananarivo's Isotore slum who have yet to see any benefits. But he still says he is lucky.
On a good day, the 23-year-old normally takes home $1.20 after hours working in the sun beside hawkers desperately trying to sell their tangerines and tomatoes before they rot.
"My work is enough to buy rice for my wife and children most days," he said. "Not everyone living here can say that."
For Pierre, a 43-year-old taxi driver, the biggest concern remains soaring prices for petrol and rice.
"Our petrol is 9,000 francs, when it was only 6,000 in January, so we taxis increased our fares," he said. "But now who can afford the fares?"