Background : Located in the Indian Ocean, the Comoros archipelago consists of four islands. Three of them, Grande Comore, Anjouan and Mohéli, form a sovereign state : the Union of the Comoros. The fourth, Mayotte, has the status of a French overseas department. Malaria is endemic and remained a major public health problem in this area until recent years.
The control strategies deployed by the 2 states since the early 2000s are close, combining use of rapid diagnostic test, artemisinin-based combination as first-line drug, vector control by residual spraying and long-lasting insecticidal nets distribution. In addition, the Union of the Comoros has carried out mass drug administration campaigns. Are these malaria control programmes effective ?
Results : In the Union of the Comoros, 169 550 cases were recorded from 2010 to 2016. The annual incidence decreased from 49,7 in 2010 (36 538 cases) to 2,08 per 1,000 inhabitants in 2016 (1657 cases). Progress varies between the 3 islands. Two of them entered the elimination phase with an incidence below 1‰ in 2016 : Anjouan 0,03 (10 cases) and Mohéli 0,11 (6 cases). However the incidence remains above the threshold of 1 in Grande Comore : 4,05 (1641 cases) in 2016.
From 2002 to 2017, 4808 cases were reported on Mayotte island where the annual incidence dropped from 10,3 in 2002 (1649 cases) to 0,04 per 1,000 inhabitants in 2017 (9 cases). The incidence is below 1‰ since 2010. In 2014 Mayotte was declared by WHO to be in the elimination phase.
Conclusion : The Comoros archipelago is on track for a malaria elimination. The continuation of the current fight undertaken by the two states, by improving cooperation between them in order to harmonize their practices, should make it possible to gain the status of malaria-free area in the near future.