title: Major decline in malaria morbidity and mortality in the Union of Comoros between 2010 and 2014: The effect of a combination of prevention and control measures.
abstract: BACKGROUND
  Malaria remains a public health challenge in sub-Saharan Africa. In response to this, many countries are working towards achieving the World Health Assembly and Roll Back Malaria Partnership target of a 75% decline in malaria incidence.
  
  
  OBJECTIVE
  To assess trends in malaria morbidity and mortality in the three islands of the Comoros Archipelago from 2010 to 2014.
  
  
  METHODS
  This was a retrospective study in which all confirmed malaria cases and deaths recorded between 2010 and 2014 were accessed from the national malaria control database. Trends and comparisons in malaria incidence and case fatality rates for all age groups, including under-5 children and pregnant women, were analysed using Microsoft Excel and SPSS version 16.
  
  
  RESULTS
  A substantial decline in malaria incidence was observed for each island between 2010 and 2014; from 75.98 cases per 1 000 population in 2010 to 0.14 in 2014 in Moheli, 60.60 to 0.02 in Anjouan and 235.36 to 5.47 in Grand Comoro. Additionally, a general reduction in malaria case fatalities was observed. In Moheli, there were no case fatalities between 2010 and 2014, while there was a decline in the case fatality rate in Anjouan (from 1.20 fatalities per 1 000 cases to 0) and Grand Comoros (0.51 to 0). There were also significant differences (p&lt;0.05) in malaria incidence and case fatalities between the three islands. A similar trend was observed for pregnant women and under-5 children.
  
  
  CONCLUSIONS
  Our study indicates a significant decline in malaria morbidity and mortality in the islands of Moheli, Anjouan and Grand Comoro from 2010 to 2014. This considerable reduction is attributed to a combination of malaria prevention and control interventions implemented during the study period.
authors.affiliation: School of International Economics and Trade, China Pharmaceutical University, Nanjing, China; Department of Internal Medicine - Gastroenterology, Southern Medical University, Guangzhou, China. saidabasse2000@yahoo.fr.
authors.forename: Said Abasse
authors.initials: SA
authors.lastname: Kassim
authors.forename: Peter Bai
authors.initials: PB
authors.lastname: James
authors.forename: Rachel Nammahime
authors.initials: RN
authors.lastname: Alolga
authors.forename: Assogba Gabin
authors.initials: AG
authors.lastname: Assanhou
authors.forename: Said Mohamed
authors.initials: SM
authors.lastname: Kassim
authors.forename: Anfane
authors.initials: A
authors.lastname: Bacar
authors.forename: Rahamatou
authors.initials: R
authors.lastname: Silai
authors.forename: Lei
authors.initials: L
authors.lastname: Tian
authors.forename: Hongchao
authors.initials: H
authors.lastname: Li
authors.forename: Aixia
authors.initials: A
authors.lastname: Ma