After independence in 1975, the French withdrew their medical teams, leaving the three islands' already rudimentary health care system in a state of severe crisis. French assistance was eventually resumed, and other nations also contributed medical assistance to the young republic. Despite improvements in life expectancy and the infant mortality rate, Comoros in 1993 continued to face public health problems characteristic of developing countries.
Life expectancy at birth was estimated at fifty-six years in 1990, up from fifty-one years in 1980. The crude birthrate was forty-eight per 1,000 and the crude death rate, twelve per 1,000 according to 1989 statistics. All three of these figures were close to the averages for sub-Saharan Africa. The rate of infant mortality per 1,000 live births was eighty-nine in 1991, down from 113 in 1980. The 1990 average rate for sub-Saharan Africa was 107.
Malaria was ubiquitous in the islands, with 80 to 90 percent of the population said to be affected by the disease. Other prevalent maladies included tuberculosis, leprosy, and parasitic diseases. In 1989 about half of all children one year old or younger had been immunized against tuberculosis, diphtheria, pertussis, tetanus, polio, and measles, a proportion roughly comparable to the rate of immunization among other states in subSaharan Africa. Per capita daily caloric intake in 1988 was 2,046, about average for sub-Saharan Africa but only a little better than 90 percent of daily requirements. Children were most often the victims of malnutrition. Their generally poor diets were deficient in protein in part because local custom discouraged the feeding of fish to children. The scarcity of safe drinking water--available to about one in three Comorans--made intestinal parasites a problem and compounded malnutrition, with children again being the main victims.
The World Bank estimated that in 1993 Comoros had one physician per 6,582 Comorans, a marked improvement over the ratio of one to 13,810 reported in 1983. Comparable data for subSaharan Africa as a whole were not available; however, it appeared that Comorans enjoyed a more favorable ratio than many of their neighbors in East Africa and the Indian Ocean.
Despite improvements in life expectancy, infant mortality, and the number of physicians, the overall quality of care remained poor. About 80 percent of the population lives within one hour's walk of a health facility, usually headed by a trained nurse, but paramedical staff are in short supply and many health facilities are in poor condition. Some international medical aid has been provided, mostly by France and the World Health Organization (WHO).
Although Comoros lacks homegrown narcotics, the islands are used as a transit site for drugs coming mainly from Madagascar. In view of international concern about drug trafficking, in 1993 France began providing technical expertise in this field to Comoros. In addition, the World Bank in a 1994 report pointed out the "high prevalence of sexually transmitted diseases and the low use of condoms" as a significant health threat with regard to the spread of acquired immune deficiency syndrome (AIDS), which already affected the islands. However, in the period prior to 1990 and extending through 1992, the WHO reported that Comoros had a very low incidence of AIDS--a total of three cases with no case reported in 1992, or an overall case rate of 0.1 per 100,000 population.
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