Introduced in the early 18th century in Ile de France, presently Mauritius, an isolated undeveloped uninhabited island situated in the Indian Ocean and part of the sub Saharan African region by immigrant settlers from Europe who over the years, a span of about 2 centuries, brought slaves and indentured labourers from Africa, Madagascar and Asia as manpower to develop the place, Tuberculosis (TB) soon became a major health problem.
Introduced in the early 18th century in Ile de France, presently Mauritius, an isolated undeveloped uninhabited island situated in the Indian Ocean and part of the sub Saharan African region by immigrant settlers from Europe who over the years, a span of about 2 centuries, brought slaves and indentured labourers from Africa, Madagascar and Asia as manpower to develop the place, Tuberculosis (TB) soon became a major health problem.
It cannot be defined from which specific country TB reached the island, it was already prevalent in Europe, Africa and Asia as well. Under the existing local conditions, poverty and misery, no natural resources, relying on importation for all its needs, harsh living and working conditions specially for the slaves and indentured Indian workers, inadequate food, unsatisfactory housing and sanitary facilities, unavailable inaccessible health services, shortage of qualified health officers and frequently visited by devastating cyclones among others, the prevalence and incidence of TB increased considerably.
During the French colonization period by the French East India Company from 1715 to 1810, the slave trade between Africa, Madagascar and Ile de France flourished. Two hospitals, one in Port-Louis and the other in Mahébourg were built near the seaports essentially to meet the requirements for a port and for their navy and military officers. Two basic healthcare dispensing points, one in Pamplemousses and the other in Long Mountain, run by nuns from France, were opened for others, slaves included. This insufficient, if not absent, health coverage led to a high morbidity and mortality in the overall population and a decreasing workforce which was itself replaced with new arrivals again from Africa and Asia.
1810 saw the start of the British occupation of Mauritius. The slave trade despite the 1833 Abolition of Slavery Act passed in the British Parliament continued for good few years beyond. By 1834, there were about 70,000 slaves and 10,000 Europeans on the island. The British, well determined to establish themselves, needed working hands which they recruited as from 1833 from the poor rural areas in India, their other occupied country, under the indenture system to replace the African slaves refusing to work in the sugarcane plantations. Under the deplorable conditions in the sugar estates the newcomers also suffered. By the end of recruitment period, in 1920, about 450,000 indentured labourers had already arrived. With a continuous inflow from the above three continents and airborne man-to-man mode of transmission of the causative organism the TB burden rose considerably and had a direct impact on all. It was an alarming situation, measures had to be taken. A health services development plan with the aim to make health care available, accessible and affordable to all was elaborated. It basically divided the health sector into 2, preventive and curative divisions with infrastructural development, logistic support, trained staff, and a legal framework for action among others. The collaboration and expert guidance from international authorities namely the WHO ensured service delivery norms.
Mauritius, independent since 1968, has left no stone unturned to contain the disease. It has strengthened and decentralized the health services for a maximum health coverage of the island and its dependencies, the Outer Islands-Rodrigues, Agalega, St Brandon. Through an action plan, it intervenes rapidly to contain the spread of the disease and has been able to reduce the TB burden rate of the island to the lowest in Africa since 2020s. The fight against TB is relentless.
We reproduce here some information which we have collected and hope that they will be of help to the readers, especially to those interested in Public Health.
Dates, Measures/Events
A Brief account
- Public Health Act (PHA) 40 of 1884. Strengthening of powers of the Sanitary Health Authority to act in cases of TB. Setting up of hospitals in sugar estate (SE) employing more than 40 labourers. Medical Officers visits X 2/3 per week.
- Poor Law Medical Service. Setting up of
(a) district hospitals mainly for SE workers
(b) A Medical and Health department with preventive and curative sections.
- Healthcare dispensing points. Already 7 district hospitals operational: The Civil Hosp in Port-Louis; Barkly Hospital in Plaines Wilhems; one in Pamplemousses, Flacq, Long Mountain, Mahébourg and Souillac.
- Isolation. A special ward for TB Patients opened at The Civil Hospital.
- Care for vulnerable groups. Setting up of a Maternal and Child Welfare Society for improving mother and child health specially those in the high risk group.
- PHA 47 of 1925. Enforcement of public health regulation & disease control measures including treatment should be given to all TB patients whether resident or nonresident, TB patients to refrain from undertaking work where there is risk of disease propagation, obligatory contact tracing.
PHA- Ordinance 24 of 1925. TB became an obligatory notifiable disease
Setting up of a curative and preventive section with decentralization of services within the medical and health department.
Preventive. Introduction of vaccination in MRU BCG & oral vaccination .
- Preventive. Overall no. of vaccinated cases : 10,299.
- Preventive. BCG Vaccination given to hospital staff and children who have been in contact with Tb patients.
- Statistics. TB incidence 400/500 per year.
Ordinance 33 of 1949. Reinforcement of PHA sanitary measures for obligatory TB notification.
Survey. TB incidence 400, population 499,400.
Training. A Medical Officer, Dr. Fakim, sent for training in Tuberculosis.
Preventive. Immunization against TB made compulsory for all neonates and booster dose at primary school entry age.
- Preventive. Mass vaccination campaign under Dr. A Wagner started.
All school children to be vaccinated. New primary school entrants in Port-Louis vaccinated.
Act 85 of 1951. The Edgar Laurent Tuberculosis Foundation Act passed. It basically calls for close cooperation between the public/private/community against TB.
- Curative. Upon return of TB specialist Dr. Fakim, a TB ward and a Chest Clinic were opened in Victoria Hospital, followed by same wards in the district hospitals. A 50 bed TB ward was made available at the Orthopaedic Hospital in Floréal.
Curative. Altogether 225 beds available in the island for TB inpatient care.
1956-1958.
Screening. TB sensitivity Survey was carried out by WHO. It revealed a 20% infection rate among those below 19 years and 55% in adults.
- Curative. Opening of The Sir Edgar Laurent Chest Clinic, built by funds from the same foundation. TB patient care transferred from the Civil Hospital to the clinic which eventually became the TB treatment centre for the whole island.
- Preventive. BCG vaccination to new primary school entrants in whole island.
- Infrastructure. Several hospitals destroyed during the cyclone Carol. Conversion of the Pointe–aux-Cannoniers quarantine centre into a Tuberculosis hospital. Closure of Tb wards in Long Mountain, Moka, Souillac hospital.
- Preventive. Neonatal vaccination for neonates in Plaines Wilhems.
- 1 Infrastructure. Closure of TB ward in Flacq Hospital.
- Preventive. Neonatal vaccination program extended to all regions.
- Infrastructure. The SSR National Hospital opened in Pamplemousses. Survey of TB prevalence in whole island by case finding method by mobile Chest XRay by the Health dept.
- Infrastructure. Poudre D’Or Hospital converted into a Central Hospital for Chest Diseases.
Survey. TB incidence 300, population 805,489.
- Infrastructure. A central TB Lab set up next to the Chest Clinic Port-Louis to reduce the workload on the Tb lab at Victoria hospital. Closure of TB wards in Victoria, Civil, Pointe-aux-Cannoniers Hospital. Survey. MMR Odelca Units installed at SSRN hospital and Princess Margaret Orthopaedic Centre.
- Services. Sir E.Laurent Foundation Fund donates a vehicle to the Chest Clinic for domiciliary distribution of anti TB medicine and contact tracing.
- Survey. Visit of WHO expert Dr. Kochi 26th-31st August to evaluate the present and advise on measures to improve the situation.
- Preventive. Pre-arrival compulsory TB screening in their country of origin for any foreigner who wishes to take up employment in Mauritius.
- PHA 2006. Provides a legal framework to the 1925 Act.
- Services. Decentralization of the services, TB care in the 5 regional hospitals.
- Act 1 of 2020. Spitting in public became an offence liable for prosecution.
- PH Regulations. Emphasis on Infectious Diseases Control :
Case reporting/testing/Isolation/Penalties for non- compliance.
Ongoing Measures Diagnosis
Early diagnosis is the aim. Advances in the scientific fields have simplified diagnostic procedures. Mauritius offers a free public health service through a network of healthcare points – community health centres, area health centres, mediclinics, district hospitals, regional hospitals, The Chest Clinic, Poudre D’Or Central Hospital for Chest Diseases to all its citizens.
The school health program includes screening for TB among primary students.
The private health institutions, clinics and hospitals run a paying service, infectious diseases included.
Treatment and Care Management. Treatment is as per an established protocol by a team of health professionals under the responsibility of the Consultant–in-Charge at the Chest Clinic, Port-Louis and Central Hospital for Chest Diseases at Poudre D’Or with follow-up in the outstations need be.
The authorities may have recourse to legal action against defaulter patients.
Record keeping. Registration of confirmed positive TB cases are done as per
Year/month/Serial no/date/Surname/Name/age/Gender/Complete residential address – house no, road, locality/village/town/Country (if applicable)
A master register is kept at The Chest Clinic, Port-Louis for all TB cases irrespective of their site of treatment public or private institutions.
As TB is related to socio-economic status info on same – job occupation is obtained during history taking.
That anti TB medication is dispensed only against prescription only at the Chest Clinic Port-Louis ensures that all receiving said care get duly registered.
A notification sheet is forwarded to the Health Statistics dept, MOH and Wellness within the shortest delay for any new case of Tb registered at any time of the year.
Early Contact Tracing. Mauritius has a good road network and telecommunications system thus making contact with any region possible almost within a day.
Procurement of Anti TB medication. The anti TB drugs are solely imported by the MOH QL.
The Pharmacy Board monitors the supply regularly to avoid any shortage at any time.
Training. The Government ensures that the Ministry of Health and Wellness – The Chest Clinic is staffed with qualified personnel by investing on the training of the health-medical/paramedical personnel through scholarships abroad or granting study leave.
Collaboration with the University of Mauritius, and other local educational institutions for studies in Public Health.
Collaboration with the French Universities-Université de Bordeaux for post graduate courses in Public Health for Medical and Health officers.
Collaboration with International organizations for training courses for both medical and paramedical staff locally
On the job training with the continuous professional development courses, clinical attachment of Medical officers in the Chest Disease Hosp at Poudre D’Or.
Strengthening of measures in the fight against TB
Support to patients. A financial assistance is given to needy patients laid off from work during their treatment
Legal. Amendment of acts, ordinances, laws to empower the sanitary health authorities for enforcement of the regulations, penalization if convicted or other measures.
Community Participation. Inter/intrasectoral collaboration with other ministries eg Min of Education, Family Welfare, Social Security.
Health information, education, communication campaign with NGOs.
Monitoring and Evaluation of Activity. The TB situation in the country is regularly evaluated with studies carried out in the Ministry of Health and Wellness and jointly with the Ministry of Education. The findings are forwarded to the concerned parties for the necessary.
Conclusion
Mauritius has moved from a high TB risk country to one with the lowest TB burden rate and incidence rate of 12 cases per 100,000 population (2023) in the African region due to the commitment of the policy makers, dedication of the health services and active community participation in the fight against TB. It has an organized infrastructure and a well-defined plan of action to intervene at any time. Advances in the care and management of TB and improvement in the living standards and quality of life, Mauritius having one of the highest GDP in Africa, have been the main contributing factors for this progress. However, Mauritius, an island of 2,040 km², with a population of about 1.3 million inhabitants including about 35,000 migrant workers (2025) – one of the most densely populated country in the world – has to maintain with regional and international collaboration its vigilance for the constant safeguard of its population’s health.
Dr Mala Modun-Bissessur
(LRCP LRCS I DPH)
See references of this paper on lemauricien.com.
References
Registre Medical Chest Clinic, Port-Louis
Actions for life –WHO publications
Tuberculosis Aide Mémoire OMS
Tuberculosis Wikipedia Encyclopedia
Tuberculosis Net Doctor
Encyclopedie Medical Doctissimo
Health Statistics Annual Publications Mauritius
Treatment of Tuberculosis Guideliness for National Programmes
Housing and Population Census Report
Mémoires Historiques de F.Bertrand Mahé de La Bourdonnais
