Early detection a game-changer in the fight against leprosy in Madagascar

Ambatoboeny - In Madagascar, leprosy remains a major public health concern. Each year, between 1500 and 2000 new cases are reported, placing the country among the 23 priority countries for the World Health Organization (WHO) in the fight against leprosy. The disease remains endemic in 37 remote districts across 16 of the country's 24 regions. In 2024, a total of 1713 new cases were recorded. Almost 350 people (20% of all cases) are living with permanent disabilities caused by leprosy, which indicates late diagnosis.

Thanks to strengthened detection efforts, particularly through annual screening campaigns organized in the most affected regions, the country is intensifying early management to limit disabilities and providing post exposure treatment to break chains of transmission.

In the district of Ambatoboeny, one of the most endemic areas of Madagascar, the detection rate of around 40% of cases per 100 000 inhabitants-compared with a national average of around 5% per 100 000-illustrates the seriousness of the situation. The number of people newly diagnosed with leprosy in the district increased from 95 in 2024 to 132 in 2025. This rise reveals the effectiveness of active case finding strategies and early diagnosis implemented in the field.

Geographical isolation, exacerbated by flooding of the Kamoro and Betsiboka rivers that makes some communities inaccessible for several months, deprives many people of early screening and regular access to treatment.
These physical barriers are compounded by deeply rooted beliefs that fuel stigma, delay diagnosis and expose patients to severe and disabling forms of the disease. For many, leprosy is still perceived as a hereditary illness, a social taboo, or the result of witchcraft.

To address these challenges, the Ministry of Health, with support from partners such as WHO and the Raoul Follereau Foundation, organizes annual active screening campaigns in endemic districts. Intensified leprosy control activities in Ambatoboeny began in 2023. They aim to strengthen case detection, reduce disabilities through early diagnosis and interrupt transmission chains through post exposure chemoprophylaxis.

In November 2025, it was during one of these campaigns that Freddy, a 24 year old cart driver, was diagnosed. "For several months, I had been suffering from numbness, burning sensations and a loss of sensation in my left leg. Sometimes it felt paralyzed, which affected my ability to work," explains the father of one.

The patches appearing on his skin exposed him to mockery and stigma, prompting him to take advantage of the arrival of medical teams to seek care. Freddy had never imagined he had leprosy. "I was surprised when the doctor told me it was leprosy. Now that I know what I have, I hope to get the treatment I need and regain my strength so I can provide a decent life for my family," he says.

During screening campaigns, community health workers ensure social mobilization. Radio announcements in local languages and the distribution of posters help reach as many people as possible.

Data highlights the effectiveness of this proactive approach. In 2023, the district of Ambatoboeny recorded 110 new leprosy cases, 64 of which were identified through active screening. In 2024, 62 of the 95 diagnosed cases came from this approach. In 2025, activities were strengthened with support from the WHO Madagascar country office. During the campaign held in November 2025, 16 new cases were detected among 91 people screened. Thanks to active strategies, eight patients who had previously been lost to follow up were also located and reintegrated into care-underscoring the importance of continuous and rigorous monitoring. No new cases were recorded among children under 14.

"The absence of cases in children is an encouraging sign that will need to be confirmed through thorough contact follow up," says Dr Cécile Lusta Rasoamanana, head of the leprosy control unit at the Ambatoboeny District Public Health Service. "Active case finding allows us to identify, examine and treat patients immediately. It breaks the chain of transmission and prevents severe and irreversible disabilities. It also helps us find people who stopped their treatment and reintegrate them into care. Beyond the medical aspect, this initiative is a reminder that leprosy is treatable and curable," she says.

These campaigns are also an opportunity to strengthen equity and combat stigma. "Highly isolated populations finally gain access to screening, treatment and information. This is an essential step in reducing disabilities, restoring the dignity of affected persons and dispelling longstanding misconceptions," emphasizes Dr Lovasosa Mbolamanana Andrianiriana, Head of the National Leprosy Control Programme at the Ministry of Public Health.

This integrated approach-combining community engagement, operational strategy, screening and free treatment-aligns with WHO's strategy to eliminate leprosy by 2030. WHO supports the training of clinicians to detect atypical forms of the disease and community health workers to conduct awareness raising and anti stigma efforts.

The Organization also provides specialized tools such as PCR testing on nerve biopsies and nerve ultrasound to enhance early detection. It ensures continuous free access to multidrug therapy, an essential treatment for preventing disabilities and reducing transmission.

"Reaching communities is essential to break transmission chains and protect the most vulnerable," says Dr Laurent Musango, WHO Representative in Madagascar. "Our goal is clear: reduce disabilities linked to leprosy, break stigma and protect every community. Together, we are advancing toward the elimination of leprosy in Madagascar."