Early Detection Shifts the Tide in Madagascar’s Long Fight Against Leprosy

ANTANANARIVO — In many parts of the world, leprosy is often spoken of as a disease of the past. In Madagascar, it remains a present and persistent public health challenge. Each year, between 1,500 and 2,000 new cases are recorded, placing the island nation among the World Health Organisation’s 23 priority countries for leprosy control. But a growing focus on early detection is beginning to change the trajectory of the disease and the lives of those it affects.

According to the Ministry of Public Health, leprosy remains endemic in 37 remote districts across 16 of Madagascar’s 24 regions. In 2024 alone, 1,713 new cases were identified. Alarmingly, nearly one in five patients was already living with permanent disabilities by the time of diagnosis, a clear sign that the disease is often detected too late.

Health authorities say this is precisely what they are trying to reverse.

Over the past three years, Madagascar has intensified active case-finding efforts, particularly in the country’s most affected regions. Annual screening campaigns, supported by the WHO and partners such as the Raoul Follereau Foundation, are bringing clinicians and community health workers directly into hard-to-reach communities.

The results are striking. In Ambatoboeny district, one of the most leprosy-affected areas in the country, detection rates stand at around 40 cases per 100,000 people, compared to a national average of about 5 per 100,000. New diagnoses rose from 95 cases in 2024 to 132 in 2025.

Rather than signalling a worsening epidemic, health officials say the increase reflects something more hopeful: people are being found earlier, before irreversible nerve damage sets in.

“Active case finding allows us to identify, examine and treat patients immediately,” said Dr Cécile Lusta Rasoamanana, head of the leprosy control unit at the Ambatoboeny District Public Health Service. “It breaks the chain of transmission and prevents severe and irreversible disabilities.”

Madagascar’s geography plays a major role in delayed diagnosis. In districts like Ambatoboeny, seasonal flooding of the Kamoro and Betsiboka rivers can cut off entire communities for months at a time. During these periods, access to health facilities is virtually impossible.

“These physical barriers mean that many people miss routine screenings and start treatment far too late,” explained a public health official involved in the programme. “By the time they reach care, nerve damage has often already occurred.”

The challenge is compounded by poverty, limited transport infrastructure and shortages of trained health workers in rural areas.

Beyond geography, stigma remains one of the most powerful obstacles to early diagnosis. In some communities, leprosy is still believed to be hereditary, a curse, or the result of witchcraft. These beliefs often lead people to hide symptoms until the disease becomes impossible to ignore.

For Freddy, a 24-year-old cart driver and father of one, that delay nearly cost him his livelihood.

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“For months, I felt numbness and burning in my leg,” he recalled. “Sometimes it felt paralysed. People started mocking me because of the patches on my skin.”

It was only when a mobile screening team arrived in his area in November 2025 that he sought help. “I never imagined it was leprosy,” he said. “But now I know it can be treated. I just want to get better and take care of my family.”

Health workers say Freddy’s story is common and underscores why community engagement is just as important as medical treatment.

Radio broadcasts in local languages, posters, and door-to-door mobilisation by community health workers are all used to spread a simple message: leprosy is curable, and early treatment prevents disability.

Data from Ambatoboeny suggests the strategy is paying off. In 2023, 64 of the district’s 110 new cases were identified through active screening. In 2024, that figure rose to 62 out of 95 cases. During the November 2025 campaign, 16 new cases were detected among just 91 people screened.

Crucially, no new cases were recorded among children under the age of 14, an encouraging indicator that transmission may be slowing.

“The absence of cases in children is a positive sign, though it must be confirmed with thorough contact follow-up,” said Dr Rasoamanana.

Campaigns have also helped locate patients who had previously dropped out of care. In 2025 alone, eight such individuals were traced and reintegrated into treatment, highlighting the importance of continuous follow-up in long-term disease control.

Madagascar’s efforts are part of the WHO’s global strategy to eliminate leprosy as a public health problem by 2030. The organisation supports the country through clinician training to identify atypical cases, specialised diagnostic tools such as PCR testing and nerve ultrasounds, and guaranteed free access to multidrug therapy.

“Reaching communities is essential to break transmission chains and protect the most vulnerable,” said Dr Laurent Musango, WHO Representative in Madagascar. “Our goal is clear: reduce disabilities linked to leprosy, break stigma and protect every community.”

Leprosy may no longer dominate global headlines, but in Madagascar, it remains a daily reality for thousands. Yet the shift toward early detection, community engagement and sustained follow-up is offering something long missing from the fight against the disease: momentum.