In Madagascar, leprosy continues to pose a significant public health challenge, with between 1,500 and 2,000 new cases reported annually. The disease is endemic in 37 remote districts across 16 of the country’s 24 regions. In 2024, 1,713 new cases were recorded, and nearly 350 people—about 20 percent of all cases—live with permanent disabilities caused by late diagnosis. These figures place Madagascar among the 23 priority countries identified by the World Health Organization (WHO) for leprosy control.
Strengthened detection efforts, particularly through annual screening campaigns in the most affected regions, have allowed the country to intensify early management, limit disabilities, and provide post-exposure prophylaxis to break chains of transmission. In the Ambatoboeny district, one of the most endemic areas, the detection rate is around 40 cases per 100,000 inhabitants, compared to the national average of 5 per 100,000. The number of newly diagnosed cases in Ambatoboeny rose from 95 in 2024 to 132 in 2025, demonstrating the effectiveness of active case-finding and early diagnosis strategies.
Geographical isolation and seasonal flooding from the Kamoro and Betsiboka rivers limit access to screening and treatment for some communities. These challenges are compounded by deep-rooted beliefs that fuel stigma, delay diagnosis, and expose patients to severe forms of the disease. Leprosy is often mistakenly considered hereditary, a social taboo, or linked to witchcraft, which prevents timely care.
To address these obstacles, the Ministry of Health, with support from WHO and the Raoul Follereau Foundation, organizes annual active screening campaigns in endemic districts. Intensified leprosy control in Ambatoboeny, launched in 2023, focuses on early diagnosis to reduce disabilities and the use of post-exposure chemoprophylaxis to interrupt transmission. Community health workers mobilize residents through radio broadcasts and posters in local languages to maximize participation.
Data from recent campaigns highlight the impact of this proactive approach. In 2023, 64 of 110 new cases were identified through active screening; in 2024, 62 of 95 cases were detected this way. In November 2025, 16 new cases were found among 91 people screened, and eight previously lost-to-follow-up patients were reintegrated into care. Notably, no new cases were reported among children under 14, signaling progress in reducing transmission.
Healthcare officials emphasize the importance of early detection. Active case finding allows immediate examination and treatment, breaking transmission chains and preventing severe disabilities. It also helps locate patients who had interrupted treatment and reintegrate them into care. Campaigns contribute to reducing stigma, restoring dignity, and ensuring highly isolated populations access both screening and treatment.
This integrated approach aligns with WHO’s strategy to eliminate leprosy by 2030. WHO supports clinician training to detect atypical cases, equips community health workers for awareness and anti-stigma initiatives, and provides specialized diagnostic tools such as PCR testing on nerve biopsies and nerve ultrasound. Free multidrug therapy ensures continuous treatment to prevent disabilities and reduce transmission.
WHO representatives highlight that reaching vulnerable communities is crucial to breaking transmission chains, protecting the most at-risk populations, and advancing toward the elimination of leprosy in Madagascar. The combination of community engagement, operational strategy, screening, and free treatment is central to safeguarding health, reducing disability, and combating long-standing stigma associated with the disease.
