Leprosy in Sub-Saharan Africa
Leprosy has afflicted humans since ancient times with molecular evidence showing Eastern Africa probably played a more significant role in its global spread. The tide turned against the disease in the 1980s when effective multidrug therapy (MDT) was introduced worldwide. By 2005, all countries in sub-Saharan Africa had attained the WHO elimination target of prevalence less than 1 per 10,000 population. In 2021, Africa accounted for 15% of global leprosy new case detection, with a worrying number of new cases having significant disability at diagnosis. Public stigma has also contributed to the persistence of segregated settlements for leprosy sufferers long after cure. Leprosy spread is believed to be by droplet and skin transmission, with growing evidence for zoonotic spread from infected armadillos, a species not found outside the Americas. The presentation of leprosy in sub-Saharan Africa is as elsewhere, varying between two polar states of tuberculoid and lepromatous leprosy and modified by complications, including acute reactions. No case in sub-Saharan Africa has been linked to the recently discovered Mycobacterium lepromatosis.
Clinical diagnosis and classification of leprosy at present are most amenable for treatment purposes, with the continuous supply of MDT being the backbone of leprosy control activities. A fixed-duration course of rifampicin, dapsone, and clofazimine remains the mainstay of treatment. There is now a greater push toward interrupting leprosy transmission with contact tracing and leprosy prevention with SDR being key strategies. Also vitally important is the needed strengthening of weak African healthcare systems within which integrated leprosy services are provided as well as increased involvement of sufferers and communities.
Leprosy control activities are now suffering from reduced attention on both global and subregional scales, and the knowledge of frontline healthcare workers regarding leprosy is dwindling. With leprosy likely to remain with us for the foreseeable future, more research, political commitment, and collaborative action are required to sustain the gains and move Africa and the rest of the world toward zero leprosy—i.e., zero disease, zero disability, and zero discrimination and stigma.