Project coordination
National Leprosy Control Program of Madagascar
Partners
Hôpital militaire d'Antananarivo
Leiden University Medical Center (LUMC)
Institute of Tropical Medicine
Fondation Mérieux, Scientific and Medical Department
School Health Service, Ministry of education
Fondation Raoul Follereau
Centre d'Infectiologie Charles Merrieux
Aim: To co-develop, evaluate and constantly improve a school-based intervention that consists of (i) sensitizing school children and staff about leprosy and scabies, and (ii) active screening of leprosy and scabies among school children, with the aim of increasing knowledge about skin diseases and the acceptability of medical interventions such as clinical screening and blood sampling for anti PGL-I test at community level.
Full project title:
Empowering Young Minds: A School-Based Strategy to Combat Skin Neglected Tropical Diseases in Madagascar
Project summary:
Access to healthcare remains a major challenge in Madagascar. More than 60% of the population lives over five kilometres from a health centre, and only a small proportion of people living in extreme poverty benefit from financial support for healthcare. However, barriers to healthcare are not limited to distance and cost. Even when services are available, they are not always accepted or viewed as the preferred source of care. Previous studies, including our earlier research on post-exposure prophylaxis for leprosy, have shown that healthcare interventions do not always achieve the expected level of community uptake.
These challenges contribute to ongoing health problems across the country. Madagascar faces a dual burden of disease, with both communicable diseases and chronic conditions such as diabetes and hypertension affecting the population. Among the most neglected conditions are leprosy and scabies, which continue to disproportionately impact vulnerable communities.
Leprosy remains a public health concern in Madagascar. In 2023, children accounted for 6% of newly diagnosed leprosy cases, a figure that has remained largely unchanged over the past five years. This persistent level of transmission presents a challenge to the World Health Organization's goal of eliminating leprosy by 2030. For scabies, reliable national data remain limited, although the Ministry of Health regularly receives reports of outbreaks. For both diseases, cases are often detected late because many people only seek care when symptoms become severe. These delays highlight the need for greater awareness and earlier detection.
The World Health Organization recommends involving schools in health promotion activities. By learning about disease prevention and sharing that knowledge with their families and communities, children can become important agents of change. Although similar school-based approaches have shown promising results in other countries, no child-centred strategy has yet been tested in Madagascar.
This project aims to evaluate such an approach over a three-year period. The study will be conducted in primary schools across four regions of Madagascar, including both urban and rural settings with varying levels of leprosy and scabies occurrence. The research will explore how children, teachers, and community members understand these diseases and how they respond to interventions such as health education, medical screening, and biological sample collection.
Working closely with schoolchildren and teachers, the project will develop a child-friendly awareness tool tailored to the school environment. Health education activities will be implemented alongside skin disease screening campaigns. The study will also collect finger-prick blood samples from healthy children who show no visible signs of leprosy to assess how many have been exposed to Mycobacterium leprae without developing disease. This information will be used as an indicator of disease transmission within the wider community. Participation in this component of the study will be limited to children whose parents or guardians have provided informed consent.
To evaluate the effectiveness of the intervention, Knowledge, Attitudes, and Practices (KAP) surveys will be conducted before and after the awareness campaigns. The findings will help assess changes in awareness, perceptions, and behaviours related to leprosy and scabies.
By generating evidence on the role of schools and children in disease awareness and early detection, the project seeks to inform new approaches to the control of neglected skin diseases in Madagascar and other similar settings.