Sustaining Leprosy Elimination in Sri Lanka: The Way Forward
Background: Leprosy (Hansen’s disease) remains a public health concern in Sri Lanka decades after achieving WHO elimination as a public health problem (<1 prevalence per 10,000) in 1995. Although prevalence targets were reached, new case detection rates have remained persistently elevated, with 1,000–2,000 new cases annually and evidence of ongoing transmission, including among children. Continued disability and social stigma complicate disease control.
Objectives: To evaluate current epidemiology, control efforts, and barriers to elimination in Sri Lanka, and propose an evidence-based way forward, aligned with the WHO “Towards Zero Leprosy” Strategy (2021–2030).
Methods: A mixed-methods approach was used, combining national surveillance data (Ministry of Health and Anti-Leprosy Campaign), active case finding surveys, quality of life and stigma studies, and review of global control strategies. Quantitative data on annual case detection rates by age, disability, and geographic region were compiled. A narrative synthesis of interventions and outcomes was undertaken.
Results: Sri Lanka reports approximately 1,500–2,000 new leprosy cases annually, with about 10% in children. Case detection rates fluctuate between 7 and 12 per 100,000 population. Grade 2 disability proportions (visible deformities) range from 6–8%, indicating delayed diagnosis. Active case finding in endemic districts reveals hidden disease burdens (~20/10,000 in targeted surveys). Stigma and quality-of-life impacts remain substantial. Global strategies emphasize integrated services, enhanced surveillance, and prevention of transmission, stigma reduction, and disability management.
Conclusions: While past efforts successfully reduced prevalent leprosy, sustained transmission persists. Achieving elimination of transmission and zero disability requires strengthened surveillance, integrated health services, intensified contact tracing with post-exposure prophylaxis (PEP), stigma reduction programs, and regionally tailored interventions. A roadmap toward elimination by 2035 is proposed, aligning national targets with WHO guidance.