Assessment of leprosy in post-insurgency Northeastern Nigeria: a retrospective study

Abstract

Background The Boko Haram insurgency has severely disrupted healthcare systems in Northeastern Nigeria, creating significant challenges for neglected tropical disease control. This study assessed the impact of this conflict on leprosy epidemiology by comparing key indicators between highly affected and relatively stable states. Methods We conducted a retrospective, longitudinal analysis of 401 leprosy cases recorded from 2017 to 2020 in four states: the highly conflict-affected Adamawa, Borno, and Yobe, and the less-affected Gombe State. Data on demographics, clinical classification, disability grade, and treatment outcomes were extracted from official leprosy registries. Results The analysis revealed a divergent disease burden. Gombe State, the less-affected comparator, showed the highest number of child cases (n = 47), indicating ongoing active transmission. In contrast, the conflict-affected Adamawa state had the highest new case detection rate (30 per 1m pop.) and an alarmingly high proportion of patients presenting with Grade-2 Disability (G2D) at diagnosis (87.7%), underscoring severe delays in diagnosis. Multibacillary disease was predominant across the region (84.5%). Treatment completion was high, with 95% of the 399 patients who started Multidrug Therapy (MDT) successfully finishing their regimen. Conclusion Our findings highlight a critical crisis of late diagnosis in conflict-affected areas of Northeastern Nigeria, as evidenced by the extremely high G2D rates. Despite this, high treatment completion rates demonstrate the resilience of the health system. The results underscore an urgent need to integrate flexible, community-based active case-finding strategies into leprosy control programs in insecure regions to reduce disability and interrupt transmission.