As the world observes Rare Disease Day, attention turns to visceral leishmaniasis (VL), commonly known as kala-azar. While rare in many regions, this neglected tropical disease (NTD) remains a major public health concern in Kenya’s arid and semi-arid areas, particularly Marsabit County. Despite its endemic presence, kala-azar is often underreported and misdiagnosed due to limited healthcare access and low awareness levels.
Kala-azar is caused by the Leishmania donovani parasite and is transmitted through the bite of infected female sandflies. The disease is most prevalent in tropical and subtropical regions, with over 95% of cases occurring in just 10 countries, including Kenya, Sudan, South Sudan, Ethiopia, and Somalia. Eastern Africa has the second-highest burden of VL cases after India, and Kenya continues to experience recurrent outbreaks, particularly in counties like Marsabit, Wajir, Isiolo, and Baringo.
According to the World Health Organization (WHO), between 2020 and 2023, Kenya recorded over 2,000 confirmed and suspected cases, with a case fatality rate of 0.5%. Currently, active outbreaks are ongoing in Kitui, West Pokot, Wajir, and Isiolo counties. Marsabit, in particular, has seen a significant rise in cases, with reported infections increasing from 136 in 2014 to 2,338 in 2019.
Kala-azar is a slow-developing disease that can take weeks or months for symptoms to appear. It primarily affects the immune system and internal organs, leading to:
Prolonged fever
Severe weight loss
Enlarged spleen and liver, causing abdominal swelling
Anaemia, extreme fatigue, and pale skin
Swollen lymph nodes in some cases
In South Asia, the disease can also cause skin darkening, leading to the name “kala-azar,” meaning “black fever.” Without proper treatment, VL has an almost 100% fatality rate within two years. As the disease progresses, it weakens the immune system, making patients vulnerable to life-threatening secondary infections and organ failure. Additionally, some individuals may develop post-kala-azar dermal leishmaniasis (PKDL), which results in skin lesions that can continue spreading the parasite.
Despite ongoing control efforts, several challenges continue to fuel the spread of kala-azar in Kenya, including:
Limited Healthcare Access – Many affected regions lack adequate diagnostic facilities and treatment centers.
Poverty and Malnutrition – Malnutrition weakens immune responses, making individuals more susceptible to infections.
Climate Change and Deforestation – Changes in temperature and deforestation have expanded sandfly habitats, increasing disease transmission.
Human Migration and Displacement – Movement due to conflicts, trade, and environmental changes has spread the disease to new areas.
Drug Resistance and Treatment Gaps – Inconsistent treatment and misuse of anti-leishmanial drugs have led to resistance, making treatment more difficult.
Addressing kala-azar requires a multi-faceted approach. Early diagnosis and proper treatment with anti-leishmanial drugs remain the most effective way to control the disease. Strengthening healthcare access, improving vector control, and raising awareness are crucial steps in preventing future outbreaks.
The WHO and the Kenyan government have been working to curb the spread of VL through:
Increased surveillance and rapid response mechanisms
Provision of anti-leishmanial drugs from the WHO’s emergency stockpile
Public-private collaborations to improve healthcare infrastructure
Awareness campaigns targeting at-risk communities
Kala-azar is the second-deadliest parasitic disease globally, after malaria, with an estimated 20,000 to 40,000 deaths annually. In 2022, Eastern Africa accounted for 73% of global VL cases, with nearly half occurring in children under 15. These statistics highlight the urgent need for increased funding, better diagnostics, and stronger public health interventions.
By prioritizing research, enhancing treatment accessibility, and strengthening disease surveillance, Kenya and the global community can take significant strides toward controlling and eventually eliminating kala-azar.
