Kenya's Kala-azar challenge: Data-driven precision offers a path to elimination

Kenya is at a critical juncture in its fight against neglected tropical diseases (NTDs), affecting millions primarily in arid and semi-arid lands. Here, poverty, malnutrition, and climate vulnerability converge, with the burden of NTDs extending far beyond health, perpetuating poverty and constraining productivity.

Yet success is possible as Kenya eliminated human African trypanosomiasis in 2025 and guinea worm disease in 2017. The same determination must now target the remaining NTDs, especially kala-azar (visceral leishmaniasis).

Between 2017 and 2025, Kenya documented approximately 12,000  Kala-azar cases primarily within arid and semi-arid counties. National figures, however, mask a key insight: extreme geographic concentration that reshapes the elimination strategy. Just three counties, Turkana, West Pokot, and Wajir, account for 68% of cases. At the ward level, eighteen high-burden wards contribute 43.7% of cases.

This community-level disease data transforms strategy. Ward-level mapping pinpoints transmission hotspots, enabling targeted interventions matching local ecology, and resource focus where impact is highest. Blanket county approaches give way to concentrated action. Climate change heightens the urgency, expanding sandfly habitats in endemic counties while droughts and floods displace populations into high-transmission zones. Ward-level surveillance captures these shifts for timely, adaptive responses.

Predictive analysis (modelling) indicates that interrupting 90% of transmission in seven high-burden sub-counties could halve national incidence. The upcoming Kenya Strategic Plan for Control of Cutaneous Leishmaniasis and Elimination of Visceral Leishmaniasis, aligned with WHO frameworks and the national NTD Masterplan, will operationalize stratified, equity-focused interventions.

When Treatment Success Isn’t Enough: The Syndemic Reality

Kenya has made strong gains, with treatment completion at 84.9%. Yet case fatality rates remain high, averaging over three percent in 2025. The driver is not just the parasite but interconnected factors. Severe malnutrition is the deadliest comorbidity, linked to increased mortality, especially in children under two. Increasing VL cases in infants and toddlers suggest intense local transmission near homesteads. HIV co-infection raises mortality in young adults. Two-thirds of cases occur in children under 15, peaking in those under four and 5–14 years, reflecting immature immunity and household-level exposure.

For vulnerable populations in remote ASAL counties, Kala-azar is fundamentally a disease of poverty, malnutrition, and weakened immunity, requiring integrated nutrition support, TB-HIV screening, and enhanced case management.

One Health Imperatives: Beyond Human Cases

Kenya’s leishmaniasis landscape is evolving. Northeastern Kenya has a confirmed zoonotic Leishmania tropica cycle, with the involvement of domestic dogs and rock hyraxes as reservoirs. In high-burden wards, interventions must combine indoor residual spraying, environmental management of breeding sites, livestock enclosure improvements, dog population control, and sustained entomological surveillance. Collaboration among human and animal health experts, insect scientists, and communities is vital to understand reservoirs of the principal vectors for Kala-azar, while incorporating social determinants into epidemiology and the design of interventions.

 The Challenge of Invisibility and Roadmap to Elimination

Communities in high-burden areas face intersecting challenges, including distance from health facilities, seasonal mobility disrupting follow-up and care-seeking, climate-induced displacement, and border conflict hindering access. Six sub-counties have emerged as new foci, likely tied to migration and climate shifts.

The path forward requires capturing when and where infections happen, predictive modeling, and a costed roadmap, the operational backbone that the new strategic plan must provide. Importantly,  surveillance must include monitoring post-kala-azar dermal leishmaniasis  and human reservoirs through systematic follow-up.

Financing Elimination in a Constrained Landscape

Financing poses a major hurdle. Global development assistance for NTDs is shrinking, with recent U.S. funding withdrawal from the WHO threatening coordination, drug support, advocacy, partnerships, and cross-border harmonization, the very architecture supporting elimination efforts.

Simultaneously, domestic financing mechanisms must evolve. The Social Health Insurance system must expand coverage for NTDs and ensure equity for vulnerable populations. Integrating Kala-azar diagnosis, treatment, and follow-up care into social health insurance packages isn’t merely about fairness; it’s an elimination imperative.

Seizing the Moment on Multiple Fronts

Kenya’s Kala-azar elimination holds strong advantages: surveillance across forty treatment centers, growing political will, improved diagnostics, and critically, geographic concentration enabling focused action in roughly 50 high-burden wards. Yet transmission dynamics, driven by climate, migration, and ecology, are shifting rapidly, and new transmission foci signal the danger ahead.

Elimination is achievable through precision targeting. Success hinges on sustained political commitment, including implementing the nine-country African Kala-azar elimination MOU, adequate financing, and integrated action before transmission dynamics shift further.

As the strategic plan launches, Kenya can accelerate progress by streamlining data, using predictive forecasting, and allocating resources using evidence-based methods. This requires exploiting high-resolution mapping to concentrate efforts in priority wards and sub-counties; tackling syndemics (malnutrition, HIV, child vulnerability) through integrated nutrition, immunization, and co-infection care; advancing One Health vector and reservoir control; and fortifying ASAL health systems through expanded community health workers, last-mile diagnostics, reliable drug/nutrition supply chains, and shock-responsive mechanisms.

For six million Kenyans in endemic areas, especially children, this isn’t about aspirational targets. It’s whether data-driven precision, multi-front syndemic and vector control, and resilient, equitable health systems can finally break the cycle of a disease stalking Kenya’s most vulnerable communities since 1935.

 The path runs through 18  high-burden wards, resilient systems, and coordinated multi-sector action.

The time to unite, act, and eliminate is now.

 The writer is a Senior Research Fellow at the Center for Epidemiological Modelling Analysis (CEMA) - University of Nairobi