Kala-azar Cases Rise in Kenya, Raising Endemic Concerns

Kenya is facing a surge in cases of kala-azar, a deadly neglected tropical disease also known as visceral leishmaniasis. The disease, spread by sandflies, has seen a significant increase in recent years, impacting vulnerable populations and straining healthcare resources.

Cases of kala-azar have risen from 1,575 in 2024 to 3,577 in 2025, according to Kenya’s health ministry. Health officials attribute the spread to changing climatic conditions, expanding human settlements, and the disease becoming endemic in previously unaffected regions.

Misdiagnosis and Delayed Treatment

Harada Hussein Abdirahman, a 60-year-old grandmother, was bitten by a sandfly while herding livestock in Mandera county, a known hotspot for the disease. For nearly a year, she received repeated misdiagnoses of malaria and dengue fever from a local pharmacist, delaying proper treatment and causing her health to deteriorate. She experienced hearing problems as a result of the subsequent treatment to remove toxins from her body.

Regional Impact and Risk Factors

East Africa accounts for over two-thirds of global kala-azar cases, according to the World Health Organization. Dr. Cherinet Adera, a researcher at the Drugs for Neglected Diseases Initiative in Nairobi, notes that climate change is expanding the range of sandflies and increasing the risk of outbreaks. Northeastern Kenya, along with neighboring regions in Ethiopia and Somalia, has recently experienced severe drought, creating conditions favorable for sandfly proliferation.

Outbreak at a Quarry Site

A recent surge in cases among migrant workers at a quarry site in Mandera led authorities to restrict movement during dusk and dawn, when sandflies are most active. At least two workers died, and the fates of others who returned to their villages are currently unknown. Workers expressed fear and described witnessing colleagues rapidly decline due to the illness.

Treatment Challenges and Elimination Efforts

In 2023, six African nations adopted a framework in Nairobi to eliminate kala-azar by 2030. However, Dr. Paul Kibati, a tropical disease expert for the health NGO Amref, stated that there are “very few facilities in the country able to actively diagnose and treat” the disease. He emphasized the need for increased training to prevent fatal errors in testing and treatment. Treatment can last up to 30 days, involving daily injections and often blood transfusions, costing approximately 100,000 Kenyan shillings ($775) excluding medication costs.

Sandfly Habitats and Vulnerable Populations

Sandflies commonly shelter in cracks in poorly plastered mud houses, anthills, and soil fissures, multiplying during the rainy season following prolonged drought. Kala-azar disproportionately affects the poorest communities, exacerbated by malnutrition and weakened immunity. Health officials anticipate a rise in cases when the rainy season begins.