WEB DESK: For nearly a year, constant misdiagnoses of the life-threatening kala-azar disease caused a sharp decline in the health of 60-year-old Harada Hussein Abdirahman. This occurred against the backdrop of an unprecedented outbreak in Kenya’s arid regions, where the disease has claimed a record number of lives.
Kala-azar, transmitted through sandflies, ranks among the most lethal neglected tropical diseases. If untreated, it has a staggering fatality rate of 95 percent, manifesting symptoms like fever, significant weight loss, and severe enlargement of the spleen and liver. The disease, also referred to as visceral leishmaniasis, has seen an alarming rise in cases in Kenya, surging from 1,575 in 2024 to 3,577 in 2025, as reported by the health ministry.
What’s more worrying is that kala-azar is spreading into previously unaffected areas, becoming endemic due to shifting climatic conditions and expanding human settlements. Health officials warn that millions are at risk.
Abdirahman, a grandmother from Mandera County in northeastern Kenya—a known hotspot for the disease—contracted kala-azar after being bitten by an infected sandfly while herding livestock. Mandera, however, only has three treatment centers equipped to handle kala-azar cases. For close to a year, she had no choice but to visit a local pharmacist who misdiagnosed her condition as malaria or dengue fever several times.
For months, Abdirahman thought her life was nearing its end. She described her ordeal as worse than any of the illnesses she was initially believed to have. Although she eventually received treatment, the aggressive medications caused long-term side effects, including hearing loss.
According to data from the World Health Organization, East Africa accounts for over two-thirds of global kala-azar cases. Experts attribute this increasing threat to climate change, which is expanding the range of sandflies and escalating the likelihood of outbreaks in new areas.
Dr. Cherinet Adera from the Drugs for Neglected Diseases Initiative based in Nairobi confirmed that shifting weather patterns are playing a significant role in increasing transmission.
A spike in cases among migrant workers last year at a quarry site in Mandera forced local authorities to impose restrictions on movement during dawn and dusk when sandflies are most active. Despite these efforts, at least two workers died. Many others left the area for their home villages; their fates remain unknown.
One worker, Evans Omondi, who had traveled hundreds of miles from western Kenya to work at the quarry, recounted how little they initially knew about the illness claiming the lives of their colleagues. Another worker, Peter Otieno, described the grim reality of watching many become weaker and sicker.
With this health crisis mounting, leaders from six heavily-affected African countries convened in Nairobi in 2023 to adopt a regional framework aiming to eliminate kala-azar by 2030. However, significant barriers stand in the way.
Very few facilities across Kenya are adequately prepared for the active diagnosis and treatment of kala-azar, according to Dr. Paul Kibati, a tropical disease expert with health NGO Amref. He emphasized the urgent need for improved training since errors in both testing and treatment can be deadly.
Treatment itself is long and demanding. It typically spans up to 30 days and requires daily injections along with frequent blood transfusions. Costs can soar to as high as 100,000 Kenyan shillings (around $775), excluding drug expenses. Kibati warns this underscores the dire need for better-equipped facilities nationwide.
The sandfly, the primary carrier of kala-azar, thrives in cracks within poorly plastered mud houses, anthills, and soil fissures. The population of these insects multiplies during rainy seasons following extended droughts—a pattern seen recently in northeastern Kenya and neighboring regions in Ethiopia and Somalia.
Kala-azar disproportionately affects the poorest members of society due to their vulnerability stemming from malnutrition and weakened immunity. Kibati expressed concern that cases will further spike when rains return, worsening an already dire public health emergency.
