Background Visceral leishmaniasis (VL), a neglected tropical disease (NTD)continues to affect several countries worldwide, including Uganda, where it remains a significant public health concern in the Karamoja Region. This region borders Kenya, where VL is endemic. Globally and within East Africa, VL persists due to a combination of ecological suitability for sandfly vectors, chronic underdiagnosis, limited access to care in remote and pastoralist communities, high levels of malnutrition and poverty, and cross-border population movement that sustains transmission. The World Health Organization (WHO) targets to eliminate VL as a public health problem by reducing case fatality to <1%, but the current burden of VL is unknown. We described VL patients, their treatment outcomes, and identified factors associated with death in Uganda, from 2019–2024, to check progress towards meeting the country’s targets. Methods We conducted a retrospective observational review of patient records from 2019–2024 at the main VL treatment center in Amudat District, Uganda, abstracting socio-demographic, clinical, treatment, and outcome dataWe used logistic regression to determine factors associated with death. Results Among 972 patients, 670 (69%) were male and 742 (76%) were age ≤ 18 years. Three hundred and seventy-three (38%) were from Kenya, while most, 434/599 (72%) Ugandan patients were from Moroto District. The highest number of cases (322) was recorded in 2022, with Ugandans making up 80% of all patients that year(259/322), unlike previous years (2019–2021) when Kenyan patients predominated. There was no identifiable seasonal pattern/variation in the number of cases diagnosed. The commonest symptoms were fever (98%), night sweats (77%), and abdominal swelling (72%). The average duration of sickness was 2.6 months (standard deviation (SD)=0.3 months). Severe anemia was common (512/972; 53%), and among the patients tested for co-infections, 175/969 (18%) were co-infected with malaria and 185/593 (31%) with Human Immunodeficiency Virus (HIV). For most patients, 898 (92%), this was their index episode of VL. Almost all patients 957 (98%) were cured. and most 743 (76%) patients were treated with the 1 st - line regimen. The case fatality rate (CFR) declined from 2% in 2020 and 2021 to <1% in 2023 and 2024. Being HIV positive was associated with death (Adjusted odds ratios (AOR) 10, 95% Confidence Intervals (CI) 2.2-50, p = 0.003). Conclusion This study indicates progress towards the elimination of VL while highlighting the significance of cross-border transmission and the importance of screening/treatment of co-infections, especially HIV.
Namara et al. (Thu,) studied this question.