A new, comprehensive framework has been launched to guide health authorities, policy-makers and other stakeholders towards elimination of visceral leishmaniasis (VL) as a public health problem in eastern Africa.
Also known as kala-azar, VL is a deadly parasitic disease that causes fever, weight loss, spleen and liver enlargement, and – if untreated – death. Transmitted by the bite of infected female sandflies, VL is endemic in 80 countries around the world. In 2022, eastern Africa accounted for 73% of global VL cases, half of which occurred in children aged under 15 years.
The elimination framework outlines five main strategies for guiding VL elimination: (i) early diagnosis and treatment; (ii) integrated vector management; (iii) effective surveillance; (iv) advocacy, social mobilization and partnership-building; and (v) implementation and operational research. It also describes a stepwise process for implementing the main elimination phases and sets country and regional targets; these include a 90% reduction in VL burden in the eastern Africa sub-region to fewer than 1500 cases per year by 2030; detection and treatment of 90% of cases within 30 days of onset of symptoms by 2030; a 100% decline in VL deaths in children by 2030; 100% of VL–HIV patients started on antiretroviral therapy; and the detection, reporting and management of all post kala-azar dermal leishmaniasis (PKDL) cases.
"The introduction of this new framework represents a significant step forward in our collective efforts to eliminate VL from eastern Africa," said Dr Saurabh Jain, Scientist and WHO Focal Point for VL. "By providing countries with tailored tools and strategies, we are laying a strong foundation for sustained progress in the fight against this neglected tropical disease."
The framework was developed by the World Health Organization (WHO) in collaboration with various partners, including the non-profit drug research and development organization Drugs for Neglected Diseases initiative (DNDi) and health ministries across the region. It was launched at a meeting co-hosted by WHO, DNDi and the Ministry of Health in Ethiopia. The meeting was attended by officials from the health ministries of nine high VL burden countries in Africa, namely Chad, Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda, as well as representatives from the African Union, researchers, academia, the private sector and funding institutions.
"The VL elimination framework will offer important direction to countries in the region and provide momentum to reach the finish line of elimination," said Dr Dereje Duguma, State Minister of the Federal Ministry of Health, Ethiopia. "The Government of Ethiopia remains committed to working with partners to develop programmes at all levels, from national to community, to expand access to health care and achieve the targets of elimination by 2030."
The launch of the eastern Africa framework comes at a time when countries in Asia are already demonstrating success in eliminating VL as a public health problem.
Between 2004 and 2008, Bangladesh, India and Nepal collectively accounted for 70% of global cases. However, in October last year, WHO announced that Bangladesh had successfully eliminated VL as a public health problem – making it the first country in the world to achieve this status. The elimination process in Asia began in 2005 with the launch of a regional strategic framework for VL. This framework, coupled with an accelerated elimination programme, political commitment and sustained stakeholder support, significantly contributed to achieving elimination goals.
The new framework for eastern Africa presents a similar opportunity for the nine endemic countries, offering a comprehensive approach for countries to implement strategies, assess progress, identify gaps and build capacity.
"VL is a severe disease primarily affecting vulnerable groups, such as children and the poorest populations. I am very pleased that the framework's core pillars prioritize innovation for these neglected populations. Since its establishment in 2003, DNDi has focused on developing new, safer, more efficacious and patient-friendly treatments. This, combined with complementary strategies such as vector control, undoubtedly will play a pivotal role in the journey towards elimination," said Professor Samuel Kariuki, the Eastern Africa Director for DNDi.
Continuous research and development of new tools will be key to overcoming remaining obstacles and sustaining elimination of VL. Current tools, though effective, remain challenging due to complex administration and potential toxicity, limiting their use in primary health care settings. .
The launch of the framework follows the Nairobi Declaration (January 2023), where representatives from the ministries of health of Chad, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda, along with key stakeholders in the region, committed to eliminating VL as a public health problem by 2030.
The framework was developed in consistency with the WHO road map for neglected tropical diseases 2021–2030, a 10-year plan formulated to guide all nations working towards the control and elimination of neglected tropical diseases.
