World Health Organization · 1st edition, 2025 · 55 pages
A strategic progress report on visceral and cutaneous leishmaniasis control, surveillance, and elimination efforts for national programmes and clinicians in endemic areas.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- National leishmaniasis programme managers, NTD focal points, clinicians in endemic areas, public health professionals, policy-makers, and WHO country offices in the African Region
- Evidence
- Descriptive epidemiological analysis based on WHO Global Health Observatory data, national programme reports, and peer-reviewed literature; normative recommendations reference WHO TRS-949 (2010) and WHO VL/HIV treatment guidelines (2022)
- Reviewed
- 15 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO Regional Office for Africa report documents two decades of progress in leishmaniasis prevention, control, and elimination efforts across the African Region. The document highlights that visceral leishmaniasis (VL) cases in the Region declined by 34% from 6,538 in 2015 to 4,330 in 2023, while reporting rates improved significantly, with countries reporting VL data increasing from six in 2013 to twelve in 2022. Six African countries (Chad, Eritrea, Ethiopia, Kenya, South Sudan, and Uganda) contribute to 95% of the global VL burden, with East Africa emerging as a transmission hotspot where 50% of cases involve children under 15 years.
The report details the evolution of control strategies, including early diagnosis and prompt treatment with combination therapy (sodium stibogluconate plus paromomycin for 17 days), integrated vector management, strengthened surveillance systems, and robust partnerships. The African Region now accounts for 37% of global VL cases and 4% of cutaneous leishmaniasis (CL) cases. A new Strategic Framework for the elimination of VL as a public health problem in Eastern Africa (2023–2030) was launched in June 2024, targeting a case fatality rate below 1%.
Key challenges persist, including inadequate funding, population displacement due to conflict, low programme ownership, limited access to services in remote areas, high VL/HIV coinfection rates (up to 20% in Ethiopia), and gaps in diagnostic capacity. The document emphasizes that sustainable progress requires strengthened surveillance, improved access to diagnosis and treatment, research for better diagnostic tools and oral medications, enhanced national ownership, and continued partnership coordination.
Key points
For clinicians — doses and thresholds as stated in the guideline
- First-line VL treatment in East Africa: combination therapy with sodium stibogluconate (100 mg/ml, 30 ml vial) plus paromomycin (375 mg/ml, 2 ml ampoule) for 17 days, reducing treatment duration by 40% from the previous 30-day monotherapy regimen
- VL case fatality rate target: below 1% for primary VL; actual rates in 2023 were Ethiopia 2%, Eritrea 7.4%, South Sudan 3.7%, Uganda 0%
- VL diagnostic algorithm: rapid diagnostic test (RDT) sensitivity 96% in Ethiopia (884/919 cases); 100% of new VL cases in Uganda diagnosed by RDT
- Second-line VL treatment: liposomal amphotericin B, donated through WHO partnership with Gilead Sciences for severely ill patients, HIV coinfection, and treatment failures
- VL/HIV coinfection: present in 3% of Ethiopian VL cases (31/991), with Ethiopia reporting the world's highest coinfection rate at 20% among migrant agricultural workers
- CL integrated management: included in national NTD master plans; Chad showed five-fold increase in case detection (from 38 cases in 2020 to 1,604 in 2023) through integrated skin NTD approach
- Post-kala-azar dermal leishmaniasis (PKDL) surveillance: underreported across the Region; Ethiopia reported 27 cases (2019–2023), Kenya 8, South Sudan 48, Uganda 4
- Active case finding in Uganda (2022): resulted in four-fold increase in VL case detection, with 87% of cases in children below 15 years and 24% female
Estimated quantities of first-line combination regimen for VL in endemic countries (2023 annual quantifications for medicine donation)
Table extracted from the guideline
| Country | Sodium stibogluconate 10% (100mg/ml), 30ml vial | Paromomycin solution 375mg/ml, 2ml ampoule |
|---|---|---|
| Chad | 540 | 1,400 |
| Ethiopia | 6,448 | 16,924 |
| Eritrea | 2,480 | 5,840 |
| Uganda | 2,400 | 5,712 |
| South Sudan | 3,436 | 13,967 |
Source: World Health Organization, Leishmaniasis: 20 years of progress towards elimination in the WHO African Region. Reproduced in summary form.
What changed in this edition
Versus the previous edition
- New Strategic Framework for the elimination of visceral leishmaniasis as a public health problem in Eastern Africa (2023–2030) launched in June 2024
- VL combination therapy (sodium stibogluconate plus paromomycin) now standard first-line treatment, replacing 30-day monotherapy with 17-day regimen
- Number of countries reporting VL data increased from 6 (2013) to 12 (2022); CL reporting countries increased from 7 to 14 in same period
- Integrated skin NTD framework (2022–2030) introduced for cutaneous leishmaniasis control alongside other skin NTDs
- WHO treatment guideline on visceral leishmaniasis in HIV coinfected patients in East Africa and South-East Asia published in 2022
From the guideline
Verbatim
“The goal of the strategy is to improve the health status of vulnerable groups and at-risk populations living in areas endemic to VL in eastern Africa by eliminating VL as a public health problem and reducing the case fatality rate for primary VL to less than 1%.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked extensively on infectious disease elimination programmes in the WHO European Region, I find this African Region leishmaniasis report highly instructive for Georgia's ongoing efforts to strengthen disease surveillance and laboratory diagnostics. Although Georgia is not currently endemic for leishmaniasis, the document's systematic approach to integrated surveillance—exemplified by the successful DHIS2 implementation in Kenya and Ethiopia—offers a valuable model for our own electronic health information system (EHIS), which we continue to refine for notifiable disease reporting. The 17-day combination therapy regimen for VL, validated through rigorous clinical trials in East Africa, demonstrates how operational research in endemic settings can transform treatment protocols and reduce both morbidity and health system burden. For Georgian clinicians, I would emphasize maintaining clinical awareness of leishmaniasis as a differential diagnosis in any patient presenting with prolonged fever, hepatosplenomegaly, and pancytopenia who has travel history to endemic regions—particularly Ethiopian or Kenyan migrant workers or Georgian nationals returning from work in the Middle East. One implementation caveat that resonates with our own programme experience: the report candidly acknowledges that even with donated medicines and strong technical guidelines, high case fatality rates (7.4% in Eritrea, well above the 1% target) persist due to late presentation, weak referral systems, and conflict-related disruptions—reminding us that clinical protocols alone cannot substitute for accessible, functioning primary health care infrastructure and community trust.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 15 Oct 2026
Applicability
Georgia and the South Caucasus
While Georgia is not endemic for leishmaniasis, this document is relevant for the country’s role in regional health security, migration health, and technical cooperation within the WHO European Region. Georgia shares borders with countries where leishmaniasis has been reported (Turkey, Armenia, Azerbaijan), and climate change may alter vector distribution patterns. Georgian health authorities should maintain awareness of leishmaniasis as a differential diagnosis in febrile illness among travellers and migrants from endemic areas, particularly those returning from East Africa, the Eastern Mediterranean, or Central Asia. The document’s emphasis on integrated disease surveillance, rapid diagnostic test algorithms, and strengthened laboratory capacity aligns with Georgia’s ongoing health system strengthening initiatives. The integrated skin NTD approach described could inform Georgia’s dermatology and infectious disease services in establishing diagnostic pathways for imported cases, and the surveillance framework offers lessons for Georgia’s electronic health information systems (EHIS).
Questions this guideline answers
Quick answers
What is the recommended first-line treatment for visceral leishmaniasis in East Africa?
Combination therapy with sodium stibogluconate (20 mg/kg/day intramuscularly) plus paromomycin (15 mg/kg/day intramuscularly) for 17 days. This regimen has replaced the previous 30-day monotherapy, reducing treatment duration by 40% and improving patient outcomes while decreasing hospital bed occupancy and costs.
How is visceral leishmaniasis diagnosed in resource-limited settings?
Rapid diagnostic tests (RDT) are the primary diagnostic tool, with 96% sensitivity reported in Ethiopia and 100% usage in Uganda. RDT-positive cases in endemic areas can be treated presumptively. Parasitological confirmation via direct examination (bone marrow or splenic aspirate) is reserved for RDT-negative cases with strong clinical suspicion, treatment failures, and HIV coinfected patients. PCR is used for species identification and research.
What is the target case fatality rate for visceral leishmaniasis elimination?
The Strategic Framework for Eastern Africa (2023–2030) sets a target case fatality rate of less than 1% for primary VL. However, most reporting countries in 2023 exceeded this threshold: Ethiopia 2%, Eritrea 7.4%, South Sudan 3.7%. Only Uganda achieved the target at 0%. High case fatality is often linked to late presentation, HIV coinfection, severe malnutrition, and limited access to treatment in remote areas.
How should post-kala-azar dermal leishmaniasis (PKDL) be managed and why is it important?
PKDL appears as macular, papular, or nodular rash usually on the face, upper arms, and trunk following VL treatment. It is critical because PKDL patients serve as reservoirs for ongoing transmission. The document notes severe underdiagnosis and underreporting across the African Region (Ethiopia: 27 cases 2019–2023, Kenya: 8, South Sudan: 48, Uganda: 4), mainly due to poor patient follow-up after VL treatment. National programmes should strengthen post-treatment surveillance and ensure patients are followed for at least 6–12 months after successful VL treatment.
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- Issuer
- World Health Organization
- Type
- Guidance (normative)
- Edition
- 1st edition, 2025
- Status
- Current
- Published
- 2025-12-08
- Languages
- English
- Scope
- Regional progress report covering 47 Member States of WHO African Region; focuses on visceral and cutaneous leishmaniasis epidemiology, control strategies, and elimination frameworks for 2005–2024
- Audience
- National leishmaniasis programme managers, NTD focal points, clinicians in endemic areas, public health professionals, policy-makers, and WHO country offices in the African Region
- Pages
- 55
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-9-031576-6
- Evidence
- Descriptive epidemiological analysis based on WHO Global Health Observatory data, national programme reports, and peer-reviewed literature; normative recommendations reference WHO TRS-949 (2010) and WHO VL/HIV treatment guidelines (2022)
- Record history
- Created 15 Oct 2026 · updated 15 Oct 2026 · next check Apr 2027
World Health Organization Regional Office for Africa. Leishmaniasis: 20 years of progress towards elimination in the WHO African Region. Brazzaville: WHO Regional Office for Africa; 2025. 55 p. ISBN: 978-92-9-031576-6. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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