In Kenya’s Turkana County and neighboring counties , there is a devastating outbreak of kala-azar, also known as visceral leishmaniasis (VL), — but it’s not acting alone- Children, their bodies weakened by hunger, are succumbing to kalazar—a parasitic disease transmitted by sandflies.
In northern Kenya, as climate change fuels erratic weather and deepens food insecurity, the region faces a perfect storm: malnutrition, extreme heat, and one of the world’s most neglected tropical diseases-Kala-azar
According to Kennedy Wasilwa, clinical officer and kala-azar focal person at Lodwar County Referral Hospital (LCRH), between January and March this year, Turkana County reported 178 confirmed kala-azar cases from just 15 facilities, with 11 deaths.
He adds that, those numbers are likely only a fraction of the real burden. “We’re no longer just battling Kala-azar — we’re battling malnutrition, comorbidities exacerbated with climate change,” says Wasilwa adding that, “Most of the children who come in are already severely malnourished, and that makes treatment harder, recovery slower, and fatalities more likely.”
He says that, until recently, U.S government-funded nutritional supplements helped stabilize patients. But that support stopped.
“Most children come to us severely malnourished, making recovery difficult,” Wasilwa explains. “And since U.S. government support for nutrition supplements stopped, our ability to stabilize these patients has been severely compromised.”
Transmitted by the bite of infected female phlebotomine sandflies, kala-azar is nearly always fatal if untreated. It causes fever, extreme weight loss, and swelling of the liver and spleen.
In Kenya, where routine health services are already stretched, the disease is now preying on a population weakened by hunger, and worsening environmental conditions.
He says that the standard treatment — a 17-day regimen of sodium stibogluconate (SSG) combined with paromomycin — is administered under strict inpatient care due to its toxicity.
“Stock-outs of RK-39 diagnostic test kits and DAT (Direct Agglutination Test) supplies have crippled timely diagnosis. There are also very few trained personnel capable of performing spleen or bone marrow aspirates.”
Climate Crisis Fuels Sandfly Surge
According to Wasilwa the outbreak coincides with erratic weather patterns — intensified by climate change — that have transformed once-dry areas into ideal breeding grounds for sandflies.
He says that after seasonal rains, the tiny insects swarm out of ant hills, dry riverbeds, and acacia trees near homesteads and livestock enclosures bringing them into close contact with children, particularly boys aged 5 to 15, who often tend goats and sheep outdoors mostly at dusk and dawn — the peak hours for sandfly activity.
“The rains bring more sandflies, and the drought brings more hunger,” Wasilwa explains. “It’s a deadly cycle. Malnourished children have lower immunity, and that makes kala-azar far more dangerous.”
The overlap between food insecurity and disease is undeniable. Until recently, nutritional supplements for children were provided by U.S. government aid, but that support has lapsed, leaving local facilities unable to stabilize patients before treatment.
Health System on the Brink
The standard treatment for kala-azar — a 17-day course of sodium stibogluconate (SSG) and paromomycin — is highly toxic and requires close inpatient monitoring.
However, Wasilwa says that frequent drug stock-outs and test kit shortages make even basic diagnosis and treatment a challenge.
Many patients are diagnosed late, often after being misdiagnosed with malaria.
“We’re admitting five to ten patients daily now — double what we used to,” Wasilwa says. “And in December, over 50 children were hospitalized at once.”
He says that although the treatment is offered for free, patients are charged for basic lab work such as liver function tests and hemoglobin level which is essential before beginning treatment, but they are often unaffordable for impoverished families.
“Blood transfusions, critical for patients with severe anemia, are also limited due to chronic shortages and low donor turnout.”
Cultural Barriers and Delayed Care
He explains that, beyond infrastructure problems, traditional beliefs complicate care.
Wasilwa says that lack of blood supplies compounds the crisis. Most kala-azar patients arrive with severe anemia, but blood banks in the region are poorly stocked. Cultural beliefs and strict eligibility criteria mean few locals donate blood.
“Some patients arrive with traditional cuts on their abdomen — an attempt to “drain” the disease believed to reside in the spleen. These marks delay medical treatment and increase risk of secondary infection.”
He says that post kala-azar dermal leishmaniasis (PKDL), a condition affecting patients after treatment which manifests as disfiguring skin lesions is socially stigmatizing, further isolating survivors and perpetuating the cycle of silence around the disease.
Wider Regional Spread and Underreporting
The crisis is not confined to Turkana. In Wajir County, 600 kala-azar cases have been reported since late 2024, with 26 deaths. Over 100 patients are still receiving treatment in overcrowded and under-resourced facilities according to media reports.
“The figures we have don’t reflect the reality,” says Wasilwa. “Most cases go unreported because people are too far from health centers or don’t recognize the symptoms in time.”
He adds that “With routine surveillance largely passive and limited to a few equipped centers, the true scope of the outbreak is likely much larger.”
Call to Action: Prevention Starts with Preparedness
Health experts are calling for an urgent, coordinated response that combines medical intervention with climate adaptation strategies.
“We need reliable supply chains for drugs and tests, trained personnel, nutritional support, and better outreach,” says Wasilwa. “But most importantly, we need to prepare communities — clear anthills, use insecticide-treated nets, and educate families about early signs.”
The World Health Organization has identified kala-azar as the second deadliest parasitic disease after malaria. And yet, in regions like northern Kenya, it remains dangerously under-prioritized.
