Leishmaniasis: 20 years of progress towards elimination in the WHO African Region
Overview
Leishmaniasis is a neglected tropical disease that predominantly affects impoverished populations. It remains a significant health issue in four eco-epidemiological regions: the Americas, East Africa, North Africa, and West Asia and Southeast Asia. According to WHO’s Weekly epidemiological record (WER), 99 countries and territories are endemic for leishmaniasis. The cutaneous form of the disease, which is widespread globally, is endemic in 90 countries, while the more severe visceral form is endemic in 80 countries.
Although the overall reporting rate for leishmaniasis is low, the African Region has made notable progress, achieving high reporting rates in 2023 and 2024. This improvement is attributed to advocacy efforts, standardized reporting tools and training for data managers and health professionals. The Eastern Mediterranean Region (EMR) bears the highest burden, accounting for 81% of cutaneous leishmaniasis and 42% of visceral leishmaniasis cases globally. In 2024, the EMR and Algeria reported 84% of all new cutaneous leishmaniasis (CL) cases, with 11 countries each reporting over 4000 cases, totalling 91% of global cases. The African Region contributed about 4% of the global CL cases in 2023 (Afghanistan, Algeria, Brazil, Colombia, Iran (Islamic Republic of), Iraq, Pakistan, Peru, Syrian Arab Republic, Sri Lanka and Yemen).
For VL (visceral leishmaniasis), the East African foci, including countries from the Eastern Mediterranean and the WHO African Region, reported the majority of cases (73%). In 2023, the Eastern Mediterranean and African Regions reported 42% and 37% of global cases, respectively. Brazil, Ethiopia, Kenya, and Sudan each reported over 1000 cases, accounting for 60% of the global burden. Six of the 13 countries contributing to 95% of global visceral leishmaniasis cases are in the African Region (Chad, Eritrea, Ethiopia, Kenya, South Sudan and Uganda).
Following the successful visceral leishmaniasis elimination programme in Southeast Asia, East Africa has emerged as a hotspot for transmission. In that region, 50% of reported cases involve children under 15, with nearly 25% of cases being female. To address this, the Strategic framework for the elimination of visceral leishmaniasis as a public health problem in Eastern Africa (2023–2030) was launched in Addis Ababa, Ethiopia, on 11 June 2024.
Despite progress, challenges remain, including inadequate funding, population movement, insecurity, low programme ownership, and limited access to services. The key priorities include strong advocacy for resource mobilization, improved access, government ownership, research and development for better diagnostic, treatment, and prevention tools, and strengthening surveillance systems to achieve global leishmaniasis targets.
