# Characteristics, treatment outcomes and factors associated with death among patients with Visceral Leishmaniasis, Uganda, 2019–2024

## TL;DR

This study examines the characteristics and treatment outcomes of visceral leishmaniasis patients in Uganda, showing progress toward elimination goals and highlighting the role of HIV co-infection in mortality.

## Contribution

The study provides updated insights into VL patient demographics, treatment success, and mortality risk factors in Uganda, emphasizing cross-border transmission and HIV co-infection.

## Key findings

- Most patients were male children, with over one-third from Kenya, indicating cross-border transmission.
- HIV co-infection was the strongest predictor of death, with an adjusted odds ratio of 10.
- The case fatality rate dropped to below 1% by 2023 and 2024, showing progress toward elimination targets.

## Abstract

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.

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.

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 1st- 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).

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.

Visceral leishmaniasis (VL), also known as kala-azar, remains a significant but under-researched public health concern in Uganda, particularly in the semi-arid, cross-border Karamoja region. This retrospective study analyzed individual-level data from 972 patients treated for VL at Amudat Hospital between 2019 and 2024 to characterize patient profiles, treatment outcomes, and factors associated with mortality. Most patients were male children, with over one-third originating from neighboring Kenya, highlighting the cross-border nature of VL transmission. The majority presented with typical VL symptoms—fever, night sweats, abdominal swelling, and anemia—and nearly all were diagnosed using rapid diagnostic tests. HIV co-infection was common (30%) and strongly associated with death, making it the only significant predictor of mortality in multivariate analysis. The overall case fatality rate was low (1%), with most patients completing treatment and being cured, indicating substantial progress toward VL elimination targets. However, findings underscore the need for continued surveillance, improved management of co-infections, and coordinated cross-border interventions to interrupt transmission and achieve national and regional VL elimination goals.