Ekidor Kiyong is only 15 years old, but he has already had a close encounter with a deadly disease. A herder from Turkana, northern Kenya, he is coming to the end of his treatment for kala-azar, which is spread through the bites of infected sandflies.
His aunt, Ester Loskiria, has accompanied him to Lodwar County Referral Hospital. She tells Dialogue Earth that the disease, also called visceral leishmaniasis, began with malaria-like symptoms – fever, headache, fatigue, loss of appetite.
“He’s getting better now,” she says with relief, before adding that the KES 30,000 (USD 230) cost of his treatment is a large burden for the family.
If left untreated, kala-azar is fatal in 95% of cases, according to the World Health Organization (WHO).
The WHO describes the disease as climate-sensitive, partly because changes in temperature, rainfall and humidity can have a big impact on sandfly numbers. Sandflies can breed and thrive in deeply cracked soil, for example, which is increasingly prevalent as the climate warms. Deforestation for firewood is another problem, as the flies also thrive in sandy, degraded land.
The disease is endemic in Kenya’s Rift Valley, eastern and north-eastern regions, according to a 2024 Lancet article. Reported cases have been increasing in the country in recent years, with 607 in 2018 and 1,463 in 2019. The Lancet puts the annual reported figure at 1,600, with 170 deaths, though the actual number of cases is likely to be far higher.
Kenya’s Turkana, a semi-arid county in the Rift Valley, is particularly badly affected. The spread there highlights a stark intersection between health and environmental justice. Sometimes referred to as the “forgotten disease”, kala-azar disproportionately affects communities already grappling with poverty, limited healthcare access and worsening climatic conditions. The situation shows how the poorest and most marginalised communities often bear the brunt of environmental degradation.
Turkana’s recurrent outbreaks are due in part to poor healthcare infrastructure, limited awareness, malnutrition and displacement, say experts consulted by Dialogue Earth.
Beyond Lodwar lies Loima, one of Turkana’s remote sub-counties, where the rugged Loima Hills rise against the horizon. The vegetation here, shaped by a harsh, semi-arid climate, mirrors the resilience of its people. It is a landscape of determined, thorny acacia and twisting commiphora trees, scattered across the dusty plains and offering precious shade. On the slopes of the hills, the vegetation thickens slightly, with hardy bushwillows and moringa trees clinging to the rocky soil – a testament to life’s endurance in a landscape often defined by drought.
It is here that Charles Tukei, a father of 15 from Nakutan village, lost his five-year-old son to kala-azar. He says the disease is spread by people who migrate. The WHO states that when non-immune people move into areas where transmission is high, epidemics of kala-azar can result. Poor awareness and delayed diagnosis further increase the risk of transmission in vulnerable communities.
“This disease is dangerous,” Tukei says. “Most of the people here don’t know it very well. It begins like malaria, and when my son caught it, I thought it was malaria. I gave him over-the-counter medication, but he did not get better.” Tukei then took him to the Lodwar County Referral Hospital, but by the time they arrived, the disease had advanced. “The doctor tried to resuscitate him, but he died from spleen complications after two hospital visits.”
Kennedy Wasilwa, a clinical officer and kala-azar coordinator at the hospital, tells Dialogue Earth: “We are trying our best to treat all the patients. Advanced-stage cases mostly present fevers associated with the enlarged spleen. And also, most of them [exhibit] bleeding, weight loss, loss of appetite, and severe abdominal pains among other symptoms.”
Around Tukei’s village, deforestation is evident where trees have been cut down for firewood and trade. Sand, an obvious habitat for sandfly, is abundant.
“In Turkana, environmental justice is closely tied to the fight against neglected diseases like kala-azar,” says Wasilwa. “The changing climate, with its escalating temperatures and deforestation, exacerbates the spread of diseases, while the region’s underdeveloped healthcare system only magnifies the crisis.”
In Nairobi, Cherinet Adera is a senior market access manager and researcher at the East Africa office of the Drugs for Neglected Diseases initiative (DNDi). He explains that sandflies can thrive in humid, lowland areas with high temperatures.
Consistent rainfall would ordinarily suppress their density, because sandfly usually breed in the cracks of dry earth where moisture collects, he says. But “if there’s a drought, or if there’s a temperature rise, sandfly density increases, meaning the risk of transmission is higher, especially if there are untreated leishmaniasis patients in the community.
“Deforestation, often followed by urbanisation, brings people closer to sandfly habitats, increasing the risk,” he adds.
Adera said the WHO is about to recommend a new two-week treatment regime, down from 17 days, to reduce time spent in hospitals. The new regime includes a daily combination of an intramuscular injection and an oral drug.
Kala-azar continues to be a major health problem in East Africa, North Africa, the Americas, and West and Southeast Asia, according to a 2023 WHO update. In that year, 73% of reported cases came from East Africa. While four countries – Kenya, Ethiopia, Sudan and Brazil – together represented 60% of global cases.
Samuel Kariuki, director of East Africa at DNDi, notes that robust climate data, aligned with changes in vector density, can help predict the future spread of kala-azar.
“Climate change … creates warmer ecosystems that allow sandflies to thrive and multiply. Deforestation disrupts their natural habitats, forcing the parasites to spread to new, more conducive ecosystems, including human habitats,” Kariuki says.
“When both climate change and deforestation occur simultaneously, they pose a dual risk to the survival and spread of these vectors.”
Kariuki emphasises the need for collaboration between environmental scientists, public health experts and climate change policymakers. Together they can address the root causes of leishmaniasis and other neglected tropical diseases, he says.
Policy advocacy must be grounded in robust data from field observations and analyses to make a convincing case for meaningful interventions, he adds.
“We must create people-centered interventions that reflect the cultural sensitivities of affected communities. New tools, such as medicines, vaccines and vector-control methods, must be acceptable to these populations, who should be involved in all stages of developing interventions. This approach will ensure long-term ownership and sustainability.”
Adera says creating awareness is key to stopping transmission. Health strategies from various partners, including Kenya’s Ministry of Health, the WHO and the DNDi can strengthen the fight against kala-azar.
“The community must be actively engaged,” he explains. “The success of kala-azar elimination, as seen in Bangladesh, shows that concerted efforts and government commitment can reduce the disease burden.”
Countries including Kenya, Uganda, Sudan, South Sudan, Ethiopia, Djibouti and Eritrea are committed to eliminating kala-azar in East Africa. Adera says the goal is to reduce the case fatality rate to less than 1%, and to decrease the disease’s prevalence by 90% over the next 12-13 years.
Kariuki lays out his vision: “By strengthening healthcare infrastructure, promoting sustainable environmental practices, and empowering local communities with education and resources, we can mitigate the effects of climate change and prevent the spread of diseases like kala-azar, ensuring long-term health and environmental justice.”
