03656nas a2200301   4500000000100000008004100001260001200042653002200054653001000076653002700086653001100113653002000124100001300144700001400157700001400171700001400185700001300199700001600212700001100228700001600239700001500255245013700270856007500407300000900482490000700491520284200498022001403340       2026                            d  c02/202610aTreatment Outcome10aDeath10aVisceral Leishmaniasis10auganda10acharacteristics1 aNamara B1 aAnkunda I1 aMigisha R1 aKwesiga B1 aBulage L1 aNabatanzi S1 aArio A1 aMubangizi A1 aKadobera D00aCharacteristics, treatment outcomes and factors associated with death among patients with Visceral Leishmaniasis, Uganda, 2019-2024.  uhttps://pmc.ncbi.nlm.nih.gov/articles/PMC12956114/pdf/pntd.0014032.pdf  a1-140 v203 a<p><strong>BACKGROUND: </strong></p>

<p>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 &lt;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.</p>

<p><strong>METHODS:</strong></p>

<p>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.</p>

<p><strong>RESULTS: </strong></p>

<p>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 &lt;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).</p>

<p><strong>CONCLUSION: </strong></p>

<p>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.</p>
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