WHO approves new shorter, less painful Kala-azar treatment for East Africa

The World Health Organisation (WHO) has issued new treatment guidelines that will allow patients with kala-azar in Uganda and other East African countries to receive shorter, safer and less painful treatment for the disease.

Kala-azar, also known as visceral leishmaniasis, is a serious disease spread through the bite of infected sandflies. It attacks internal organs, causing prolonged fever, severe weight loss and weakness. Without treatment, it can be fatal.

East Africa carries the world's highest burden of kala-azar, accounting for 79% of reported cases in 2024. Half of those affected are children under the age of 15.

The new treatment cuts the number of injections from 34 over 17 days to just 14 over 14 days while patients complete part of their treatment using tablets. Clinical trials carried out in Ethiopia, Kenya, Sudan and Uganda showed the new approach cured more than 90% of patients.

"In places like Amudat, many of our patients are children under 15 who, together with their caregivers, travel long distances to reach care. For a sick child, having to endure up to 34 painful injections is extremely difficult. Reducing this to just 14 injections, combined with an oral medicine, makes treatment far more manageable for our young patients," said Dr Patrick Sagaki from Amudat Hospital.

Reacting to the development, Dr Daniel Ngamije Madandi, the WHO Director of Malaria and Neglected Tropical Diseases, said on Thursday (July 29, 2026) that "for too long, patients suffering from leishmaniasis have endured treatments nearly as punishing as the disease itself.”

He said the new WHO guidelines mark a turning point.

"By recommending safer, shorter and more patient-friendly regimens, we are not just improving care; we are accelerating our fight to eliminate this devastating disease and offering renewed hope to communities across Africa and Asia."

Studies conducted in Sudan found that the new treatment dramatically reduces the time patients with PKDL spend in hospital. Instead of remaining admitted for between two and three months, many patients will only need about two weeks in hospital before completing the rest of their treatment at home.

Some patients, however, will continue receiving the current treatment because the new tablets are not recommended during pregnancy.

"For decades, we have treated patients with long, painful and potentially toxic regimens that are difficult to deliver in the settings where this disease occurs," said Dr Koert Ritmeijer, Neglected Tropical Diseases Advisor at Médecins Sans Frontières.

"These new recommendations mark an important shift toward treatments that are better suited to the realities on the ground. The goal is not just effective treatment, but treatment that patients can realistically access and complete."

Prof. Ahmed Musa, Sudan's Minister of Higher Education and Scientific Research and a former lead investigator in the studies, said the new recommendations would make treatment much easier for patients and their families.

"Shorter hospital stays mean patients with PKDL no longer need to spend weeks away from home. Reducing the number of painful, toxic injections and replacing them with an oral component has made treatment not only easier but also safer for patients," he said.

WHO also announced shorter treatment options for post-kala-azar dermal leishmaniasis (PKDL), a skin condition that can develop after someone recovers from kala-azar. The updated guidelines cover East Africa and South Asia.

The skin rashes and patches may spread across the body months after a person has recovered from kala-azar. Although it is not usually life-threatening, the condition often leads to stigma and social isolation because of the visible skin changes. It can also contribute to continued spread of the disease in affected communities.

The new treatment options were developed by the non-profit Drugs for Neglected Diseases initiative (DNDi), together with its partners.

Dr Fabiana Alves, Director of DNDi's Leishmaniasis-Mycetoma Cluster, said the organization welcomed WHO's decision to include the new treatments in its guidelines.

She added that researchers are already working on an all-tablet treatment that could eventually remove the need for injections altogether.

Following WHO's decision, countries affected by kala-azar and PKDL, including Uganda, are expected to update their national treatment guidelines to introduce the new treatment options.