Visceral Leishmaniasis (Kala-Azar) Risk Mapping using Geo-Spatial Tools: A Case Study in KaftaHumera District, North Western Ethiopia

BackgroundEthiopia bears a high burden of visceral leishmaniasis (VL). Early access to VL diagnosis and care improves clinical prognosis and reduces transmission from infected humans; however, significant obstacles exist. The approximate 250,000 seasonal mobile workers (MW) employed annually in northwestern Ethiopia may be particularly disadvantaged and at risk of VL acquisition and death. Our study aimed to assess barriers, and recommend interventions to increase access, to VL diagnosis and care among MWs.Methodology/Principal findingsIn 2017, 50 interviews and 11 focus group discussions were conducted with MWs, mobile residents, VL patients and caretakers, community leaders and healthcare workers in Kafta Humera District, Tigray. Participants reported high vulnerability to VL among MWs and residents engaged in transitory work. Multiple visits to health facilities were consistently needed to access VL diagnosis. Inadequate healthcare worker training, diagnostic test kit unavailability at the primary healthcare level, lack of VL awareness, insufficient finances for care-seeking and prioritization of income-generating activities were significant barriers to diagnosis and care. Social (decision-making and financial) support strongly and positively influenced care-seeking; workers unable to receive salary advances, compensation for partial work, or peer assistance for contract completion were particularly disadvantaged. Participants recommended the government/stakeholders intervene to ensure: MWs access to bed-nets, food, shelter, water, and healthcare at farms or sick leave; decentralization of diagnostic tests to primary healthcare facilities; surplus medications/staff during the peak season; improved referral/feedback/reporting/training within the health system; free comprehensive healthcare for all VL-related services; and community health education.Conclusions/SignificanceContrary to what health policy for VL dictates in this endemic setting, study participants reported very poor access to diagnosis and, consequently, significantly delayed access to treatment. Interventions tailored to the socio-economic and health needs of MWs (and other persons suffering from VL) are urgently needed to reduce health disparities and the VL burden.

In a recent paper, Nagpal et al. voiced concerns about the limited or biased use of scientific evidence to support public health interventions to control neglected tropical diseases (NTDs). Visceral leishmaniasis (VL), also known as kala-azar, is one of the major NTDs and does not escape this problem. Transmission is vector-borne and the Indian subcontinent is the region reporting most of the VL cases worldwide. In this region, the main causative species is Leishmania donovani and Phlebotomus argentipes is the vector. Transmission is considered anthroponotic and peridomestic—occurring at night when female sand flies bite people sleeping inside their house. The World Health Organization and the governments of India, Nepal, and Bangladesh set out in 2005 to eliminate VL from the region by 2015 through a combination of early treatment of cases and vector control. However, while recent advances in diagnostic tools and drugs have significantly improved case management strategies, the available vector control tools against P. argentipes remain limited. The elimination initiative promotes the use of indoor residual spraying (IRS) of households and cattle sheds to reduce vector density, but the evidence underpinning the effectiveness of IRS in this region is scanty. Historical observations show that L. donovani transmission declined concomitantly with dichlorodiphenyltrichloroethane (DDT) spraying during the 1950s–60s to eradicate malaria. In the aftermath of this malaria eradication campaign, very few VL cases were observed in endemic regions until the mid-seventies, when there was resurgence of a VL epidemic in India. To date, there are no randomized trials showing the effect of IRS on the incidence of clinical VL, though some studies showed a reduction in vector density. When the VL elimination initiative was launched in 2005, there were no clear alternatives for IRS as a vector control strategy. Insecticide treated nets (ITNs) were proposed as an alternative or complement to IRS on the basis of analogy arguments regarding their given efficacy against malaria or on data from observational studies suggesting ITNs reduce the risk of VL; but as for IRS, there were no randomized trials evaluating the effect of ITNs on L. donovani transmission. In this context, a number of field studies were conducted in the Indian subcontinent in the past decade to evaluate the effectiveness and impact of ITNs and other vector control tools on VL. Most of these studies have been reviewed in detail in two recent papers. The only two studies evaluating the impact of vector control interventions on clinical outcomes found conflicting results. First, the KALANET project, a cluster randomised controlled trial (CRT) in India and Nepal, showed that mass-distribution of ITNs did not reduce the risk of L. donovani infection or clinical VL. Then, an intervention trial in Bangladesh suggested that widespread bed net impregnation with slow-release insecticide may reduce the frequency of VL. Technical (e.g., type of nets and insecticides, lack of replicas and randomisation in Bangladesh) and biological factors (e.g., insecticide susceptibility and sand fly behaviour) may explain the different results observed. This apparent contradiction raises the question about the role that ITN may play in controlling VL in the Indian subcontinent but has also triggered a lot of discussion on methodology and evidence levels required when evaluating vector control tools for VL. In this paper, we would like to summarise the lessons learned from the KALANET CRT in terms of methodology to inform the generation of future evidence and discuss interpretation of findings against this background.

BackgroundVisceral leishmaniasis (VL) is a vector-borne disease whose factors involved in transmission are poorly understood, especially in more urban and densely populated counties. In Brazil, the VL urbanization is a challenge for the control program. The goals were to identify the greater risk areas for human VL and the risk factors involved in transmission.MethodologyThis is an ecological study on the relative risk of human VL. Spatial units of analysis were the coverage areas of the Basic Health Units (146 small-areas) of Belo Horizonte, Minas Gerais State, Brazil. Human VL cases, from 2007 to 2009 (n = 412), were obtained in the Brazilian Reportable Disease Information System. Bayesian approach was used to model the relative risk of VL including potential risk factors involved in transmission (canine infection, socioeconomic and environmental features) and to identify the small-areas of greater risk to human VL.Principal FindingsThe relative risk of VL was shown to be correlated with income, education, and the number of infected dogs per inhabitants. The estimates of relative risk of VL were higher than 1.0 in 54% of the areas (79/146). The spatial modeling highlighted 14 areas with the highest relative risk of VL and 12 of them are concentrated in the northern region of the city.ConclusionsThe spatial analysis used in this study is useful for the identification of small-areas according to risk of human VL and presents operational applicability in control and surveillance program in an urban environment with an unequal spatial distribution of the disease. Thus the frequent monitoring of relative risk of human VL in small-areas is important to direct and prioritize the actions of the control program in urban environment, especially in big cities.

BackgroundVector-borne diseases are highly sensitive to environmental and climatic conditions, which can directly affect vector behavior, parasite development, and transmission dynamics. Identifying the key meteorological drivers of these diseases and understanding the timing of their impacts is crucial for enhancing public health preparedness. This study focuses on visceral leishmaniasis (VL) in Brazil; a parasitic vector-borne disease spread by the bite of infected sandflies whose distribution is heavily influenced by environmental conditions.MethodologyWe analyzed monthly confirmed VL cases from 2007-2022 using distributed lag nonlinear models within a spatiotemporal Bayesian hierarchical model framework to assess the nonlinear, time-lagged associations between locally defined weather anomalies and VL risk across space. We evaluated the exposure-lag-response relationships between anomalies in monthly average temperature, precipitation, and relative humidity; and VL incidence across Brazilian microregions, considering lags ranging from 0 to 4 months.Principal findingsAmong the 53,968 VL cases reported during the study period, the majority occurred in the Northeast and Central North regions. Our model revealed statistically significant nonlinear relationships between meteorological anomalies and VL risk. Associations were most pronounced in rural and deforested microregions, where climatic extremes intensified transmission risk.Conclusions and significanceThis analysis identified an increased VL risk at higher-than-usual temperatures and a lower risk with higher-than-usual humidity and precipitation across various lags. We offer novel foundational insights for the future development of early warning systems, especially relevant to regions like Brazil facing a substantial VL burden.

BackgroundImproving knowledge on local determinants of visceral leishmaniasis (VL) is crucial to guide the development of relevant control strategies. This study aimed to identify individual and household level determinants of primary VL in 24 highly endemic villages of Tabarak Allah hospital’s catchment area, Gedaref State, Sudan.MethodsFrom September 2012 to July 2013, in an unmatched case-control design, 198 patients with primary VL were compared to 801 controls free of VL symptoms and with a negative VL rapid test. Using random spatial sampling, controls were selected with a distribution of age, sex and village of residence proportionate to the distribution of the target population. Data were collected using a structured questionnaire.ResultsChildren and men were at higher risk of VL. Reporting VL patient(s) in the household in the previous year was the strongest VL risk factor. In a multivariate analysis, VL risk increased with household size, sleep location (outside the yard, not in the farm), evening outdoor activities in the rainy season (playing, watching TV, radio listening), use of ground nut oil as animal repellent and of smoke of Acacia seyal as indoor repellent, presence of dogs in the yard at night, Acacia nilotica in the yard’s immediate surroundings and of a forest at eye range. VL risk appeared to decrease with the use of drinking water sources other than the village water tank, a buffer distance from the adjacent house yard, and with the presence of animals other than dogs in the yard at night. In contrast with previous studies, housing factors, mosquito-net use, black cotton soil, ethnicity, socioeconomic index, presence of Balanites aegyptica and Azadirachta indica in the yard were not independent VL determinants.Discussion and conclusionAlthough these results do not provide evidence of causality, they provide useful suggestions for guiding further intervention studies on VL preventive measures.

Visceral leishmaniasis (VL) is a neglected tropical disease that is globally distributed and has the potential to cause very serious illness. Prior literature highlights the emergence and spread of VL is influenced by multiple factors, such as socioeconomic status, sanitation levels or animal and human reservoirs. The study aimed to retrospectively investigate the presence and infectiousness of VL in Rio Grande do Norte (RN), Brazil between 2007 and 2020. We applied a hierarchical Bayesian approach to estimate municipality-specific relative risk of VL across space and time. The results show evidence that lower socioeconomic status is connected to higher municipality-specific VL risk. Overall, estimates reveal spatially heterogeneous VL risks in RN, with a high probability that VL risk for municipalities within the West Potiguar mesoregion are more than double the expected VL risk. Additionally, given the data available, results indicate there is a high probability of increasing VL risk in the municipalities of Natal, Patu and Pau dos Ferros. These findings demonstrate opportunities for municipality-specific public health policy interventions and warrant future research on identifying epidemiological drivers in at-risk regions.

Although visceral leishmaniasis disease is controlled overall in China, it remains a serious public health problem and remains fundamentally uncontrolled in Jiashi County, Xinjiang Uygur Autonomous Region. During 2005–2015, there were two outbreaks in Jiashi County. Assessing the influence of meteorological factors on visceral leishmaniasis incidence is essential for its monitoring and control. In this study, we applied generalized estimating equations to assess the impact of meteorological factors on visceral leishmaniasis risk from 2005 to 2015. We also compared meteorological factors among years with Kruskal–Wallis test to explore possible reasons behind the two outbreaks that occurred during our study period. We found that temperature and relative humidity had very significant associations with visceral leishmaniasis risk and there were interactions between these factors. Increasing temperature or decreasing relative humidity could increase the risk of visceral leishmaniasis events. The outbreaks investigated might have been related to low relative humidity and high temperatures. Our findings will support the rationale for visceral leishmaniasis control in China.

Understanding and mapping the distribution of sandflies and sandfly-associated pathogens (SAPs) is crucial for guiding the surveillance and control effort. However, their distribution and the related risk burden in China remain poorly understood. We mapped the distribution of sandflies and SAPs using literature data from 1940 to 2022. We also mapped the human visceral leishmaniasis (VL) cases using surveillance data from 2014 to 2018. The ecological drivers of 12 main sandfly species and VL were identified by applying machine learning, and their distribution and risk were predicted in three time periods (2021-2040, 2041-2060, and 2061-2080) under three scenarios of climate and socioeconomic changes. In the mainland of China, a total of 47 sandfly species have been reported, with the main 12 species classified into three clusters according to their ecological niches. Additionally, 6 SAPs have been identified, which include two protozoa, two bacteria, and two viruses. The incidence risk of different VL subtypes was closely associated with the distribution risk of specific vectors. The model predictions also revealed a substantial underestimation of the current sandfly distribution and VL risk. The predicted areas affected by the 12 major species of sandflies and the high-risk areas for VL were found to be 37.9-1121.0% and 136.6% larger, respectively, than the observed range in the areas. The future global changes were projected to decrease the risk of mountain-type zoonotic VL (MT-ZVL), but anthroponotic VL (AVL) and desert-type zoonotic VL (DT-ZVL) could remain stable or slightly increase. Current field observations underestimate the spatial distributions of main sandfly species and VL in China. More active surveillance and field investigations are needed where high risks are predicted, especially in areas where the future risk of VL is projected to remain high or increase.

To the Editors: We read the retrospective analysis about visceral leishmaniasis (VL) and secondary hemophagocytic lymphohistiocytosis (HLH) described by López et al.1 In our hospital (Meyer Children’s Hospital in Florence, Italy) a cluster of 5 patients in 5 months (November 2021–March 2022) with VL and secondary HLH was recently recorded. Patients’ characteristics are reported in Table 1. TABLE 1. - Patient’ s Characteristics. Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Age (mo) 10 12 18 11 16 Sex (M, F) M M M F F BT (°C) at admission 38.7 38.6 39.4 39.9 40 Splenomegaly + + + + + Blood tests at admission Hb (g/dL) 7.6 7.8 8.3 9.1 10.5 PLTs (×109/L) 66 96 131 229 108 WBC (% N) (×109/L) 3 (10.2) 5.21 (15.1) 4.77 (17.7) 5.36 (6.8) 4.74 (37.4) Ferritin (ng/mL) 1195 1806 6945 7084 4962 Triglycerides (mg/dL) 234 438 269 299 165 ALT (UI/L) 49 71 132 76 59 AST (UI/L) 68 107 253 90 89 CRP (mg/dL) 2.98 6.84 2.63 2.37 4.19 Fibrinogen (mg/dl) 153 204 152 259 219 Timing lat BMA (days after admission; days after onset) (1; 9) (1; 13) (3; 20) (3; 12) NA Leishmania DNA on BMA + NA + + NA Morphology on BMA Hemophagocytosis Hemophagocytosis Hemophagocytosis Hemophagocytosis NA Real-time PCR on blood − + + + + Serological assay for L. + Dubious + + + Fever remission (days after first dose of Lip-Ampho-B; days after admission) 2; 9 4; 7 1; 7 1; 5 3; 5 Length of hospitalization (d) 22 17 8 10 12 Blood tests at discharge Hb (g/dL) 10.1 9.8 9.9 8.1 9 PLTs (×109/L) 363 389 308 404 115 WBC (%N)(x109/L) 8.24 (26.9) 15.88 (38.7) 10.24 (28.8) 13.46 (13.6) 5.48 (28.7%) Ferritin (ng/mL) 15 90 700 832 3812 Triglycerides (mg/dL) 242 137 416 384 310 ALT (UI/L) 34 53 330 50 47 AST (UI/L) 30 41 127 43 94 CRP (mg/dL) <0.29 0.16 0.16 0.15 0.52 Fibrinogen (mg/dL) 136 236 299 242 257 ALT indicates alanine aminotransferase; AST, aspartate aminotransferase; BMA, bone marrow aspiration; BT, body temperature; CRP, C reactive protein; Hb, hemoglobin; NA, not applicable; PLT, platelets; WBC, white blood cells. They were admitted with suspected HLH; meanwhile, infectious tests were ongoing, due to life-threatening clinical conditions, immunosuppressive therapy was started to achieve the control of the fast-evolving HLH. Leishmania was detected by molecular methods in the blood in all patients and in the bone marrow in 3 of them. In addition, 4 of them had a positive serology for Leishmania infantum (determined by chemiluminescence immunoassay). After these positive results, liposomal amphotericin B was started with clinical improvement. VL is endemic in Southern Europe,2 with 50,000–90,000 new cases estimated annually worldwide by the World Health Organization (WHO),2 and nearly, half of the VL cases occur in children.3 The fatality rate of this condition is about 100% within 2 years, if not treated.2 Actually, L. infantum is the one most often associated with VL,4 and it is transmitted through infected phlebotomine sandflies bites.3 VL should be suspected in children with prolonged fever of unknown origin, hepatosplenomegaly and/or pancytopenia.2 Immune response to Leishmania is associated with an interaction of T helper 1-2 cytokines, interferon-gamma, interleukin 4 and 105: this could be explained why leishmaniasis is a cause, although rare in childhood,3 of HLH. The presence of Leishman bodies in the bone marrow or tissue sections as splenic smears of lymph node samples is theoretically the gold standard,5 but to achieve the correct diagnosis also the molecular testing on bone marrow aspiration and/or the blood, along to the detection of antileishmanial antibodies, are recommended.4 To our knowledge, our case series represented the only cluster (5 cases in 5 months) in these last 10 years in Italy, except for another cases series in 20136 in Bologna within a 6-month period (14 patients with VL but only 4 of them presenting HLH), a case report described in Rome3 and other 2 cases described in twins from Germany-Switzerland border, after traveling to Tuscany in 2018.7 Interestingly, a higher prevalence of Leishmania in dogs was recorded in 2021 in Tuscany8 (our patients had reported previously contact with dogs), and an increased number of leishmaniasis (both in adults and in children) was reported to the Tuscany Public Health Services in 2021 (personal communication). This epidemiologic link suggests that close monitoring of Leishmaniasis cases is necessary to understand the epidemiologic situation of each country, with the aim to implement prevention strategies. Moreover, considering the risk of VL in travelers to Southern Europe is pivotal to increase awareness not only among local physicians but also globally to avoid misdiagnosis in nonendemic countries. In conclusion, due to its high fatality rate, prompt diagnosis and early appropriate treatment has crucial importance and a multidisciplinary approach is pivotal to obtaining a full recovery.

The prevalence of parasitic protozoan diseases in Iraq, 2016

Trypanosomiasis, a parasitic vector-borne disease, poses a serious threat to both animal and human populations, especially in areas where the convergence of vectors and their hosts is easy. The Yankari Game Reserve in northeastern Nigeria is poorly understood as an environment with complex dynamics of Trypanosomiasis transmission. Using geospatial techniques, this paper comprehensively conducted an epidemiological risk assessment and mapping of Trypanosomiasis in the Yankari Game Reserve. This was achieved through combining Geospatial tools and methods such as Geographic Information Systems (GIS), Remote Sensing, and Spatial Analysis. This way, acquired data sets were integrated and analysed to generate risk maps delineating areas of high Trypanosomiasis transmission potential. Results indicated a spatial heterogeneity in the distribution of tsetse flies and trypanosome infections within the Game Reserve – Yankari. Environmental variables, including elevation, vegetation cover and proximity to water bodies, are identified as important predictors of Trypanosomiasis risk. Risk map results provide invaluable insights that aid in focusing target interventions on curtailing and mitigating the spread of Trypanosomiasis in the Game Reserve Region. The study also demonstrated the versatility of geospatial tools and techniques in interpreting the epidemiology of Trypanosomiasis, as well as highlighting the relevance of integrating multidisciplinary approaches for disease management and surveillance in wildlife reserves. Notably, this will significantly improve our understanding of the dynamics of Trypanosomiasis transmission and enhance the decision-making process, thereby safeguarding the health of both animal and human populations within and beyond Yankari Game Reserve.

Backgrounds: Visceral leishmaniasis (VL) is a vector-borne disease posing increasing public health concerns. Although efforts to eliminate VL are underway, its global risk distribution remains unclear, because of changes in transmission risk. Methods: Worldwide province-level data on VL incidence were obtained from multiple sources. We analyzed the global evolution features of VL and estimated its ecological niches with boosted regression tree models. A risk map was generated to analyze regions with high VL risk. Results: A total of 558 articles and 2,694 records from 310 provinces were included. The model indicated that precipitation in the warmest quarter and poor socio-demographic index were the most significant risk factors affecting VL distribution. The risk map indicated that Brazil, Iran, Ethiopia, and India were the regions with the highest probability of infection. We estimated that 5.3 billion people live in regions at risk of VL. Conclusions: VL is undergoing geographic expansion. Our study increases understanding of VL’s global-risk distribution and how risk factors influencing the disease transmission. Our findings may aid in promoting disease control in future surveillance activities.

Impact of sexual trajectories of men who have sex with men on the reduction in HIV transmission by pre-exposure prophylaxis

As of 2021, the National Kala-azar Elimination Programme (NKAEP) in India has achieved visceral leishmaniasis (VL) elimination (<1 case / 10,000 population/year per block) in 625 of the 633 endemic blocks (subdistricts) in four states. The programme needs to sustain this achievement and target interventions in the remaining blocks to achieve the WHO 2030 target of VL elimination as a public health problem. An effective tool to analyse programme data and predict/ forecast the spatial and temporal trends of VL incidence, elimination threshold, and risk of resurgence will be of use to the programme management at this juncture. We employed spatiotemporal models incorporating environment, climatic and demographic factors as covariates to describe monthly VL cases for 8-years (2013-2020) in 491 and 27 endemic and non-endemic blocks of Bihar and Jharkhand states. We fitted 37 models of spatial, temporal, and spatiotemporal interaction random effects with covariates to monthly VL cases for 6-years (2013-2018, training data) using Bayesian inference via Integrated Nested Laplace Approximation (INLA) approach. The best-fitting model was selected based on deviance information criterion (DIC) and Watanabe-Akaike Information Criterion (WAIC) and was validated with monthly cases for 2019-2020 (test data). The model could describe observed spatial and temporal patterns of VL incidence in the two states having widely differing incidence trajectories, with >93% and 99% coverage probability (proportion of observations falling inside 95% Bayesian credible interval for the predicted number of VL cases per month) during the training and testing periods. PIT (probability integral transform) histograms confirmed consistency between prediction and observation for the test period. Forecasting for 2021-2023 showed that the annual VL incidence is likely to exceed elimination threshold in 16-18 blocks in 4 districts of Jharkhand and 33-38 blocks in 10 districts of Bihar. The risk of VL in non-endemic neighbouring blocks of both Bihar and Jharkhand are less than 0.5 during the training and test periods, and for 2021-2023, the probability that the risk greater than 1 is negligible (P<0.1). Fitted model showed that VL occurrence was positively associated with mean temperature, minimum temperature, enhanced vegetation index, precipitation, and isothermality, and negatively with maximum temperature, land surface temperature, soil moisture and population density. The spatiotemporal model incorporating environmental, bioclimatic, and demographic factors demonstrated that the KAMIS database of the national programmme can be used for block level predictions of long-term spatial and temporal trends in VL incidence and risk of outbreak / resurgence in endemic and non-endemic settings. The database integrated with the modelling framework and a dashboard facility can facilitate such analysis and predictions. This could aid the programme to monitor progress of VL elimination at least one-year ahead, assess risk of resurgence or outbreak in post-elimination settings, and implement timely and targeted interventions or preventive measures so that the NKAEP meet the target of achieving elimination by 2030.

BackgroundAs of 2021, the National Kala-azar Elimination Programme (NKAEP) in India has achieved visceral leishmaniasis (VL) elimination (<1 case / 10,000 population/year per block) in 625 of the 633 endemic blocks (subdistricts) in four states. The programme needs to sustain this achievement and target interventions in the remaining blocks to achieve the WHO 2030 target of VL elimination as a public health problem. An effective tool to analyse programme data and predict/ forecast the spatial and temporal trends of VL incidence, elimination threshold, and risk of resurgence will be of use to the programme management at this juncture.Methodology/principal findingsWe employed spatiotemporal models incorporating environment, climatic and demographic factors as covariates to describe monthly VL cases for 8-years (2013–2020) in 491 and 27 endemic and non-endemic blocks of Bihar and Jharkhand states. We fitted 37 models of spatial, temporal, and spatiotemporal interaction random effects with covariates to monthly VL cases for 6-years (2013–2018, training data) using Bayesian inference via Integrated Nested Laplace Approximation (INLA) approach. The best-fitting model was selected based on deviance information criterion (DIC) and Watanabe-Akaike Information Criterion (WAIC) and was validated with monthly cases for 2019–2020 (test data). The model could describe observed spatial and temporal patterns of VL incidence in the two states having widely differing incidence trajectories, with >93% and 99% coverage probability (proportion of observations falling inside 95% Bayesian credible interval for the predicted number of VL cases per month) during the training and testing periods. PIT (probability integral transform) histograms confirmed consistency between prediction and observation for the test period. Forecasting for 2021–2023 showed that the annual VL incidence is likely to exceed elimination threshold in 16–18 blocks in 4 districts of Jharkhand and 33–38 blocks in 10 districts of Bihar. The risk of VL in non-endemic neighbouring blocks of both Bihar and Jharkhand are less than 0.5 during the training and test periods, and for 2021–2023, the probability that the risk greater than 1 is negligible (P<0.1). Fitted model showed that VL occurrence was positively associated with mean temperature, minimum temperature, enhanced vegetation index, precipitation, and isothermality, and negatively with maximum temperature, land surface temperature, soil moisture and population density.Conclusions/significanceThe spatiotemporal model incorporating environmental, bioclimatic, and demographic factors demonstrated that the KAMIS database of the national programmme can be used for block level predictions of long-term spatial and temporal trends in VL incidence and risk of outbreak / resurgence in endemic and non-endemic settings. The database integrated with the modelling framework and a dashboard facility can facilitate such analysis and predictions. This could aid the programme to monitor progress of VL elimination at least one-year ahead, assess risk of resurgence or outbreak in post-elimination settings, and implement timely and targeted interventions or preventive measures so that the NKAEP meet the target of achieving elimination by 2030.