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Background: Ethiopia 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 Findings: In 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/significance: Contrary 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., Competing Interests: The authors have declared that no competing interests exist.

Background: Visceral leishmaniasis (VL) has been well documented by the Medecins sans Frontieres (MSF) VL treatment programmeme in the Tigray region of Ethiopia, but reports are limited from other facilities in this region where this disease continues to cause substantial morbidity and mortality., Objective: To describe the clinical manifestations and treatment outcomes of VL in a government hospital in Axum, Ethiopia., Design: Retrospective analysis of 111 patients treated for visceral leishmaniasis., Setting: Saint Mary's Hospital, Axum, Ethiopia., Subjects: One hundred and Eleven patients treated for visceral leishmaniasis in a government hospital in Axum, Ethiopia., Results: All patients were male and most reported travel history to Humera, a known endemic area. Patients presented with classic signs and symptoms, including fever, weight loss, splenomegaly and anaemia. Almost one third (15/53) of patients who underwent HIV testing had a positive result. Crude death rate at six months was 13.5 per 100 patients (95% CI: 6.7 - 20.3 per 100 patients). Presence of HIV and other co-infections were associated with increased risk of death., Conclusions: Clinical manifestations and treatment outcomes in this setting were comparable to that of the MSF programmeme in Tigray, Ethiopia and highlight the importance of HIV testing for patients presenting with visceral leishmaniasis.

Tests on a panel of 421 serum samples from Ethiopia and 11 from Europe with the direct agglutination test (DAT) and freeze-dried antigen (Leishmania donovani 1S) showed that a cut-off titre of 1:200 or 1:400 could be employed. Using a cut-off titre of 1:400, 181 (88.3%) of 205 serum samples from visceral leishmaniasis (VL) patients tested positive, as did 5 (13.9%) of 36 sera from patients with localized cutaneous leishmaniasis, 5 (71.4%) sera from 7 patients with diffuse cutaneous leishmaniasis and 8 (89.9%) sera from 9 HIV-positive VL patients. We also found that 19 (57.6%) sera from 33 treated VL patients were still positive in the DAT at 1.5 to 5 years after treatment.

A semi-prospective study of clinical and laboratory data of kala-azar was made in 27 patients from Metema-Humera lowlands in north-west Ethiopia. Most patients were labour migrants. A high mortality rate (55.6%) was found in these labourers in spite of therapy with pentavalent antimonials. We suspect that kala-azar in this region is a zoonosis and believe that the clinical picture is similar to that of the Sudan.