Kenya has experienced several outbreaks of Visceral Leishmaniasis, with several counties in arid and semi-arid regions identified as endemic areas (Tinui, 2008). Since 1st January 2020 to September 2021, a total of 1152 (suspected and confirmed) visceral leishmaniasis cases had been reported in seven counties; Marsabit, Garissa, Kitui, West Pokot, Mandera, Wajir and Baringo Counties. By the time of the investigation, the outbreak was currently active in four counties, West Pokot County in Pokot North Sub County, Mwingi North in Kitui County, Wajir County in Wajir North, Eldas and Wajir West Sub – Counties and Mandera County in Kotulo sub county. A total of ten deaths had been reported in these counties (CFR 1%) (Kenya, 2021).

Visceral Leishmaniasis is not known to be endemic in Tharaka Nithi County with only sporadic cases reported in the county previously (Ministry of Health Kenya, 2021). However, in the month of September 2021, the county had reported 56 suspected cases of Kala azar, with 18 (32%) confirmed using rk 39 rapid test. Most of these cases (98%) were from Tharaka North sub-county, which borders Mwingi North sub county in Kitui County. In a previous investigation carried out in Kitui in July 2020, a total of 123 suspected and confirmed V.L. cases were line-listed between May 2020 to July 2020 (FELTP, n.d.)

Gatanga ward in Tharaka North Sub County has a poverty index of 72-85%, with a poverty gap of 21-30%, the highest in Tharaka Nithi County (County Tharaka Nithi, 2018). With the National Drought Management Authority (NDMA) in its August Drought bulletin placing the county on alert status, there had been an influx of pastoralists from neighboring counties. In addition, the food security situation in the county was dire at the time and hence immunity of the population could be lowered due to malnutrition. (Management & Authority, 2021).

Therefore, a team from Kenya FELTP was deployed to confirm the existence of an outbreak in this sub county, identify and describe cases, provide information to guide case management, prevention and control measures. The investigation started on the 5th of October 2021 and was conducted over a period of nine days

Objectives of the activity:

• To describe cases of Visceral Leishmaniasis in Tharaka Nithi County
• To determine the risk factors contributing to transmission of leishmaniasis in the community
• To conduct health facility assessment to guide establishment of a treatment centre in the county
• To conduct a rapid assessment of the surveillance status in Tharaka Nithi County
• To conduct sensitization on prevention and control of the disease

A detailed report was shared with the stakeholders after the completion of the investigation.