The leishmaniases are protozoan infections that are among the neglected tropical diseases (NTDs). Over one billion people are at risk of these diseases in virtually all continents. These diseases debilitate large numbers of people, keeping them from full, productive lives. Visceral leishmaniasis (VL) is the most severe form of these diseases, killing more people than any other parasitic disease except malaria. About 90% of the global burden for VL is found in just 7 countries, 4 of which are in Eastern Africa (Sudan, South Sudan, Ethiopia and Kenya), 2 in Southeast Asia (India, Bangladesh) and Brazil, which carries nearly all of cases in South America. In 2005 the World Health Organization launched a strategy to eliminate VL in the Indian subcontinent resulting in significant progress there. The London Declaration on NTDs in 2012, with targets to 2020, heightened attention to VL, and NTDs were formerly adopted into the Sustainable Development agenda for 2015-2030. However, there has been limited progress in most regions and especially in Eastern Africa. Challenges remain as instability, population movements and environmental changes test programming and political commitments. We review disease transmission and management dynamics, epidemiology, policy interventions, and identify outstanding issue towards elimination concluding with the call that, at the start of another decade, there is need to redouble efforts to control this deadly disease as part of the push towards the Sustainable Development Goals.

The leishmaniases are a group of four vector-borne neglected tropical diseases (NTDs) with 1.6 billion people in some 100 countries at risk. They occur in certain eco-epidemiological foci that reflect manipulation by human activities, such as migration, urbanization and deforestation, of which poverty, conflict and climate change are key drivers. Given their synergistic impacts, risk factors and the vulnerabilities of poor populations and the launch of a new 2030 roadmap for NTDs in the context of the global sustainability agenda, it is warranted to update the state of knowledge of the leishmaniases and their effects. Using existing literature, we review socioeconomic and psychosocial impacts of leishmaniasis within a framework of risk factors and vulnerabilities to help inform policy interventions. Studies show that poverty is an overarching primary risk factor. Low-income status fosters inadequate housing, malnutrition and lack of sanitation, which create and exacerbate complexities in access to care and treatment outcomes as well as education and awareness. The co-occurrence of the leishmaniases with malnutrition and HIV infection further complicate diagnosis and treatment, leading to poor diagnostic outcomes and therapeutic response. Even with free treatment, households may suffer catastrophic health expenditure from direct and indirect medical costs, which compounds existing financial strain in low-income communities for households and healthcare systems. The dermatological presentations of the leishmaniases may result in long-term severe disfigurement, leading to stigmatization, reduced quality of life, discrimination and mental health issues. A substantial amount of recent literature points to the vulnerability pathways and burden of leishmaniasis on women, in particular, who disproportionately suffer from these impacts. These emerging foci demonstrate a need for continued international efforts to address key risk factors and population vulnerabilities if leishmaniasis control, and ultimately elimination, is to be achieved by 2030.