Targeting environmental determinants and settlements in public health planning for the containment of visceral leishmaniasis: a One Health perspective.

Visceral leishmaniasis (also known as kala-azar) continues to be a major public health challenge in endemic regions. While vector control and clinical management have gained considerable attention, environmental determinants of transmission are often not prioritized in elimination strategies. In this article, we highlight gaps in surveillance that overlook environmental risks and propose their integration into routine elimination activities. At the same time, we also propose strengthening community-based monitoring, systematic environmental assessments, and harmonized data collection as tools to support existing approaches. These interventions are envisaged from a One Health perspective, underscoring the interconnected roles of human, animal, and environmental health. By integrating environmental measures with established epidemiological and clinical strategies, we propose a comprehensive approach to support the sustainability of kala-azar elimination efforts. The contribution of this perspective lies in emphasizing environmental surveillance as an essential pillar of elimination programs rather than a peripheral activity.