The cumulative cases, case fatality rate, and trend in the incidence and mortality rate of visceral leishmaniasis (VL) were investigated in Gadarif State, Eastern Sudan.

During the 14-year study period (2002–2015), a total of 51 773 patients were registered in Gadarif State with clinical and laboratory evidence of proven VL.

The trend in VL was considerably higher in the years 2003–2005 as compared to the last 5 years of 2011–2015.

The highest fatality rate was observed in the year 2002 (4.8%) and it had declined in 2014 and 2015.

Rural residence was statistically associated with death related to VL (p = 0.021).

Immediate interventions are needed in terms of health education and the implementation of preventive measures, with a specific focus on people residing in rural areas.