OBJECTIVE To study selected epidemiological aspects of visceral leishmaniasis, assess direct agglutination test (DAT) as a diagnostic method and the sero-epidemiological prevalence of the disease among apparently healthy children in Basrah, Iraq. METHODS This prospective study included 146 children suspected of visceral leishmaniasis who were admitted to Basrah Maternity and Children Hospital and Basrah General Hospital from November 2004 till November 2005 and 37 serum samples that were collected from patients with different diseases considered in the differential diagnosis of visceral leishmaniasis. In addition, 1000 apparently healthy children were randomly selected for the sero-epidemiological survey. Direct agglutination test was done for all of them. RESULTS Out of 146 suspected visceral leishmaniasis cases, 124 (84.9%) were proved by the examination of bone marrow aspirate, 132 (91.1%) were positive by direct agglutination test (DAT) and only 3 (2%) were positive by immunochromatographic strip test. The sensitivity and specificity of DAT were (100%), with a cut-off point of 1:800. In the in-patient group children less than 2 years of age were mainly affected. The highest frequency of disease was reported in July, 24 cases (18.8%). Sand flies were recorded in the environment of all sero-positive cases (100%) in each group, stray dogs and wild canines were present in (75.7% and 15.5%) in in-patients group compared to (69% and 22.5%) in sero-epidemiological group, respectively. Low maternal education was present in a significantly higher frequency among sero-positive cases. CONCLUSIONS Direct agglutination test can be used as a screening tool for visceral leishmaniasis on a wide range in endemic areas, with a high sensitivity and specificity.