Kala Azar, Visceral Leishmaniasis
Conditions
Keywords
Leishmania donovani, cluster-randomised control trial, Long Lasting Impregnated Nets, Bednets, Sandflies
Brief summary
A cluster-randomized vector control trial in Bihar, India, and neighboring Nepal, will test the efficacy of long-lasting impregnated bednets (LLINs, Permanets) for reducing visceral leishmaniasis incidence. The intervention unit is the village (400-1000 people). The study is designed to detect a 50% reduction in Leishmania donovani incidence in intervention compared to control clusters over 2 years. 24 clusters (selected as high incidence during previous years) will be randomly allocated to intervention or control. Following health education, and with informed consent, all households in intervention villages will receive free Permanets (from September 2006). Net usage will be monitored and new nets provided if required. Control villages will not be given untreated nets, as - although commonly used in this region - their effectiveness against sandflies has not been proven. Pre-intervention infection status of villagers (\>2 yrs) will be evaluated serologically from finger-prick blood (and past/current disease status noted). Incident infections will be recorded by 3-monthly active search for clinical cases, and by annual serological diagnoses to detect subclinical infections. All villagers (\>2yrs) will be leishmanin skin tested at the end of the trial for further subclinical infection detection, and sera from a sub-sample will be tested for antibodies to sandfly saliva antigens (a measure of sandfly exposure). All clinical cases will be given free treatment. Free Permanets will be provided to control villages after the trial. Complementary studies involve entomological surveillance by light traps in a sample of houses and social/economic questionnaire surveys. The entomological surveys will test whether community-wide use of LLINs provides any mass effect, which could protect those in the community who fail to use LLIN for any reason.
Interventions
DEVICELong Lasting Impregnated Nets (LLIN)
Distribution of LLIN in selected clusters
Sponsors
Institute of Tropical Medicine, Belgium
University Hospital, Geneva
Rajendra Memorial Research Institute of Medical Sciences
Institute of Medical Sciences of the Banaras Hindu University, India
International Centre for Diarrhoeal Disease Research, Bangladesh
B.P. Koirala Institute of Health Sciences
London School of Hygiene and Tropical Medicine
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
2 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
(Clusters): 1. at least have seen 1 case per year in each of the last 3 years 2. An average of at least 1% Incidence rate over the period of past 3 years.
Exclusion criteria
(Clusters): 1. Minimum 500 people 2. Maximum 2000 people 3. Distance between clusters 2000 meters (distance between borders) 4. Houses in tola/ward not sprayed (DDT, other) in 2006 5. Accessibility
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| L. donovani infection | yearly |
Secondary
| Measure | Time frame |
|---|---|
| Kala Azar cases | quarterly |
Countries
India, Nepal
Outcome results
None listed