title: Effect of fly control on trachoma and diarrhoea.
abstract: BACKGROUND
  Domestic flies are accepted vectors of diarrhoea, but their role in trachoma transmission has never been quantified and no study has shown that fly control decreases the prevalence of trachoma. We assessed the effect of fly control on public health in a pilot study in Gambian villages.
  
  
  METHODS
  We studied two pairs of villages--one pair in the 1997 wet season, and one pair in the 1998 dry season. For each pair, deltamethrin was sprayed for 3 months to control flies in one village whilst the other was used as a control. Fly populations were monitored with traps. We surveyed trachoma at baseline and at 3 months, and collected daily data on diarrhoea in children aged between 3 months and 5 years.
  
  
  RESULTS
  Fly control decreased numbers of muscid flies by around 75% in the intervention villages compared with controls. Trachoma prevalence was similar at baseline (wet season, prevalence in intervention village 8.8% vs control 12.2%; dry season, 18.0% vs 16.0%), but after 3 months of fly control there were 75% fewer new cases of trachoma in the intervention villages (wet season 3.7% vs 13.7%; dry season 10.0% vs 18.9%; rate ratio and relative risk of pooled data 0.25 [adjusted 95% CI 0.09-0.64], p=0.003). There was 22% less childhood diarrhoea in the wet season (14% vs 19%, period prevalence ratio 0.78 [0.64-0.95], p=0.01), and 26% less diarrhoea in the dry season (6% vs 8%; 0.74 [0.34-1.59], p=0.60) compared with controls.
  
  
  CONCLUSIONS
  Muscid flies are important vectors of trachoma and childhood diarrhoea in The Gambia. Deltamethrin spray is effective for fly control and may be useful for reducing trachoma and diarrhoea in some situations, but further research on sustainable fly-control methods is needed.
authors.affiliation: Medical Research Council, Banjul, The Gambia.
authors.forename: P M
authors.initials: PM
authors.lastname: Emerson
authors.forename: S W
authors.initials: SW
authors.lastname: Lindsay
authors.forename: G E
authors.initials: GE
authors.lastname: Walraven
authors.forename: H
authors.initials: H
authors.lastname: Faal
authors.forename: C
authors.initials: C
authors.lastname: Bøgh
authors.forename: K
authors.initials: K
authors.lastname: Lowe
authors.forename: R L
authors.initials: RL
authors.lastname: Bailey
mesh_terms: D000818:Animals; D002675:Child, Preschool; D003967:Diarrhea / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007300:Insect Control / Q000379:methods*; D007306:Insecticides / Q000627:therapeutic use; D009117:Muscidae / Q000187:drug effects*; D009570:Nitriles; D010865:Pilot Projects; D011722:Pyrethrins / Q000627:therapeutic use; D014141:Trachoma / Q000517:prevention & control / Q000635:transmission*
chemical_list: D007306:Insecticides; D009570:Nitriles; D011722:Pyrethrins; C017180:decamethrin