title: Role of flies and provision of latrines in trachoma control: cluster-randomised controlled trial.
abstract: BACKGROUND
  Eye-seeking flies have received much attention as possible trachoma vectors, but this remains unproved. We aimed to assess the role of eye-seeking flies as vectors of trachoma and to test provision of simple pit latrines, without additional health education, as a sustainable method of fly control.
  
  
  METHODS
  In a community-based, cluster-randomised controlled trial, we recruited seven sets of three village clusters and randomly assigned them to either an intervention group that received regular insecticide spraying or provision of pit latrines (without additional health education) to each household, or to a control group with no intervention. Our primary outcomes were fly-eye contact and prevalence of active trachoma. Frequency of child fly-eye contact was monitored fortnightly. Whole communities were screened for clinical signs of trachoma at baseline and after 6 months. Analysis was per protocol.
  
  
  RESULTS
  Of 7080 people recruited, 6087 (86%) were screened at follow-up. Baseline community prevalence of active trachoma was 6%. The number of Musca sorbens flies caught from children's eyes was reduced by 88% (95% CI 64-100; p<0.0001) by insecticide spraying and by 30% (7-52; p=0.04) by latrine provision by comparison with controls. Analysis of age-standardised trachoma prevalence rates at the cluster level (n=14) showed that spraying was associated with a mean reduction in trachoma prevalence of 56% (19-93; p=0.01) and 30% with latrines (-81 to 22; p=0.210) by comparison with the mean rate change in the controls.
  
  
  CONCLUSIONS
  Fly control with insecticide is effective at reducing the number of flies caught from children's eyes and is associated with substantially lower trachoma prevalence compared with controls. Such a finding is consistent with flies being important vectors of trachoma. Since latrine provision without health education was associated with a significant reduction in fly-eye contact by M sorbens, studies of their effect when combined with other trachoma control measures are warranted.
authors.affiliation: Medical Research Council Laboratories, PO Box 273, Banjul, The Gambia. p.m.emerson@durham.ac.uk
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
authors.forename: Steve W
authors.initials: SW
authors.lastname: Lindsay
authors.forename: Neal
authors.initials: N
authors.lastname: Alexander
authors.forename: Momodou
authors.initials: M
authors.lastname: Bah
authors.forename: Sheik-Mafuji
authors.initials: SM
authors.lastname: Dibba
authors.forename: Hannah B
authors.initials: HB
authors.lastname: Faal
authors.forename: Kebba O
authors.initials: KO
authors.lastname: Lowe
authors.forename: Keith P W J
authors.initials: KP
authors.lastname: McAdam
authors.forename: Amy A
authors.initials: AA
authors.lastname: Ratcliffe
authors.forename: Gijs E L
authors.initials: GE
authors.lastname: Walraven
authors.forename: Robin L
authors.initials: RL
authors.lastname: Bailey
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D004175:Diptera / Q000187:drug effects / Q000382:microbiology*; D005714:Gambia / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007300:Insect Control / Q000379:methods*; D007303:Insect Vectors / Q000382:microbiology; D007306:Insecticides / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D014038:Toilet Facilities / Q000592:standards*; D014141:Trachoma / Q000453:epidemiology / Q000517:prevention & control*; D018505:Waste Management / Q000379:methods*
chemical_list: D007306:Insecticides