title: Intensive insecticide spraying for fly control after mass antibiotic treatment for trachoma in a hyperendemic setting: a randomised trial.
abstract: BACKGROUND
  There are no data on the cumulative effect of fly control and antibiotic distribution on trachoma in hyperendemic communities. We sought to determine whether insecticide spray intervention after mass antibiotic treatment could reduce trachoma and ocular infection with Chlamydia trachomatis in hyperendemic neighbourhoods in Tanzania.
  
  
  METHODS
  We did a single-blind, randomised clinical trial in 16 neighbourhoods (balozi) in Kongwa, Tanzania. All children aged 1-7 years were enrolled, with 119 children in the eight balozi of the intervention group and 183 in the eight control balozi. Children were examined at baseline, 6 months, and 1 year for clinical trachoma and ocular C trachomatis infection. One dose of azithromycin was offered to all residents of both intervention and control balozi after the baseline survey. Households (and surrounding areas) in the intervention group were then sprayed with insecticide throughout the ensuing year and monitored for reductions in fly counts. This study is registered at ClinicalTrials.gov, number NCT00347763.
  
  
  RESULTS
  The intervention balozi had significantly lower fly counts than controls at all monitored weeks (p<0.05), apart from weeks 7-9. The trachoma rate did not differ significantly in the intervention and control balozi at 6 months post-treatment (20%vs 33%, p=0.07), nor did it at 1 year (43%vs 44%, p=0.90). Infection with C trachomatis did not differ between groups at 6 months post-treatment (9%vs 7%, p=0.45).
  
  
  CONCLUSIONS
  Intensive insecticide spraying reduced flies in the environment, but our results suggest that fly reduction after mass antibiotic treatment has no added benefit on reduction of trachoma.
authors.affiliation: Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, MD, USA. shwest@jhmi.edu
authors.forename: Sheila K
authors.initials: SK
authors.lastname: West
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
authors.forename: Harran
authors.initials: H
authors.lastname: Mkocha
authors.forename: Wilson
authors.initials: W
authors.lastname: McHiwa
authors.forename: Beatriz
authors.initials: B
authors.lastname: Munoz
authors.forename: Robin
authors.initials: R
authors.lastname: Bailey
authors.forename: David
authors.initials: D
authors.lastname: Mabey
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007300:Insect Control / Q000379:methods*; D007306:Insecticides / Q000494:pharmacology*; D026023:Permethrin / Q000494:pharmacology*; D015397:Program Evaluation; D013636:Tanzania / Q000453:epidemiology; D014141:Trachoma / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D007306:Insecticides; D026023:Permethrin; D017963:Azithromycin