title: Effect of village-wide use of long-lasting insecticidal nets on visceral Leishmaniasis vectors in India and Nepal: a cluster randomized trial.
abstract: BACKGROUND
  Visceral leishmaniasis (VL) control in the Indian subcontinent is currently based on case detection and treatment, and on vector control using indoor residual spraying (IRS). The use of long-lasting insecticidal nets (LN) has been postulated as an alternative or complement to IRS. Here we tested the impact of comprehensive distribution of LN on the density of Phlebotomus argentipes in VL-endemic villages.
  
  
  METHODS
  A cluster-randomized controlled trial with household P. argentipes density as outcome was designed. Twelve clusters from an ongoing LN clinical trial--three intervention and three control clusters in both India and Nepal--were selected on the basis of accessibility and VL incidence. Ten houses per cluster selected on the basis of high pre-intervention P. argentipes density were monitored monthly for 12 months after distribution of LN using CDC light traps (LT) and mouth aspiration methods. Ten cattle sheds per cluster were also monitored by aspiration.
  
  
  RESULTS
  A random effect linear regression model showed that the cluster-wide distribution of LNs significantly reduced the P. argentipes density/house by 24.9% (95% CI 1.80%-42.5%) as measured by means of LTs.
  
  
  CONCLUSIONS
  The ongoing clinical trial, designed to measure the impact of LNs on VL incidence, will confirm whether LNs should be adopted as a control strategy in the regional VL elimination programs. The entomological evidence described here provides some evidence that LNs could be usefully deployed as part of the VL control program.
  
  
  BACKGROUND
  ClinicalTrials.gov CT-2005-015374.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Albert
authors.initials: A
authors.lastname: Picado
authors.forename: Murari L
authors.initials: ML
authors.lastname: Das
authors.forename: Vijay
authors.initials: V
authors.lastname: Kumar
authors.forename: Shreekant
authors.initials: S
authors.lastname: Kesari
authors.forename: Diwakar S
authors.initials: DS
authors.lastname: Dinesh
authors.forename: Lalita
authors.initials: L
authors.lastname: Roy
authors.forename: Suman
authors.initials: S
authors.lastname: Rijal
authors.forename: Pradeep
authors.initials: P
authors.lastname: Das
authors.forename: Mark
authors.initials: M
authors.lastname: Rowland
authors.forename: Shyam
authors.initials: S
authors.lastname: Sundar
authors.forename: Marc
authors.initials: M
authors.lastname: Coosemans
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
authors.forename: Clive R
authors.initials: CR
authors.lastname: Davies
mesh_terms: D000818:Animals; D001512:Bedding and Linens; D002417:Cattle; D007194:India; D007300:Insect Control / Q000379:methods*; D007303:Insect Vectors / Q000187:drug effects / Q000254:growth & development; D007306:Insecticides / Q000737:chemistry* / Q000494:pharmacology*; D007898:Leishmaniasis, Visceral / Q000517:prevention & control*; D009390:Nepal; D010691:Phlebotomus / Q000187:drug effects* / Q000254:growth & development*
chemical_list: D007306:Insecticides