title: Conflict of interest: use of pyrethroids and amidines against tsetse and ticks in zoonotic sleeping sickness endemic areas of Uganda.
abstract: BACKGROUND
  Caused by trypanosomes and transmitted by tsetse flies, Human African Trypanosomiasis and bovine trypanosomiasis remain endemic across much of rural Uganda where the major reservoir of acute human infection is cattle. Following elimination of trypanosomes by mass trypanocidal treatment, it is crucial that farmers regularly apply pyrethroid-based insecticides to cattle to sustain parasite reductions, which also protect against tick-borne diseases. The private veterinary market is divided between products only effective against ticks (amidines) and those effective against both ticks and tsetse (pyrethroids). This study explored insecticide sales, demand and use in four districts of Uganda where mass cattle treatments have been undertaken by the 'Stamp Out Sleeping Sickness' programme.
  
  
  METHODS
  A mixed-methods study was undertaken in Dokolo, Kaberamaido, Serere and Soroti districts of Uganda between September 2011 and February 2012. This included: focus groups in 40 villages, a livestock keeper survey (n = 495), a veterinary drug shop questionnaire (n = 74), participatory methods in six villages and numerous semi-structured interviews.
  
  
  RESULTS
  Although 70.5% of livestock keepers reportedly used insecticide each month during the rainy season, due to a variety of perceptions and practices nearly half used products only effective against ticks and not tsetse. Between 640 and 740 litres of insecticide were being sold monthly, covering an average of 53.7 cattle/km(2). Sales were roughly divided between seven pyrethroid-based products and five products only effective against ticks. In the high-risk HAT district of Kaberamaido, almost double the volume of non-tsetse effective insecticide was being sold. Factors influencing insecticide choice included: disease knowledge, brand recognition, product price, half-life and mode of product action, product availability, and dissemination of information. Stakeholders considered market restriction of non-tsetse effective products the most effective way to increase pyrethroid use.
  
  
  CONCLUSIONS
  Conflicts of interest between veterinary business and vector control were found to constrain sleeping sickness control. While a variety of strategies could increase pyrethroid use, regulation of the insecticide market could effectively double the number of treated cattle with little cost to government, donors or farmers. Such regulation is entirely consistent with the role of the state in a privatised veterinary system and should include a mitigation strategy against the potential development of tick resistance.
authors.affiliation: Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK. sue.welburn@ed.ac.uk.
authors.forename: Kevin
authors.initials: K
authors.lastname: Bardosh
authors.forename: Charles
authors.initials: C
authors.lastname: Waiswa
authors.forename: Susan C
authors.initials: SC
authors.lastname: Welburn
mesh_terms: D056810:Acaricides / Q000008:administration & dosage*; D000578:Amidines / Q000008:administration & dosage*; D000818:Animals; D002417:Cattle; D002418:Cattle Diseases / Q000517:prevention & control*; D016265:Conflict of Interest; D004363:Drug Utilization / Q000706:statistics & numerical data; D004478:Ectoparasitic Infestations / Q000517:prevention & control / Q000662:veterinary*; D006801:Humans; D007306:Insecticides / Q000008:administration & dosage*; D007407:Interviews as Topic; D010571:Pest Control / Q000379:methods*; D011722:Pyrethrins / Q000008:administration & dosage*; D013987:Ticks / Q000187:drug effects; D014352:Trypanosomiasis / Q000517:prevention & control; D014370:Tsetse Flies / Q000187:drug effects; D014454:Uganda
chemical_list: D056810:Acaricides; D000578:Amidines; D007306:Insecticides; D011722:Pyrethrins