title: Effectiveness and Cost of Insecticide-Treated Bed Nets and Indoor Residual Spraying for the Control of Cutaneous Leishmaniasis: A Cluster-Randomized Control Trial in Morocco.
abstract: Cutaneous leishmaniasis (CL) remains an important public health problem in Morocco. A cluster-randomized trial was conducted with the following three study arms: 1) long-lasting insecticide-treated nets (LLINs) plus standard of care environmental management (SoC-EM), 2) indoor residual spraying (IRS) with α-cypermethrin plus SoC-EM, and 3) SoC-EM alone. Incidence of new CL cases by passive and active case detection, sandfly abundance, and cost and cost-effectiveness was compared between study arms over 5 years. Incidence of CL and sandfly abundance were significantly lower in the IRS arm compared with SoC-EM (CL incidence rate ratio = 0.32, 95% confidence interval [CI] = 0.15-0.69, P = 0.005 and sandfly abundance ratio = 0.39, 95% CI = 0.18-0.85, P = 0.022). Reductions in the LLIN arm of the study were not significant, possibly due to poor compliance. IRS was effective and more cost-effective for the prevention of CL in Morocco.
authors.forename: Chafika
authors.initials: C
authors.lastname: Faraj
authors.forename: Joshua
authors.initials: J
authors.lastname: Yukich
authors.forename: El Bachir
authors.initials: EB
authors.lastname: Adlaoui
authors.forename: Rachid
authors.initials: R
authors.lastname: Wahabi
authors.forename: Abraham Peter
authors.initials: AP
authors.lastname: Mnzava
authors.forename: Mustapha
authors.initials: M
authors.lastname: Kaddaf
authors.forename: Abderrahmane Laamrani
authors.initials: AL
authors.lastname: El Idrissi
authors.forename: Btissam
authors.initials: B
authors.lastname: Ameur
authors.forename: Immo
authors.initials: I
authors.lastname: Kleinschmidt
mesh_terms: D000818:Animals; D003362:Cost-Benefit Analysis; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000191:economics; D007306:Insecticides / Q000191:economics / Q000494:pharmacology*; D016773:Leishmaniasis, Cutaneous / Q000453:epidemiology / Q000517:prevention & control*; D009018:Morocco / Q000453:epidemiology; D010691:Phlebotomus / Q000187:drug effects*
chemical_list: D007306:Insecticides
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