title: Efficacy, Safety and Cost of Insecticide Treated Wall Lining, Insecticide Treated Bed Nets and Indoor Wall Wash with Lime for Visceral Leishmaniasis Vector Control in the Indian Sub-continent: A Multi-country Cluster Randomized Controlled Trial.
abstract: We investigated the efficacy, safety and cost of lime wash of household walls plus treatment of sand fly breeding places with bleach (i.e. environmental management or EM), insecticide impregnated durable wall lining (DWL), and bed net impregnation with slow release insecticide (ITN) for sand fly control in the Indian sub-continent.
  
  
  
  This multi-country cluster randomized controlled trial had 24 clusters in each three sites with eight clusters per high, medium or low sand fly density stratum. Every cluster included 45-50 households. Five households from each cluster were randomly selected for entomological measurements including sand fly density and mortality at one, three, nine and twelve months post intervention. Household interviews were conducted for socioeconomic information and intervention acceptability assessment. Cost for each intervention was calculated. There was a control group without intervention.
  
  
  
  Sand fly mortality [mean and 95%CI] ranged from 84% (81%-87%) at one month to 74% (71%-78%) at 12 months for DWL, 75% (71%-79%) at one month to 49% (43%-55%) at twelve months for ITN, and 44% (34%-53%) at one month to 22% (14%-29%) at twelve months for EM. Adjusted intervention effect on sand fly density measured by incidence rate ratio ranged from 0.28 (0.23-0.34) at one month to 0.62 (0.51-0.75) at 12 months for DWL; 0.72 (0.62-0.85) at one month to 1.02 (0.86-1.22) at 12 months for ITN; and 0.89 (0.76-1.03) at one months to 1.49 (1.26-1.74) at 12 months for EM. Household acceptance of EM was 74% compared to 94% for both DWL and ITN. Operational cost per household in USD was about 5, 8, and 2 for EM, DWL and ITN, respectively. Minimal adverse reactions were reported for EM and ITN while 36% of households with DWL reported transient itching.
  
  
  
  DWL is the most effective, durable and acceptable control method followed by ITN. The Visceral Leishmaniasis (VL) Elimination Program in the Indian sub-continent should consider DWL and ITN for sand fly control in addition to IRS.
authors.affiliation: International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Mondal
authors.affiliation: BP Koirala Institute of Health Sciences, Entomology laboratory, Department of Microbiology, Dharan, Nepal.
authors.forename: Murari Lal
authors.initials: ML
authors.lastname: Das
authors.affiliation: Rajendra Memorial Research Institute of Medical Sciences, Patna, India.
authors.forename: Vijay
authors.initials: V
authors.lastname: Kumar
authors.affiliation: International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
authors.forename: M Mamun
authors.initials: MM
authors.lastname: Huda
authors.affiliation: Rajendra Memorial Research Institute of Medical Sciences, Patna, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Das
authors.affiliation: International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
authors.forename: Debashis
authors.initials: D
authors.lastname: Ghosh
authors.affiliation: BP Koirala Institute of Health Sciences, Entomology laboratory, Department of Microbiology, Dharan, Nepal.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Priyanka
authors.affiliation: Department of Microbiology and Immunology, McGill University, Montreal, Canada.|UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland.
authors.forename: Greg
authors.initials: G
authors.lastname: Matlashewski
authors.affiliation: UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland.|University Medical Centre Freiburg, Centre for Medicine and Society, Freiburg, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Kroeger
authors.affiliation: Center for World Health, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America.
authors.forename: Alexander
authors.initials: A
authors.lastname: Upfill-Brown
authors.affiliation: National Institute of Preventive and Social Medicine, Mohakhali, Dhaka, Bangladesh.
authors.forename: Rajib
authors.initials: R
authors.lastname: Chowdhury
mesh_terms: D000818:Animals; D001459:Bangladesh / Q000453:epidemiology; D017610:Calcium Compounds / Q000009:adverse effects / Q000191:economics; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D057148:Insecticide-Treated Bednets / Q000009:adverse effects / Q000191:economics; D007306:Insecticides / Q000009:adverse effects / Q000191:economics; D007391:International Cooperation; D007898:Leishmaniasis, Visceral / Q000469:parasitology / Q000517:prevention & control* / Q000635:transmission; D009032:Mosquito Control / Q000379:methods* / Q000592:standards; D009390:Nepal / Q000453:epidemiology; D010087:Oxides / Q000009:adverse effects / Q000191:economics; D011576:Psychodidae / Q000469:parasitology
chemical_list: D017610:Calcium Compounds; D007306:Insecticides; D010087:Oxides; C016538:lime