Longlasting insecticidal nets for prevention of Leishmania donovani infection in India and Nepal: paired cluster randomised trial

Objective To test the effectiveness of large scale distribution of longlasting nets treated with insecticide in reducing the incidence of visceral leishmaniasis in India and Nepal. Design Paired cluster randomised controlled trial designed to detect a 50% reduction in incidence of Leishmania donovan...

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Autores principales: Picado, Albert, Singh, Shri Prakash, Rijal, Suman, Sundar, Shyam, Ostyn, Bart, Chappuis, François, Uranw, Surendra, Gidwani, Kamlesh, Khanal, Basudha, Rai, Madhukar, Paudel, Ishwari Sharma, Das, Murari Lal, Kumar, Rajiv, Srivastava, Pankaj, Dujardin, Jean Claude, Vanlerberghe, Veerle, Andersen, Elisabeth Wreford, Davies, Clive Richard, Boelaert, Marleen
Formato: Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011370/
https://www.ncbi.nlm.nih.gov/pubmed/21190965
http://dx.doi.org/10.1136/bmj.c6760
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author Picado, Albert
Singh, Shri Prakash
Rijal, Suman
Sundar, Shyam
Ostyn, Bart
Chappuis, François
Uranw, Surendra
Gidwani, Kamlesh
Khanal, Basudha
Rai, Madhukar
Paudel, Ishwari Sharma
Das, Murari Lal
Kumar, Rajiv
Srivastava, Pankaj
Dujardin, Jean Claude
Vanlerberghe, Veerle
Andersen, Elisabeth Wreford
Davies, Clive Richard
Boelaert, Marleen
author_facet Picado, Albert
Singh, Shri Prakash
Rijal, Suman
Sundar, Shyam
Ostyn, Bart
Chappuis, François
Uranw, Surendra
Gidwani, Kamlesh
Khanal, Basudha
Rai, Madhukar
Paudel, Ishwari Sharma
Das, Murari Lal
Kumar, Rajiv
Srivastava, Pankaj
Dujardin, Jean Claude
Vanlerberghe, Veerle
Andersen, Elisabeth Wreford
Davies, Clive Richard
Boelaert, Marleen
author_sort Picado, Albert
collection PubMed
description Objective To test the effectiveness of large scale distribution of longlasting nets treated with insecticide in reducing the incidence of visceral leishmaniasis in India and Nepal. Design Paired cluster randomised controlled trial designed to detect a 50% reduction in incidence of Leishmania donovani infection. Setting Villages in Muzaffarpur district in India and Saptari, Sunsari, and Morang districts in Nepal. Participants 13 intervention and 13 control clusters. 12 691 people were included in the analysis of the main outcome (infection), and 19 810 were enrolled for the secondary (disease) end point. Intervention Longlasting insecticidal nets (treated with deltamethrin) were distributed in the intervention clusters in December 2006. Main outcome measures Infection was determined by direct agglutination test at 12 and 24 months after the intervention in those who had negative results (titre <1:1600) at baseline. The effect estimate was computed as the geometric mean of the risk ratios for seroconversion for each cluster pair (net/no net), with its 95% confidence interval. Formal tests of effect of no intervention were obtained with a paired t test. Results There was no significant difference in the risk of seroconversion over 24 months in intervention (5.4%; 347/6372) compared with control (5.5%; 345/6319 people) clusters (risk ratio 0.90, 95% confidence interval 0.49 to 1.65) nor in the risk of clinical visceral leishmaniasis (0.99, 0.46 to 1.40). Adjustment for covariates did not alter these conclusions. Conclusions There is no evidence that large scale distribution of longlasting insecticidal nets provides additional protection against visceral leishmaniasis compared with existing control practice in the Indian subcontinent. The observed effect was small and not significant, though the confidence intervals did not exclude a 50% change in either direction. Trial registration Clinical Trials NCT 2005-015374.
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spelling pubmed-30113702011-01-05 Longlasting insecticidal nets for prevention of Leishmania donovani infection in India and Nepal: paired cluster randomised trial Picado, Albert Singh, Shri Prakash Rijal, Suman Sundar, Shyam Ostyn, Bart Chappuis, François Uranw, Surendra Gidwani, Kamlesh Khanal, Basudha Rai, Madhukar Paudel, Ishwari Sharma Das, Murari Lal Kumar, Rajiv Srivastava, Pankaj Dujardin, Jean Claude Vanlerberghe, Veerle Andersen, Elisabeth Wreford Davies, Clive Richard Boelaert, Marleen BMJ Research Objective To test the effectiveness of large scale distribution of longlasting nets treated with insecticide in reducing the incidence of visceral leishmaniasis in India and Nepal. Design Paired cluster randomised controlled trial designed to detect a 50% reduction in incidence of Leishmania donovani infection. Setting Villages in Muzaffarpur district in India and Saptari, Sunsari, and Morang districts in Nepal. Participants 13 intervention and 13 control clusters. 12 691 people were included in the analysis of the main outcome (infection), and 19 810 were enrolled for the secondary (disease) end point. Intervention Longlasting insecticidal nets (treated with deltamethrin) were distributed in the intervention clusters in December 2006. Main outcome measures Infection was determined by direct agglutination test at 12 and 24 months after the intervention in those who had negative results (titre <1:1600) at baseline. The effect estimate was computed as the geometric mean of the risk ratios for seroconversion for each cluster pair (net/no net), with its 95% confidence interval. Formal tests of effect of no intervention were obtained with a paired t test. Results There was no significant difference in the risk of seroconversion over 24 months in intervention (5.4%; 347/6372) compared with control (5.5%; 345/6319 people) clusters (risk ratio 0.90, 95% confidence interval 0.49 to 1.65) nor in the risk of clinical visceral leishmaniasis (0.99, 0.46 to 1.40). Adjustment for covariates did not alter these conclusions. Conclusions There is no evidence that large scale distribution of longlasting insecticidal nets provides additional protection against visceral leishmaniasis compared with existing control practice in the Indian subcontinent. The observed effect was small and not significant, though the confidence intervals did not exclude a 50% change in either direction. Trial registration Clinical Trials NCT 2005-015374. BMJ Publishing Group Ltd. 2010-12-29 /pmc/articles/PMC3011370/ /pubmed/21190965 http://dx.doi.org/10.1136/bmj.c6760 Text en © Picado et al 2010 This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
spellingShingle Research
Picado, Albert
Singh, Shri Prakash
Rijal, Suman
Sundar, Shyam
Ostyn, Bart
Chappuis, François
Uranw, Surendra
Gidwani, Kamlesh
Khanal, Basudha
Rai, Madhukar
Paudel, Ishwari Sharma
Das, Murari Lal
Kumar, Rajiv
Srivastava, Pankaj
Dujardin, Jean Claude
Vanlerberghe, Veerle
Andersen, Elisabeth Wreford
Davies, Clive Richard
Boelaert, Marleen
Longlasting insecticidal nets for prevention of Leishmania donovani infection in India and Nepal: paired cluster randomised trial
title Longlasting insecticidal nets for prevention of Leishmania donovani infection in India and Nepal: paired cluster randomised trial
title_full Longlasting insecticidal nets for prevention of Leishmania donovani infection in India and Nepal: paired cluster randomised trial
title_fullStr Longlasting insecticidal nets for prevention of Leishmania donovani infection in India and Nepal: paired cluster randomised trial
title_full_unstemmed Longlasting insecticidal nets for prevention of Leishmania donovani infection in India and Nepal: paired cluster randomised trial
title_short Longlasting insecticidal nets for prevention of Leishmania donovani infection in India and Nepal: paired cluster randomised trial
title_sort longlasting insecticidal nets for prevention of leishmania donovani infection in india and nepal: paired cluster randomised trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011370/
https://www.ncbi.nlm.nih.gov/pubmed/21190965
http://dx.doi.org/10.1136/bmj.c6760
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