Courtenay, Orin, Bazmani, Ahad, Parvizi, Parviz, Ready, Paul D. and Cameron, Mary M. (2019) Insecticide–impregnated dog collars reduce infantile clinical visceral leishmaniasis under operational conditions in NW Iran : a community–wide cluster randomised trial. PLoS Neglected Tropical Diseases, 13 (3). e0007193. doi:10.1371/journal.pntd.0007193

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Abstract

Objective

To assess the effectiveness of community – wide deployment of insecticide – impregnated collars for dogs - the reservoir of Leishmania infantum – to reduce infantile clinical visceral leishmaniasis (VL).

Methods

A pair matched – cluster randomised controlled trial involving 40 collared and 40 uncollared control villages (161 [95% C.L.s: 136, 187] children per cluster), was designed to detect a 55 % reduction in 48 month confirmed VL case incidence. The intervention study was designed by the authors, but implemented by the Leishmaniasis Control Program in NW Iran, from 2002 to 2006.

Results

The collars provided 50% (95% C.I. 17 · 8% – 70 · 0%) protection against infantile VL incidence (0 · 95/1000/yr compared to 1 · 75/1000/yr). Reductions in incidence were observed 2 across 76% (22/29) of collared villages compared to pair – matched control villages, with 31 fewer cases by the end of the trial period. In 11 paired villages, no further cases were recorded post – intervention, whereas in 7 collared villages there were 9 new clinical cases relative to controls. Over the trial period, 6,835 collars were fitted at the beginning of the 4 months and fly season, of which 6.9% (95% C.I. 6.25%, 7.56%) were lost but rapidly replaced. Collar coverage (percent dogs collared) per village varied between 66% and 100%, with a mean annual coverage of 87% (95% C.I. 84 · 2, 89 · 0%). The variation in post - intervention clinical VL incidence was not associated with collar coverage, dog population size, implementation logistics, dog owner compliance, or other demographic variable s tested. Larger reductions and greater persistence in incident case numbers (indicative of transmission) were observed in villages with higher pre - existing VL case incidence.

Conclusion

Community – wide deployment of collars can provide a significant level of protection against infantile clinical VL, achieved in this study by the local VL Control Program , demonstrated attributes desirable of a sustainable public health program. The effectiveness is not dissimilar to the community - level protection provided against human and canine infection with L. infantum

Item Type:	Journal Article
Alternative Title:
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science > Life Sciences (2010- )
Library of Congress Subject Headings (LCSH):	Kala-azar -- Prevention, Dog collars, Insecticides
Journal or Publication Title:	PLoS Neglected Tropical Diseases
Publisher:	Public Library of Science
ISSN:	1935-2727
Official Date:	4 March 2019
Dates:	Date Event 4 March 2019 Published 28 January 2019 Accepted
Volume:	13
Number:	3
Article Number:	e0007193
DOI:	10.1371/journal.pntd.0007193
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Related URLs:	https://journals.plos.org/plosntds/

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