Trachoma Clinical Trial
Official title:
Strategies for the Control of Blinding Trachoma: Effect of Fly Spray
The purpose of this community-based randomized trial was to determine, in trachoma hyper-endemic communities of Tanzania, the added value of intensive spraying to control flies on the fly population and on trachoma and ocular chlamydia infection at 6 months and one year after mass antibiotic treatment.
Trachoma is the leading infectious cause of blindness in the world. The World Health
Organization (WHO), recognizing the important public health impact of trachoma, has adopted
a resolution to eliminate blinding trachoma by the year 2020 (3). In order to accomplish
this ambitious goal, WHO recommends the use of "SAFE" strategy for countries implementing
trachoma control programs. This multi-faceted approach includes Surgery for trichiasis
cases, Antibiotics to treat the community pool of infection, Face washing to reduce
transmission, and Environmental change.
The environmental change component currently rests largely on efforts to reduce the fly
populations in these communities. A pilot study and clinical trial using intense insecticide
spraying reduced both flies and trachoma in a trachoma hypo-endemic area of The Gambia. In
The Gambia setting, flies appear to be an important vector for trachoma, but it is not clear
that flies are equally important in areas with hyper-endemic trachoma, nor is it known if
fly control adds value to the provision of mass antibiotic treatment for active trachoma as
part of the SAFE strategy.
The purpose of this community-based randomized trial was to determine, in trachoma
hyper-endemic communities of Tanzania, the added value of intensive spraying to control
flies on the fly population and on trachoma and ocular C. trachomatis infection at 6 months
and one year after mass antibiotic treatment. Neighborhoods with intensive spraying
(Intervention) and neighborhoods with no spraying (control) all received mass antibiotic
treatment with azithromycin immediately prior to the start of the study, enabling us to
evaluate the additional impact of fly control on trachoma.
Kongwa district in central Tanzania has been shown to have a high prevalence of active
trachoma, and was chosen as the site of this study. We randomized sixteen balozi to receive
either mass treatment with azithromycin alone (control), or mass treatment plus an intensive
fly spraying program (intervention). Pre-school aged children are the reservoirs of
infection and disease within these communities. Therefore, within each balozi, all children
aged less than eight served as sentinel markers for the status of trachoma at baseline, 6
months, and one year after baseline. In the eight intervention balozi, 119 children from 87
families were enrolled at baseline, and in the eight control balozi, 183 children from 145
families were enrolled.
The balozis were surveyed and an area surrounding the intervention balozis was targeted for
insecticide spray. A solution of 10% permethrin in water was used with a Hudson and
MicronAir sprayer machines, At the outset, spraying was carried out every two days for two
weeks (attack phase) then once per week (maintenance phase) for the rest of the study.
Two sticky traps, fly paper strips were placed in each balozi to capture flies. The traps
were changed every week, and the number of flies captured were counted. If the average
number in the intervention balozis exceeded 25% of that in the control balozis, an attack
phase, as described above, was reinstituted to keep the fly population low in the
intervention group.
The primary outcome was the prevalence of trachoma in the pre-school aged children at 6
months and one year post mass antibiotic treatment.Outcomes are reported based on masked
photographic gradings. Secondary outcome was ocular C. trachomatis infection, based on use
of Amplicor C. trachomatis qualitative PCR assay.
comparison: Balozi randomized to receive intensive fly spray intervention,compared to Balozi
with no fly spray intervention
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Prevention
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