| Aims Reducing the burden of infantile visceral leishmaniasis
(VL) due to Leishmania infantum requires interrupting sand fly
vector–canine transmission. The efficacy of community-wide
coverage with insecticide–impregnated dog collars has not been
evaluated.
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.
Results The collars provided 50% (95% C.I. 178%–700%)
protection against VL case incidence (095/1000/yr compared to
175/1000/yr). Absolute median reductions of 11 fewer
childhood cases (IQR 7.7–14.8; range: 08–54.1) per 1000 were
observed across 76% (22/29) of collared villages compared to
pair–matched control villages. In 11 paired villages, no further
cases were recorded post–intervention. Seven collared villages
experienced median increases of eight new cases (IQR 2.5–9.1;
range: 091–12.9) per 1000 children.
Conclusions Community–wide collar deployment can
provide a significant level of protection against clinical VL,
achieved in this study by the local VL Control Program. The
collar protection did not completely interrupt transmission, but
this was not attributed to intervention coverage, |