Efficacy, acceptability and cost-effectiveness of long lasting insecticidal nets in the prevention of Kala-azar.
Visceral leishmaniasis (VL) is a neglected life-threatening vector-borne disease. More than 90% of the reported VL cases occur in the Indian subcontinent, where it is considered a problem of public health importance. Though a regional elimination plan was launched in 2001, current approaches fail to control a VL epidemic in Bihar (India). Case-detection and treatment is the main strategy, with insecticide-spraying being applied to a variable extent. The efficacy of insecticide-treated bednets has been demonstrated so far in the prevention of cutaneous leishmaniasis, but not yet for VL.METHODS The efficacy of long-lasting impregnated bednets (LLIN) on VL prevention will be assessed in a community intervention trial in the Bihar focus, that e xtends on both sides of the Indian-Nepalese border. The study aims to demonstrate a 50% reduction in L.donovani incidence rates in the intervention group compared to control. Twenty clusters of households will be randomly allocated to the intervention or to the control arm. Complementary to the trial, technology assessment (TA) and socio-economic studies (SES) will be conducted. TA will evaluate the efficacy of competing technologies on a scale of proof-of-principle , as several formats of treated fabrics are currently being proposed by industry. SES will
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The proposed study targets the poorest segments of society, aiming at poverty reduction in line with EU development aid policy. Research institutes from north and south
will carry out the project in collaborative partnership , with specific targets for trai ning and capacity strengthening. The partnership will involve the local health policymakers and the community, as the goal is to integrate research results into disease control policy.