Background: Domestic flies are accepted vectors of diarrhoea, but their role in trachoma transmission has never been quantified and no study has shown that fly control decreases the prevalence of trachoma. We assessed the effect of fly control on public health in a pilot study in Gambian villages.
Methods: We studied two pairs of villages--one pair in the 1997 wet season, and one pair in the 1998 dry season. For each pair, deltamethrin was sprayed for 3 months to control flies in one village whilst the other was used as a control. Fly populations were monitored with traps. We surveyed trachoma at baseline and at 3 months, and collected daily data on diarrhoea in children aged between 3 months and 5 years.
Findings: Fly control decreased numbers of muscid flies by around 75% in the intervention villages compared with controls. Trachoma prevalence was similar at baseline (wet season, prevalence in intervention village 8.8% vs control 12.2%; dry season, 18.0% vs 16.0%), but after 3 months of fly control there were 75% fewer new cases of trachoma in the intervention villages (wet season 3.7% vs 13.7%; dry season 10.0% vs 18.9%; rate ratio and relative risk of pooled data 0.25 [adjusted 95% CI 0.09-0.64], p=0.003). There was 22% less childhood diarrhoea in the wet season (14% vs 19%, period prevalence ratio 0.78 [0.64-0.95], p=0.01), and 26% less diarrhoea in the dry season (6% vs 8%; 0.74 [0.34-1.59], p=0.60) compared with controls.
Interpretation: Muscid flies are important vectors of trachoma and childhood diarrhoea in The Gambia. Deltamethrin spray is effective for fly control and may be useful for reducing trachoma and diarrhoea in some situations, but further research on sustainable fly-control methods is needed.
PIP: The causative agent of trachoma, Chlamydia trachomatis, has been found on flies fed on heavily infected laboratory culture media. Findings are presented from an assessment of the effect of domestic fly control upon the prevalence of trachoma and associated cases of childhood diarrhea in 2 pairs of Gambian villages. 1 pair of villages was studied in the 1997 wet season and the second pair in the 1998 dry season. For each pair, deltamethrin was sprayed for 3 months to control flies in 1 village, while the other village was used as a control. Fly populations were monitored with traps. The prevalence of trachoma was measured at baseline and at 3 months, and data were collected daily on diarrhea in children aged 3 months to 5 years. Fly control decreased the numbers of muscid flies by approximately 75% in the intervention villages compared with controls. While the prevalence of trachoma was similar at baseline between study and control villages, after 3 months of fly control there were 75% fewer new cases of trachoma in the intervention villages. There was 22% and 26% less childhood diarrhea in the wet and dry seasons, respectively, compared with controls. These findings demonstrate that muscid flies are important vectors of trachoma and childhood diarrhea in The Gambia, and that the use of deltamethrin spray can help to reduce the prevalence of both trachoma and associated diarrhea cases.