***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Shigella infections are a public health problem in developing and transitional countries because of high transmissibility , severity of clinical disease , widespread antibiotic resistance and lack of a licensed vaccine . Whereas Shigellae are known to be transmitted primarily by direct fecal-oral contact and less commonly by contaminated food and water , the role of the housefly Musca domestica as a mechanical vector of transmission is less appreciated . We sought to assess the contribution of houseflies to Shigella-associated moderate-to-severe diarrhea ( MSD ) among children less than five years old in Mirzapur , Bangladesh , a site where shigellosis is hyperendemic , and to model the potential impact of a housefly control intervention . Methods Stool sample s from 843 children presenting to Kumudini Hospital during 2009–2010 with new episodes of MSD ( diarrhea accompanied by dehydration , dysentery or hospitalization ) were analyzed . Housefly density was measured twice weekly in six r and omly selected sentinel households . Poisson time series regression was performed and autoregression-adjusted attributable fractions ( AFs ) were calculated using the Bruzzi method , with st and ard errors via jackknife procedure . Findings Dramatic springtime peaks in housefly density in 2009 and 2010 were followed one to two months later by peaks of Shigella-associated MSD among toddlers and pre-school children . Poisson time series regression showed that housefly density was associated with Shigella cases at three lags ( six weeks ) ( Incidence Rate Ratio = 1.39 [ 95 % CI : 1.23 to 1.58 ] for each log increase in fly count ) , an association that was not confounded by ambient air temperature . Autocorrelation-adjusted AF calculations showed that a  housefly control intervention could have prevented approximately 37 % of the Shigella cases over the study period . Interpretation Houseflies may play an important role in the seasonal transmission of Shigella in some developing country ecologies . Interventions to control houseflies should be evaluated as possible additions to the public health arsenal to diminish Shigella ( and perhaps other causes of ) diarrheal infection Background Infectious diseases associated with poor sanitation such as diarrhoea , intestinal worms , trachoma and lymphatic filariasis continue to cause a large disease burden in low income setting s and contribute substantially to child mortality and morbidity . Obtaining health impact data for rural sanitation campaigns poses a number of method ological challenges . Here we describe the design of a village-level cluster-r and omised trial in the state of Orissa , India to evaluate the impact of an ongoing rural sanitation campaign conducted under the umbrella of  India  ’s Total Sanitation Campaign (TSC).We r and omised 50 villages to the intervention and 50 villages to control . In the intervention villages the implementing non-governmental organisations conducted community mobilisation and latrine construction with subsidies given to poor families . Control villages receive no intervention . Outcome measures include ( 1 ) diarrhoea in children under 5 and in all ages , ( 2 ) soil-transmitted helminth infections , ( 3 ) anthropometric measures , ( 4 ) water quality , ( 5 ) number of insect vectors ( flies , mosquitoes ) , ( 6 ) exposure to faecal pathogens in the environment . In addition we are conducting process documentation ( latrine construction and use , intervention reach ) , cost and cost-effectiveness analyses , spatial analyses and qualitative research on gender and water use for sanitation . Results R and omisation result ed in an acceptable balance between trial arms . The sample size requirements appear to be met for the main study outcomes . Delays in intervention roll-out caused logistical problems especially for the planning of health outcome follow-up surveys . Latrine coverage at the end of the construction period ( 55 % ) remained below the target of 70 % , a result that may , however , be in line with many other TSC intervention areas in India . Conclusion We discuss a number of method ological problems encountered thus far in this study that may be typical for sanitation trials . Nevertheless , it is expected that the trial procedures will allow measuring the effectiveness of a typical rural sanitation campaign , with sufficient accuracy and validity Background Diarrhea is one of the leading causes of death , killing 1.3 million in 2013 across the globe , of whom , 0.59 million were children under 5 years of age . Globally , about 1 billion people practice open defecation , and an estimated 2.4 billion people were living without improved sanitation facilities in 2015 . Much of the previous research investigating the effect of improved sanitation has been based on observational studies . Recent studies have executed a cluster-r and omized controlled trial to investigate the effect of improved sanitation . However , none of these recent studies achieved a sufficient level of latrine coverage . Without universal or at least a sufficient level of latrine coverage , a determination of the effect of improved latrines on the prevention of diarrheal disease is difficult . This cluster-r and omized trial aims to explore the net effect of improved latrines on diarrheal prevalence and incidence in children under five and to investigate the effect on the diarrheal duration . Method / design A phase-in and factorial design will be used for the study . The intervention for improving latrines will be implemented in an intervention arm during the first phase , and the comparable intervention will be performed in the control arm during the second phase . During the second phase , a water pipe will be connected to the gotts ( villages ) in the intervention arm . After the second phase is completed , the control group will undergo the intervention of receiving a water pipe connection . For diarrheal prevalence , five rounds of surveying will be conducted at the household level . The first four rounds will be carried out in the first phase to explore the effect of improved latrines , and the last one , in the second phase to examine the combined effects of improved water and sanitation . For documentation of diarrheal incidence and duration , the mother or caregiver will record the diarrheal episodes of her youngest child on the “ Sanitation Calendar ” every day . Of 212 gotts in the project area , 48 gotts were selected for the trial , and 1200 households with a child under 5 will be registered for the intervention or control arm . Informed consent from 1200 households will be obtained from the mother or caregiver in written form . Discussion To our knowledge , this is the second study to assess the effects of improved latrines on child diarrheal reduction through the application of Community-Led Total Sanitation . Trial registration Current Controlled Trials , IS RCT Background As many neglected tropical diseases are co-endemic and have common risk factors , integrated control can efficiently reduce disease burden and relieve re source -strained public health budgets . Diarrheal diseases and dengue fever are major global health problems sharing common risk factors in water storage containers . Where provision of clean water is inadequate , water storage is crucial . Fecal contamination of stored water is a common source of diarrheal illness , but stored water also provides breeding sites for dengue vector mosquitoes . Integrating improved water management and educational strategies for both diseases in the school environment can potentially improve the health situation for students and the larger community . The objective of this trial was to investigate whether interventions targeting diarrhea and dengue risk factors would significantly reduce absence due to diarrheal disease and dengue entomological risk factors in schools . Methodology /Principal Findings A factorial cluster r and omized controlled trial was carried out in 34 rural primary schools ( 1,301 pupils ) in La Mesa and Anapoima municipalities , Cundinamarca , Colombia . Schools were r and omized to one of four study arms : diarrhea interventions ( DIA ) , dengue interventions ( DEN ) , combined diarrhea and dengue interventions ( DIADEN ) , and control ( CON ) . Interventions had no apparent effect on pupil school absence due to diarrheal disease ( p = 0.45 ) or on adult female Aedes aegypti density ( p = 0.32 ) ( primary outcomes ) . However , the dengue interventions reduced the Breteau Index on average by 78 % ( p = 0.029 ) , with Breteau indices of 10.8 and 6.2 in the DEN and DIADEN arms , respectively compared to 37.5 and 46.9 in the DIA and CON arms , respectively . The diarrhea interventions improved water quality as assessed by the amount of Escherichia coli colony forming units ( CFU ) ; the ratio of Williams mean E. coli CFU being 0.22 , or 78 % reduction ( p = 0.008 ) . Conclusions / Significance Integrated control of dengue and diarrhea has never been conducted before . This trial presents an example for application of control strategies that may affect both diseases and the first study to apply such an approach in school setting s. The interventions were well received and highly appreciated by students and teachers . An apparent absence of effect in primary outcome indicators could be the result of pupils being exposed to risk factors outside the school area and mosquitoes flying in from nearby uncontrolled breeding sites . Integrated interventions targeting these diseases in a school context remain promising because of the reduced mosquito breeding and improved water quality , as well as educational benefits . However , to improve outcomes in future integrated approaches , simultaneous interventions in communities , in addition to schools , should be considered ; using appropriate combinations of site-specific , effective , acceptable , and affordable interventions . Trial Registration Clinical Trials.gov no. IS RCT Diarrhea is one of the most common diseases and is a leading cause of death in developing countries . This is often caused by contaminated food . Poor food hygiene st and ards are exacerbated by the presence of flies which can transmit a variety of infectious microorganisms , particularly through animal source foods . This fact becomes especially important in developing countries like Zambia , where fish is a highly valued source of protein . Our interest in this study was to identify if the flies that beset food markets in Zambia carry important pathogenic bacteria on their bodies , and subsequently if these bacteria carry resistance genes to commonly used antibiotics , which would indicate problems in eradicating these pathogens . The present study took into account fish vendors ’ and consumers ’ perception of flies and interest in interventions to reduce their numbers . We conducted semi-structured interviews with ( 1 ) traders ( comprised of r and omly selected males and females ) and ( 2 ) consumers ( including r and omly selected males and females ) . Thereafter , we collected flies found on fish in markets in Mongu and Lusaka districts of Zambia . For the entire study , a total of 418 fly sample s were analyzed in the laboratory and Salmonella spp . and enteropathogenic Escherichia coli were isolated from the flies . Further laboratory screening revealed that overall , 17.2 % ( 72/418 ) ( 95 % CI ; 43.2%–65.5 % ) of total sample s analyzed contained Extended-Spectrum Beta-Lactamase (ESBL)-producing E. coli . These significant findings call for a strengthening of the antibiotic administering policy in Zambia and the development of sustainable interventions to reduce fly numbers in food markets and improve food safety and hygiene BACKGROUND There are no data on the cumulative effect of fly control and antibiotic distribution on trachoma in hyperendemic communities . We sought to determine whether insecticide spray intervention after mass antibiotic treatment could reduce trachoma and ocular infection with Chlamydia trachomatis in hyperendemic neighbourhoods in Tanzania . METHODS We did a single-blind , r and omised clinical trial in 16 neighbourhoods ( balozi ) in Kongwa , Tanzania . All children aged 1 - 7 years were enrolled , with 119 children in the eight balozi of the intervention group and 183 in the eight control balozi . Children were examined at baseline , 6 months , and 1 year for clinical trachoma and ocular C trachomatis infection . One dose of azithromycin was offered to all residents of both intervention and control balozi after the baseline survey . Households ( and surrounding areas ) in the intervention group were then sprayed with insecticide throughout the ensuing year and monitored for reductions in fly counts . This study is registered at Clinical Trials.gov , number NCT00347763 . FINDINGS The intervention balozi had significantly lower fly counts than controls at all monitored weeks ( p<0.05 ) , apart from weeks 7 - 9 . The trachoma rate did not differ significantly in the intervention and control balozi at 6 months post-treatment ( 20%vs 33 % , p=0.07 ) , nor did it at 1 year ( 43%vs 44 % , p=0.90 ) . Infection with C trachomatis did not differ between groups at 6 months post-treatment ( 9%vs 7 % , p=0.45 ) . INTERPRETATION Intensive insecticide spraying reduced flies in the environment , but our results suggest that fly reduction after mass antibiotic treatment has no added benefit on reduction of trachoma BACKGROUND Eye-seeking flies have received much attention as possible trachoma vectors , but this remains unproved . We aim ed to assess the role of eye-seeking flies as vectors of trachoma and to test provision of simple pit latrines , without additional health education , as a sustainable method of fly control . METHODS In a community-based , cluster-r and omised controlled trial , we recruited seven sets of three village clusters and r and omly assigned them to either an intervention group that received regular insecticide spraying or provision of pit latrines ( without additional health education ) to each household , or to a control group with no intervention . Our primary outcomes were fly-eye contact and prevalence of active trachoma . Frequency of child fly-eye contact was monitored fortnightly . Whole communities were screened for clinical signs of trachoma at baseline and after 6 months . Analysis was per protocol . FINDINGS Of 7080 people 
    Output:
    
Insecticide spraying  reduced the fly population ( house index ) in the intervention group during the four months of the year when both flies and cases of diarrhoea were more common , but not at other times .