***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: A household vector control trial was carried out in the Peruvian And es to measure the effect of spraying inside walls and ceilings with lambda-cyhalothrin on the risk for residents of cutaneous leishmaniasis caused by Leishmania peruviana . The mortality rates of Lutzomyia verrucarum measured with WHO contact bioassay cones set on adobe walls characteristic of the endemic region indicated an LD95 for lambda-cyhalothrin of about 20 mg/m2 , and no reduction in effectiveness for at least 6 months on indoor adobe walls sprayed with 25 mg/m2 . A r and om selection of 112 houses were sprayed ( starting in 1992/93 ) at 6-monthly intervals with a mean dose of 34 mg/m2 , leaving 154 control houses ( with closely matched pre-intervention measurements of incidence and s and fly abundance ) . Comparisons of pre- and post-intervention s and fly indoor abundance , measured at regular intervals for up to 2 years using CDC light traps , in 22 sprayed and 21 control houses demonstrated that spraying significantly reduced the indoor abundance of Lu . verrucarum by an average of 78 % and of Lu . ( Helcocyrtomyia ) peruensis by 83 % . Spraying was also associated with a significant reduction of 77 % in the proportion of bloodfed s and flies collected in light traps . The proportion of susceptible householders acquiring leishmaniasis during the trial was significantly reduced by 54 % as a result of spraying . The observed impact of spraying was greatest , 81 % ( 95 % confidence intervals 20 - 95 % ) , when the cases detected during the first 6 months after the intervention were excluded from the analysis , suggesting a significant pre-patent period An indoor vector control trial was carried out between December 1996 and February 1997 , with the aim of reducing the population densities of Lutzomyia ovallesi , the proven vector of cutaneous leishmaniasis ( CL ) in El Ingenio , Mir and a State , Venezuela . Houses were matched according to their structure ( " bahareque " [ mud and straw ] , concrete , and wood ) and r and omly assigned to a control group ( n = 19 ) or a treated group ( n = 20 ) that was sprayed with 25 mg/m(2 ) of lambdacyhalothrin . This dose was selected on the basis of a laboratory susceptibility test of Lu . ovallesi to pyrethroids . S and fly abundance was measured using CDC light traps 7 - 79 d post-intervention , by which time the s and fly population in control houses had declined to very low levels , at what was the end of the transmission season . Catches of total females , fed females , and males were significantly lower in sprayed than in control houses immediately after treatment . Catches of total females and males in sprayed houses recovered , reaching the level of control houses after 7 and 11 weeks , respectively . Bioassays following WHO protocol s using contact cones on a s and fly laboratory colony showed a short residual effect of the insecticide explaining these results . In contrast , there was no tendency for catches of fed females in the sprayed houses to recover during the course of the trial . Previous studies of adult population dynamics showed a short season of high abundance . Combined with these results , we believe that 2 indoor sprayings with lambdacyhalothrin , the first at the beginning of November and the second at the beginning of January , would considerably reduce the Lu . ovallesi population , and control CL transmission in this and other foci where this s and fly is considered to be the main vector OBJECTIVES Kala-azar or visceral leishmaniasis is one of the major vector-borne diseases in Bangladesh . The disease is transmitted by s and fly . The incidence of the disease , which has been increasing since the early eighties , must be reduced by taking adequate vector-control measures . The objective of the present study was to identify the favorable factors and the constraints of present vector-control management in Bangladesh . METHODS Purposively selected senior entomologist and retired senior entomologist at central level , civil surgeons , entotechnicians , health inspectors and spray men from kala-azar-endemic districts , community leaders , and NGO representatives were key informants of the study . A household survey to learn about knowledge and perceptions of the people about kala-azar vector was carried out , using a structured question naire , in 202 r and omly selected households . RESULTS Practically , there was no vector-control activity in the nine most kala-azar-endemic districts of Bangladesh . Inadequate human re sources , lack of logistics , and unavailability of funds for vector control were the major constraints . Community perception about kala-azar vector was poor . However , the use of bednets in the community was high . No private organization was involved in kala-azar vector control . Knowledge of the spray men about the insecticide-spraying technique was also unsatisfactory . CONCLUSION Kala-azar vector control in Bangladesh needs immediate attention of policy-makers and donors , otherwise , elimination of kala-azar from the country by 2015 may not be achievable Background To evaluate the effect of insecticide spraying for vector control and elimination of infected dogs on the incidence of human infection with L. infantum , a r and omized community intervention trial was carried out in the city of Teresina , Brazil . Methods /Principal Findings Within each of ten localities in the city , four blocks were selected and r and omized to 4 interventions : 1 ) spraying houses and animal pens with insecticide ; 2 ) eliminating infected dogs ; 3 ) combination of spraying and eliminating dogs , and 4 ) nothing . The main outcome is the incidence of infection assessed by the conversion of the Montenegro skin test ( MST ) after 18 months of follow-up in residents aged ≥1 year with no previous history of visceral leishmaniasis ( VL ) . Reactions were measured at 48–72 h , in duration of ≥5 mm considered positive . Interventions were executed after the baseline interview and repeated 6 and 12 months later . The effects of each type of intervention scheme on the incidence of infection were assessed by calculating relative risks and 95 % confidence intervals using Poisson population -averaged regression models with robust variance . Among the 1105 participants , 408 ( 37 % ) were MST positive  at baseline . Of the 697 negatives , only 423 ( 61 % ) were reexamined at the end of the follow-up ; 151 ( 36 % ) of them converted to a positive MST . Only dog culling had some statistically significant effect on reducing the incidence of infection , with estimates of effectiveness varying between 27 % and 52 % , depending on the type of analysis performed . Conclusions / Significance In light of the continuous spread of VL in Brazil despite the large scale deployment of insecticide spraying and dog culling , the relatively low to moderate effectiveness of dog culling and the non-significant effect of insecticide spraying on the incidence of human infection , we conclude that there is an urgent need for revision of the Brazilian VL control program INTRODUCTION American cutaneous leishmaniasis is endemic in Colombia , where approximately 6.000 new cases are reported every year . Current prevention and control measures are restricted to the diagnosis and treatment of cases . OBJECTIVE To evaluate the efficacy of a multifaceted intervention to prevent the transmission of Leishmania in the endemic focus of Tumaco , on the Pacific Coast of Colombia . MATERIAL S AND METHODS A group-r and omized trial was conducted . Twenty villages were matched according to prevalence of Leishmania infection , number of inhabitants and level of community participation , and then r and omly assigned to intervention or control . The intervention included deltamethrin-impregnated bednets , repellent ( 20 % diethyltoluamide and 0.5 % permethrin ) , modification of s and fly resting sites , and health education . Villages were under surveillance for one year and the use of the intervention measures monitored . The incidence of American cutaneous leishmaniasis and Leishmania infection in the two groups were compared , adherence to the intervention and adverse events were monitored , and the results were adjusted for village intraclass correlation . RESULTS Ten cases of American cutaneous leishmaniasis were confirmed in the intervention and 23 in the control group , OR = 0.42 , 95 % CI 0.14 - 1.26 . The intervention had a greater effect in children < 10 years old , in people living on the periphery of the village and in villages with a prevalence of infection in small children > 1 % . Adverse events associated with the use of the bednets and the repellent were reported in 2 % of the participants and were always mild . CONCLUSION Incident cases of American cutaneous leishmaniasis were reduced by 58 % in the intervention group . However , the small number of cases renders the effect estimate imprecise and precludes us to cl aim a protective effect for the intervention . Specific population s could be the targets of simpler and more cost-effective interventions in the future We determined the efficacy of the use of permethrin-impregnated uniforms for prevention of malaria and leishmaniasis in a double-blind , r and omized study of Colombian soldiers on patrol . In the study of malaria , soldiers were issued impregnated uniforms ( i.e. , a shirt , an undershirt , pants , socks , and a hat ) or uniforms washed in water ; the soldiers wore the uniforms day and night for a mean of 4.2 weeks and were observed for an additional 4 weeks . Three ( 3 % ) of 86 soldiers wearing impregnated uniforms contracted malaria , whereas 12 ( 14 % ) of 86 soldiers wearing control uniforms contracted malaria ( P = .015 ) . In the study of leishmaniasis ( soldiers were in the area of endemicity for 6.6 weeks and were observed for 12 weeks thereafter ) , 4 ( 3 % ) of 143 soldiers wearing impregnated uniforms and 18 ( 12 % ) of 143 soldiers wearing control uniforms acquired disease ( P = .002 ) . In the leishmaniasis study , and presumably in the malaria study , breakthrough infections in the treated group were primarily due to bites in unclothed regions of the body ( face and h and s ) . Permethrin-treated uniforms were virtually nontoxic ( there were only two cases of mild skin irritation among 229 subjects ) , and impregnation is quick and inexpensive . Impregnation of clothing with permethrin is suggested for nonimmune population s who are likely to be exposed to malaria or leishmaniasis over a period of 1 - 2 months A large-scale intervention field trial of the effect of Olyset long-lasting insecticide-treated bednets on transmission of cutaneous leishmaniasis was carried out in 2 cities in the Islamic Republic of Iran from October 2003 to July 2005 . We enrolled 8620 individuals in 3000 households in 6 pairs of sectors in each city . Epidemiological and entomological surveys were carried out pre- and post-intervention . In both cities a statistically significant reduction was found in the incidence of new cases in intervention sectors who received bednets compared with control areas . Entomological surveys showed a reduction in numbers of female Phlebotomus sergenti captured indoors in intervention sectors Objective To test the effectiveness of large scale distribution of longlasting nets treated with insecticide in reducing the incidence of visceral leishmaniasis in India and Nepal . Design Paired cluster r and omised controlled trial design ed to detect a 50 % reduction in incidence of Leishmania donovani infection . Setting Villages in Muzaffarpur district in India and Saptari , Sunsari , and Morang districts in Nepal . Participants 13 intervention and 13 control clusters . 12 691 people were included in the analysis of the main outcome ( infection ) , and 19 810 were enrolled for the secondary ( disease ) end point . Intervention Longlasting insecticidal nets ( treated with deltamethrin ) were distributed in the intervention clusters in December 2006 . Main outcome measures Infection was determined by direct agglutination test at 12 and 24 months after the intervention in those who had negative results ( titre < 1:1600 ) at baseline . The effect estimate was computed as the geometric mean of the risk ratios for seroconversion for each cluster pair ( net/no net ) , with its 95 % confidence interval . Formal tests of effect of no intervention were obtained with a paired t test . Results There was no significant difference in the risk of seroconversion over 24 months in intervention ( 5.4 % ; 347/6372 ) compared with control ( 5.5 % ; 345/6319 people ) clusters ( risk ratio 0.90 , 95 % confidence interval 0.49 to 1.65 ) nor in the risk of clinical visceral leishmaniasis ( 0.99 , 0.46 to 1.40 ) . Adjustment for covariates did not alter these conclusions . Conclusions There is no evidence that large scale distribution of longlasting insecticidal nets provides additional protection against visceral leishmaniasis compared with existing control practice in the Indian subcontinent . The observed effect was small and not significant , though the confidence intervals did not exclude a 50 % change in either direction . Trial registration Clinical Trials NCT 2005 - 015374 Abstract Objective : To measure the impact on transmission of leishmaniasis of curtains impregnated with insecticide . Design : Cluster r and omised controlled trial : household interview survey , observational study of people 's behaviour , entomological study with light trap captures of s and flies inside houses . Setting : 14 urban sectors in Trujillo , Venezuela . Participants : 2913 inhabitants of 569houses . Intervention : Sectors were paired 
    Output:
    
Authors ' conclusions Using insecticides to reduce phlebotomine s and fly numbers may be effective at reducing the incidence of CL , but there is insufficient evidence from trials to know whether it is better to spray the internal walls of houses or to treat bednets , curtains , bedsheets or clothing