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BackgroundAlternative treatments for visceral leishmaniasis (VL) are required in East Africa. Paromomycin sulphate (PM) has been shown to be efficacious for VL treatment in India.MethodsA multi-centre randomized-controlled trial (RCT) to compare efficacy and safety of PM (20 mg/kg/day for 21 days) and PM plus sodium stibogluconate (SSG) combination (PM, 15 mg/kg/day and SSG, 20 mg/kg/day for 17 days) with SSG (20 mg/kg/day for 30 days) for treatment of VL in East Africa. Patients aged 4–60 years with parasitologically confirmed VL were enrolled, excluding patients with contraindications. Primary and secondary efficacy outcomes were parasite clearance at 6-months follow-up and end of treatment, respectively. Safety was assessed mainly using adverse event (AE) data.FindingsThe PM versus SSG comparison enrolled 205 patients per arm with primary efficacy data available for 198 and 200 patients respectively. The SSG & PM versus SSG comparison enrolled 381 and 386 patients per arm respectively, with primary efficacy data available for 359 patients per arm. In Intention-to-Treat complete-case analyses, the efficacy of PM was significantly lower than SSG (84.3% versus 94.1%, difference = 9.7%, 95% confidence interval, CI: 3.6 to 15.7%, p = 0.002). The efficacy of SSG & PM was comparable to SSG (91.4% versus 93.9%, difference = 2.5%, 95% CI: −1.3 to 6.3%, p = 0.198). End of treatment efficacy results were very similar. There were no apparent differences in the safety profile of the three treatment regimens.ConclusionThe 17 day SSG & PM combination treatment had a good safety profile and was similar in efficacy to the standard 30 day SSG treatment, suggesting suitability for VL treatment in East Africa.Clinical Trials Registration www.clinicaltrials.gov NCT00255567

Pesticide sprayers from five state-owned agricultural farms took part in a study that evaluated their knowledge, attitude and practice of pesticide use on farms. Demographic features of the sprayers showed that the majority of them had primary-level education. The duration of work as sprayers on the farms ranged from 1 month to approximately 10 years, with 59% of them having worked as sprayers for <5 years. Their knowledge about hazards from pesticides was indicated by the responses they gave to the standard questionnaire. Careful working was considered to be very important by 93% of them, while only 7% suggested the use of personal protective devices (PPD). On some of the farms, sprayers were provided with inappropriate/unfit and worn-out PPD; 18% of the sprayers had unfit goggles and 29% used worn-out gloves. To minimize risk from pesticide application, 63% suggested avoiding applications during windy and sunny weather, 32% suggested the provision and proper use of PPD, while only 3% of them felt medical check-ups and training were important, and 2% suggested risks from spraying were best controlled by leaving their job. The hygiene and sanitation practices of the sprayers require much improvement. An attitudinal change is needed, together with the provision of better facilities and infrastructure. We recommend that pesticide safety education be given to the sprayers. In addition, appropriate PPD should be used, with regular maintenance and timely replacement of worn-out parts.

BackgroundVisceral leishmaniasis (VL) has been known to exist in northwest Ethiopia (Humera-Metema lowlands) since the early 1970s associated with large scale agricultural development activities, often resulting in outbreaks. The latest outbreak of the disease that has started around 1995 in both regions, has led to the present preliminary entomological surveys (1996-2005) the results of which are reported here. Sandflies were collected using CDC light traps and Phlebotomus females were dissected for Leishmania detection and isolation; freshly fed Phlebotomus females collected were subsequently tested for their blood meal sources using ELISA. All Phlebotomus collections were identified to species.ResultsDuring the surveys (1996-2005), a total of 1963 sandflies of six Phlebotomus species (P. orientalis, P. papatasi, P. bergeroti, P. duboscqi, P. rodhaini and P. alexandri) were recorded from the study areas: the predominant species was P. orientalis in both localities. None of the total 618 P. orientalis females dissected (506 from Metema and 112 from Humera), nor the total 114 females of four other species dissected (P. papatasi, P. duboscqi, P. bergeroti and P. rodhaini) was infected with Leishmania promastigotes. ELISA-based blood meal analysis of 273 fresh fed P. orientalis females collected from Metema revealed a remarkably high bovine blood feeds (92%) with only 2.2% of human blood feeds.ConclusionBased on abundance and other circumstantial evidences (its proven role in Sudan), P. orientalis is the most likely vector of VL in northwest Ethiopia, pending further clarifications. The zoophagic feeding behaviour of P. orientalis detected in the present study could have epidemiological significance, but more investigations are required in this and other behavioural characteristics towards appropriate management of the vector.