Ecology and control of the trachoma vector Musca sorbens
The work described in this thesis was conducted In rural Gambia and builds a body of evidence Incriminating the fly Musca sorbens as a vector of the blinding disease, trachoma, which is caused by ocular infection with Chlamydia trachomatis. Literature on hygiene promotion, environmental change and flies and trachoma is reviewed in the context of the SAFE strategy for trachoma control advocated by the World Health Organization M. sorbens was present throughout the year in trachoma endemic communities; was responsible for the majority of fly-eye contacts; C. trachomatis DNA was found on it; and trachoma transmission dropped when they were removed from the environment. In a large cluster-randomised trial communities receiving fly control with insecticide for six months had a mean reduction in trachoma prevalence of 56% (95% Cl 19-93%; P=0.01) compared to controls and 37% (4-70%; P=0.068) fewer new prevalent cases of trachoma. Breeding media choice experiments showed that isolated human faeces were the preferred larval medium for M. sorbens and were capable of supporting the production of large numbers of adults. However, other animal faeces were also able to support M. sorbens development. This suggested that a community-based strategy to reduce the quantity of human faeces on the soil surface by providing latrines would have the effect of reducing the population of M. sorbens, and hence reduce fly-eye contact and trachoma transmission. The provision of latrines gave encouraging results, which were not statistically significant; 30% less active trachoma than controls after six months (-22-81%; P=0.210) and 28% (-5-60%; P=0.146) fewer new prevalent cases. Provision of latrines warrants further investigation as a method to control trachoma, particularly when used in conjunction with other control methods. The potential role of fly control in the SAFE strategy for trachoma control is discussed.