Abstract
.Mass drug administration (MDA) with azithromycin may reduce under-5 child mortality (U5M) in sub-Saharan Africa. Here, we conducted a pooled analysis of all published cluster-randomized trials evaluating the effect of azithromycin MDA on child mortality. We pooled data from cluster-randomized trials randomizing communities to azithromycin MDA versus control. We calculated mortality rates in the azithromycin and control arms in each study, and by country for multisite studies including multiple countries. We conducted a two-stage individual community data meta-analysis to estimate the effect of azithromycin for prevention of child mortality. Three randomized controlled trials in four countries (Ethiopia, Malawi, Niger, and Tanzania) were identified. The overall pooled mortality rate was 15.9 per 1,000 person-years (95% confidence interval [CI]: 15.5–16.3). The pooled mortality rate was lower in azithromycin-treated communities than in placebo-treated communities (14.7 deaths per 1,000 person-years, 95% CI: 14.2–15.3 versus 17.2 deaths per 1,000 person-years, 95% CI: 16.5–17.8). There was a 14.4% reduction in all-cause child mortality in communities receiving azithromycin MDA (95% CI: 6.3–21.7% reduction, P = 0.0007). All-cause U5M was lower in communities receiving azithromycin MDA than in control communities, suggesting that azithromycin MDA could be a new tool to reduce child mortality in sub-Saharan Africa. However, heterogeneity in effect estimates suggests that the magnitude of the effect may vary in time and space and is currently not predictable.
Highlights
More than 700 million doses of azithromycin have been distributed to trachoma-endemic districts as part of trachoma control.[1]
We identified three cluster-randomized trials undertaken in 1,608 communities from four countries (e.g., Ethiopia, Malawi, Niger, and Tanzania) that met the inclusion criteria.[11,12,16]
Across three studies in four countries that met our inclusion criteria, under-5 child mortality (U5M) was 14% lower in communities receiving azithromycin mass drug administration (MDA) than in control communities, effect estimates between studies showed some degree of heterogeneity
Summary
More than 700 million doses of azithromycin have been distributed to trachoma-endemic districts as part of trachoma control.[1]. The strongest effect by far was seen in the Niger site, which had the highest baseline child mortality rate, the greatest number of child-years of observations, the lowest loss to follow-up, and the highest
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