Effect of Mass Azithromycin Distributions on Childhood Growth in Niger

Abstract

IMPORTANCEMass azithromycin distributions may decrease childhood mortality, although the causal pathway is unclear. The potential for antibiotics to function as growth promoters may explain some of the mortality benefit. OBJECTIVE To investigate whether biannual mass azithromycin distributions are associated with increased childhood growth. DESIGN, SETTING, AND PARTICIPANTS This cluster-randomized trial was performed from December 2014 until March 2020 among 30 rural communities in Boboye and Loga departments in Niger, Africa, with populations from 200 to 2000 individuals. Communities were randomized in a 1:1 ratio to biannual mass distributions of azithromycin or placebo for children ages 1 to 59 months. Participants, field-workers, and study personnel were masked to treatment allocation. Height and weight changes from baseline to follow-up at 4 years were compared between groups. Data were analyzed from June through November 2021. INTERVENTIONS Participants received azithromycin at 20 mg/kg using height-based approximation or by weight for children unable to stand every 6 months at the participants' households. Placebo contained the vehicle of the azithromycin suspension. MAIN OUTCOMES AND MEASURES Longitudinal anthropometric assessments were performed on a random sample of children before the first treatment and then annually for 5 years. Height and weight were the prespecified primary outcomes. RESULTS Among 3936 children enrolled from 30 communities, baseline characteristics were similar between 1299 children in the azithromycin group and 2637 children in the placebo group (mean 48.2% [95% CI, 45.5% to 50.8%] girls vs 48.0% [95% CI, 45.7% to 50.3%] girls; mean age, 30.8 months [95% CI, 29.5 to 32.0 months] vs 30.6 months [95% CI, 29.2 to 31.6 months]). Baseline anthropometric assessments were performed among 2230 children, including 985 children in the azithromycin group and 1245 children in the placebo group, of whom follow-up measurements were available for 789 children (80.1%) and 1063 children (85.4%), respectively. At the prespecified 4-yearfollow-up visit, children in the azithromycin group gained a mean 6.7 cm (95% CI, 6.5 to 6.8 cm) in height and 1.7 kg (95% CI, 1.7 to 1.8 kg) in weight per year and children in the placebo group gained a mean 6.6 cm (95% CI, 6.4 to 6.7 cm) in height and 1.7 kg (95% CI, 1.7 to 1.8 kg) in weight per year.Height at 4 years was not statistically significantly different between groups when adjusted for baseline height (0.08 cm [95% CI, −0.12 to 0.28 cm] greater in the azithromycin group; P = .45), and neither was weight when adjusted for height and baseline weight (0.02 kg [95% CI, −0.10 to 0.06 kg] less in the azithromycin group; P = .64). However, among children in the shortest quartile of (continued) Key Points Question Do biannual mass azithromycin distributions, which have been shown to decrease child mortality in sub-Saharan Africa, promote child growth? Findings In this placebo-controlled cluster-randomized trial with longitudinal anthropometric monitoring among 22...

Testing the effects of mass drug administration of azithromycin on mortality and other outcomes among 1–11-month-old infants in Mali (LAKANA): study protocol for a cluster-randomized, placebo-controlled, double-blinded, parallel-group, three-arm clinical trial

“…We will build on this work and investigate in a subset of villages, the effect of azithromycin on malaria parasitemia, inflammation, and other markers of infection, immunity, and vaccine response. Besides the infection reduction pathway, growth promotion is considered another plausible mechanism that could explain some of the mortality benefit [ 27 ]. Undernutrition is an underlying factor contributing in almost half of all child deaths [ 1 ], and in low- and middle-income settings, antibiotic treatment of children might improve their linear growth [ 28 ].…”

Effect of Biannual Mass Azithromycin Distributions to Preschool-Aged Children on Trachoma Prevalence in Niger

“…A random sample of children from each community was monitored annually for a 2-year period for numerous health outcomes. The primary outcomes of the sister trial included malaria, anthropometry, and macrolide resistance and are reported elsewhere . Clinical trachoma was a prespecified secondary outcome, defined according to the WHO’s simplified grading system as the presence of trachomatous inflammation–follicular (TF) or trachomatous inflammation–intense (TI) .…”

“…The present study assessed prespecified trachoma outcomes of the sister trial included malaria, anthropometry, and macrolide resistance and are reported elsewhere. [17][18][19] Clinical trachoma was a prespecified secondary outcome, defined according to the WHO's simplified grading system as the presence of trachomatous inflammation-follicular (TF) or trachomatous inflammation-intense (TI). 20 This study followed the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline.…”

Simplified dosing of oral azithromycin for children 1–11 months old in child survival programmes: age-based and height-based dosing protocols

“…A parallel trial was conducted in 30 communities at the Niger site to monitor additional outcomes separate from the mortality trial (MORDOR morbidity trial). 10 Eligibility, randomisation and census data collection were the same in both trials, as described above. In addition, repeated random samples of 40 children aged 1–59 months were selected at baseline, 6 months, 12 months and 24 months for additional monitoring.…”

“…A parallel trial was conducted in 30 communities at the Niger site to monitor additional outcomes separate from the mortality trial (MORDOR morbidity trial) 10. Eligibility, randomisation and census data collection were the same in both trials, as described above.…”