Biannual azithromycin distribution and child mortality among malnourished children in Niger
Research snapshot1
Biannual azithromycin distribution has been shown to reduce child mortality as well as increase antimicrobial resistance. The authors assessed whether this effect differed according to underweight status in a high-mortality setting in West Africa. Children received biannual distribution of azithromycin or a placebo over two years in a large, randomised control trial in Niger. In this analysis, the effect of azithromycin distribution on child mortality was assessed for underweight subgroups using weight-for-age z-score (WAZ) thresholds of −2 and −3 in 27,222 children between one and 11 months of age who had their weight measured at their first study visit. Mortality was defined as the community mortality rate (deaths per 1,000 person-years at risk). Modification of the effect of azithromycin on mortality by underweight status was examined on the additive and multiplicative scale2 and the absolute number of deaths averted with azithromycin in each subgroup was estimated.
The communities assigned to azithromycin had lower mortality rates than those assigned to the placebo (−12.6 deaths per 1,000 person-years (95% CI −18.5 to −6.9, P < 0.001)). Reductions were larger among children with lower WAZ: −17.0 (95% CI −28.0 to −7.0, P = 0.001) among children with WAZ < −2 and −25.6 (95% CI −42.6 to −9.6, P = 0.003) among children with WAZ < −3. The estimated number of deaths averted with azithromycin was 388 (95% CI 214 to 574) overall, 116 (95% CI 48 to 192) among children with WAZ < −2 and 76 (95% CI 27 to 127) among children with WAZ < −3.
Although the absolute reduction in mortality between arms appears larger in both underweight groups, no statistically significant evidence of effect modification was demonstrated by the WAZ subgroup on either the additive or multiplicative scale. Based on these results, the authors conclude that the treatment of all children aged between one and 11 months would save five times as many lives as restricting treatments only to children with a WAZ < −3. In this setting, the number of deaths averted would be greatest if all children were treated with azithromycin, regardless of nutritional status.
1 O’Brien, K S, Arzika, A M, Maliki, R, Manzo, F, Mamkara, A K, Lebas, E, et al (2020) Biannual azithromycin distribution and child mortality among malnourished children: A subgroup analysis of the MORDOR cluster-randomized trial in Niger. PLoS Med 17(9): e1003285. https://doi.org/10.1371/journal.pmed.1003285
2 An additive interaction contrast greater than 0 indicates the joint effect of receiving placebo and being underweight is greater than the sum of the individual effects considered separately. A multiplicative interaction contrast greater than 1 indicates the joint effect of receiving placebo and being underweight is greater than the product of the individual effects considered separately.
More like this
FEX: MUAC vs WHZ in predicting mortality in hospitalised children under five years of age
Summary of research1 This research contributes to the evidence base regarding which anthropometric indicators identify malnourished sick children most at risk of death. Low...
FEX: Diagnostic criteria for severe acute malnutrition among infants under six months of age
Summary of research1 Location: Kenya What we know: Diagnosis of acute malnutrition in infants under six months old (U6M) is currently based on weight-for-length z score...
FEX: Routine amoxicillin use in treatment of uncomplicated SAM in children
Summary of research1 Location: Niger What we know: Routine use of broad-spectrum antibiotics is recommended in uncomplicated SAM case management; there is a lack of evidence...
FEX: Growth faltering in rural Gambian children after four decades of interventions: a retrospective cohort study
Summary of Research1 Nabwera HM, Fulford AJ, Moore SE and Prentice AM. (2017). Growth faltering in rural Gambian children after four decades of interventions: a retrospective...
FEX: Evaluation of an integrated health-nutrition-WASH project to reduce malnutrition prevalence in children under two in Bangladesh
By Monsurul Hoq and John Brogan Monsurul Hoq was working as a Statistician Epidemiologist during the study. He has experience in monitoring and evaluation of community-based...
FEX: Is MUAC alone a sufficient criterion for admission of children at high risk of mortality in South Sudan?
Summary of research 1 Location: South Sudan What we know: The operational implications of using MUAC as the sole anthropometric admission criterion to therapeutic feeding...
FEX: Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali
Summary of research1 Location: Mali What we know: Community-led total sanitation (CLTS) is being scaled up, but there is limited evidence on child health impacts. What this...
FEX: Finding the best criteria to identify children at high risk of mortality
View this article as a pdf This article is a summary of the following paper: Khara T, Myatt M, Sadler K, Bahwere P, Berkeley J, Black R (TBC) Anthropometric criteria for best...
FEX: Antibiotics as part of the management of severe acute malnutrition
Summary of published research1 Mothers receive instruction on how to adminster antibiotics Location: Malawi What we know already: There is a high prevalence of clinically...
FEX: Effect of nutrition survey ‘cleaning criteria’ on estimates of malnutrition prevalence and disease burden: secondary data analysis
Summary of research1 Location: Global What we know: Standardised methods for collection and reporting malnutrition prevalence data in nutrition surveys are used. What this...
Resource: Anthropometric criteria for best-identifying children at high risk of mortality: a pooled analysis of twelve cohorts
Abstract Objective: To understand which anthropometric diagnostic criteria best discriminate higher from lower risk of death in children and explore programme...
FEX: Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition in Burkina Faso
Summary of research1 Location: Burkina Faso What we know: There is no consensus on the effectiveness of lipid-nutrient supplement (LNS) compared to corn-soy blend (CSB) in...
FEX: Effect of short-term RUTF distribution on children in Niger
Summary of published research1 Mothers and children arriving for their monthly surveillance visits, as part of the trial Researchers from the Harvard School of Public Health...
FEX: Neonatal vitamin A supplementation to prevent mortality and morbidity in infancy
Summary of published review1 A recently published review set out to evaluate the effect of neonatal vitamin A supplementation on infant mortality, morbidity and early adverse...
Resource: Improving screening for malnourished children at high risk of death: a study of children aged 6–59 months in rural Senegal
Abstract Objective: To investigate whether children with concurrent wasting and stunting require therapeutic feeding and to better understand whether multiple diagnostic...
FEX: MUAC Versus Weight-for-Height in Assessing Severe Malnutrition
Summary of published paper1 An infant having MUAC measured during the study in Kenya Current WHO guidelines for the management of severe malnutrition in children recommend...
FEX: Risk factors associated with severe acute malnutrition in infants under six months in India: a cross sectional analysis
By Susan Thurstans Susan is a registered nurse and midwife with over 12 years' experience in maternal and child health and nutrition programmes in both development and...
FEX: Making connections: Joint meeting of WaSt Technical Interest Group and MAMI Special Interest Group
ENN coordinates two international technical groups, the Management of at-risk Mothers and Infants under six months Special Interest Group (MAMI SIG) and the Wasting and...
FEX: Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect
Summary of research1 Location: Global What we know: The decision not to breastfeed a child impacts on the health, nutrition and development of a child and on women's...
Resource: Effects on child growth of a reduction in the general food distribution ration and provision of small-quantity lipid-based nutrient supplements in refugee camps in eastern Chad
Abstract Background We used the United Nations High Commissioner for Refugees Standardised Expanded Nutrition Survey data to evaluate the effect of a change in food ration...
Reference this page
Biannual azithromycin distribution and child mortality among malnourished children in Niger. Field Exchange 65, May 2021. p68. www.ennonline.net/fex/65/azithromycinmortality
(ENN_7020)