1921
Volume 93, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract

A cluster-randomized trial demonstrated that mass oral azithromycin distribution reduced childhood mortality 49.6% (Trachoma Amelioration in Northern Amhara [TANA]). The relative risk of childhood mortality was then estimated using two approaches: an expert survey and a Bayesian analysis. The survey asked public health experts to estimate the true effect of mass azithromycin distribution on childhood mortality. The Bayesian estimation used the TANA study's results and prior estimates of the efficacy of other effective population-level interventions. The experts believed mass azithromycin reduces childhood mortality (relative risk = 0.83, 95% credible intervals [CrI] = 0.70–1.00). The Bayesian analysis estimated a relative risk of 0.71 (95% CrI = 0.39–0.93). Both estimates suggest that azithromycin may have a true mortality benefit, though of a smaller magnitude than found in the single available trial. Prior information about nonantibiotic, population-level interventions may have informed the expert's opinions. Additional trials are needed to confirm a mortality benefit from mass azithromycin.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.15-0106
2015-11-04
2017-09-24
Loading full text...

Full text loading...

/deliver/fulltext/14761645/93/5/1106.html?itemId=/content/journals/10.4269/ajtmh.15-0106&mimeType=html&fmt=ahah

References

  1. The UN, Inter-agency Group for Child Mortality Estimation, 2014. Levels and Trends in Child Mortality: Report 2014. New York, NY: UNICEF.
  2. Porco TC, Gebre T, Ayele B, House J, Keenan J, Zhou Z, Hong KC, Stoller N, Ray KJ, Emerson P, Gaynor BD, Lietman TM, , 2009. Effect of mass distribution of azithromycin for trachoma control on overall mortality in Ethiopian children: a randomized trial. JAMA 302: 962968.[Crossref]
  3. Keenan JD, Ayele B, Gebre T, Zerihun M, Zhou Z, House JI, Gaynor BD, Porco TC, Emerson PM, Lietman TM, , 2011. Childhood mortality in a cohort treated with mass azithromycin for trachoma. Clin Infect Dis 52: 883888.[Crossref]
  4. WHO, 2005. Resolution WHA 58.2 malaria control. Fifty-eighth World Health Assembly. Geneva, Switzerland: World Health Organization, 1625. Available at: http://apps.who.int/gb/ebwha/pdf_files/WHA58-REC1/english/A58_2005_REC1-en.pdf.
  5. Dunne MW, Singh N, Shukla M, Valecha N, Bhattacharyya PC, Patel K, Mohapatra MK, Lakhani J, Devi CU, Adak T, Dev V, Yadav RS, Lele C, Patki K, , 2005. A double-blind, randomized study of azithromycin compared to chloroquine for the treatment of Plasmodium vivax malaria in India. Am J Trop Med Hyg 73: 11081111.
  6. Gilliams EA, Jumare J, Claassen CW, Thesing PC, Nyirenda OM, Dzinjalamala FK, Taylor T, Plowe CV, Tracy LA, Laufer MK, , 2014. Chloroquine-azithromycin combination antimalarial treatment decreases risk of respiratory- and gastrointestinal-tract infections in Malawian children. J Infect Dis 210: 585592.[Crossref]
  7. Kuschner RA, Trofa AF, Thomas RJ, Hoge CW, Pitarangsi C, Amato S, Olafson RP, Echeverria P, Sadoff JC, Taylor DN, , 1995. Use of azithromycin for the treatment of Campylobacter enteritis in travelers to Thailand, an area where ciprofloxacin resistance is prevalent. Clin Infect Dis 21: 536541.[Crossref]
  8. Panpanich R, Lerttrakarnnon P, Laopaiboon M, , 2008. Azithromycin for acute lower respiratory tract infections. Cochrane Database Syst Rev CD001954.
  9. WHO, 2009. Measles vaccines: WHO position paper. Wkly Epidmiol Rec 349360.
  10. Imdad A, Herzer K, Mayo-Wilson E, Yakoob MY, Bhutta ZA, , 2010. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database Syst Rev CD008524.
  11. Azzalini A, , 1985. A class of distributions which includes the normal ones. Scand J Stat 12: 171178.
  12. Swinburne R, , 2002 (reprinted 2010). Bayes Theorem. Oxford, United Kingdom: Oxford University Press.
  13. Ojukwu JU, Okebe JU, Yahav D, Paul M, , 2009. Oral iron supplementation for preventing or treating anaemia among children in malaria-endemic areas. Cochrane Database Syst Rev CD006589.
  14. Soares-Weiser K, Maclehose H, Ben-Aharon I, Goldberg E, Pitan F, Cunliffe N, , 2010. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database Syst Rev CD008521.
  15. Meremikwu MM, Donegan S, Esu E, , 2008. Chemoprophylaxis and intermittent treatment for preventing malaria in children. Cochrane Database Syst Rev CD003756.
  16. Graves PM, Deeks JJ, Demicheli V, Jefferson T, , 2010. Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected). Cochrane Database Syst Rev CD000974.
  17. Lengeler C, , 2004. Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database Syst Rev CD000363.
  18. Lucero MG, Dulalia VE, Nillos LT, Williams G, Parreno RA, Nohynek H, Riley ID, Makela H, , 2009. Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and x-ray defined pneumonia in children less than two years of age. Cochrane Database Syst Rev CD004977.
  19. Whitty CJ, Glasgow KW, Sadiq ST, Mabey DC, Bailey R, , 1999. Impact of community-based mass treatment for trachoma with oral azithromycin on general morbidity in Gambian children. Pediatr Infect Dis J 18: 955958.[Crossref]
  20. Efron B, Greenland S, Gelman A, Kass RE, , 2010. The future of indirect evidence. Stat Sci 25: 145171.[Crossref]
  21. Malhotra-Kumar S, Coenen S, Klugman KP, Goossens H, , 2009. 3-monthly azithromycin administration for trachoma. Lancet 374: 449, author reply 449–450.[Crossref]
  22. Amza A, Kadri B, Nassirou B, Stoller NE, Yu SN, Zhou Z, Chin S, West SK, Bailey RL, Mabey DCW, Keenan JD, Porco TC, Lietman TM, Gaynor BD, , 2012. Community risk factors for ocular Chlamydia infection in Niger: pre-treatment results from a cluster-randomized trachoma trial. PLoS Negl Trop Dis 6: e1586.[Crossref]
  23. Amza A, Yu SN, Kadri B, Nassirou B, Stoller NE, Zhou Z, West SK, Bailey RL, Gaynor BD, Keenan JD, Porco TC, Lietman TM, , 2014. Does mass azithromycin distribution impact child growth and nutrition in Niger? A cluster-randomized trial. PLoS Negl Trop Dis 8: e3128.[Crossref]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.15-0106
Loading
/content/journals/10.4269/ajtmh.15-0106
Loading

Data & Media loading...

Supplementary Data

Supplementary PDF

  • Received : 06 Feb 2015
  • Accepted : 15 Mar 2015

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error