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Impact of Mass Azithromycin Distribution on Malaria Parasitemia during the Low-Transmission Season in Niger: A Cluster-Randomized Trial

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  • F.I. Proctor Foundation, Department of Ophthalmology, Department of Epidemiology and Biostatistics, Institute for Global Health, Department of Medicine, University of California, San Francisco, California; Programme National de Lutte Contre la Cecité Niamey, Niger; Zinder Hospital, Zinder, Niger; Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom

We assessed the effect of mass azithromycin treatment on malaria parasitemia in a trachoma trial in Niger. Twenty-four study communities received treatment during the wet, high-transmission season. Twelve of the 24 communities were randomized to receive an additional treatment during the dry, low-transmission season. Outcome measurements were conducted at the community-level in children < 1–72 months of age in May–June 2011. Parasitemia was higher in the 12 once-treated communities (29.8%, 95% confidence interval [CI] = 21.5–40.0%) than in the 12 twice-treated communities (19.5%, 95% CI = 13.0–26.5%, P = 0.03). Parasite density was higher in once-treated communities (354 parasites/μL, 95% CI = 117–528 parasites/μL) than in twice-treated communities (74 parasites/μL, 95% CI = 41–202 parasites/μL, P = 0.03). Mass distribution of azithromycin reduced malaria parasitemia 4–5 months after the intervention. The results suggest that drugs with antimalaria activity can have long-lasting impacts on malaria during periods of low transmission.

Author Notes

* Address correspondence to Thomas M. Lietman, F.I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, 513 Parnassus, Med Sci 309a, San Francisco, CA 94143-0412. E-mail: tom.lietman@ucsf.edu

Financial support: This study was supported by the Bill and Melinda Gates Foundation (grant no. 48027); the National Institutes of Health (grant nos. NIH/NEI K23 EYO19881-01, NIH/NCRR/OD UCSF-CTSI, and KL2 RR024130); Research to Prevent Blindness; the Harper-Ingles Trust; and That Man May See.

Authors' addresses: Bruce D. Gaynor, Nicole E. Stoller, Sun N. Yu, Stephanie A. Chin, Jeremy D. Keenan, Travis C. Porco, and Thomas M. Lietman, F.I. Proctor Foundation, University of California, San Francisco, CA, E-mails: bruce.gaynor@ucsf.edu, nicole.stoller@ucsf.edu, sun.yu@ucsf.edu, stephanie.chin@ucsf.edu, jeremy.keenan@ucsf.edu, travis.porco@ucsf.edu, and tom.lietman@ucsf.edu. Abdou Amza and Baido Nassirou, Programme FSS/Université Abdou Moumouni de Niamey, E-mails: dr.amzaabdou@gmail.com and nasbeido@yahoo.fr. Boubacar Kadri, FSS/Université Abdou Moumouni de Niamey, Programme National de Lutte Contre la Cecité, Niamey, Niger, E-mail: boubacarkadri@gmail.com. Ousmane Lawan and Laouali Maman, Zinder Hospital, Zinder, Niger, E-mails: lawanousmane@yahoo.fr and laoualimaman2007@yahoo.fr. Sheila K. West, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, E-mail: shwest@jhmi.edu. Robin L. Bailey, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK, E-mail: robin.bailey@ucsf.edu. Philip J. Rosenthal, Institute for Global Health, Department of Medicine, University of California, San Francisco, CA, E-mail: prosenthal@medsfgh.ucsf.edu.

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