The Effect of Mass Azithromycin Distribution on Childhood Mortality: Beliefs and Estimates of Efficacy

Craig W. See F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California

Search for other papers by Craig W. See in
Current site
Google Scholar
PubMed Close
,
Kieran S. O'Brien F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California

Search for other papers by Kieran S. O'Brien in
Current site
Google Scholar
PubMed Close
,
Jeremy D. Keenan F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California

Search for other papers by Jeremy D. Keenan in
Current site
Google Scholar
PubMed Close
,
Nicole E. Stoller F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California

Search for other papers by Nicole E. Stoller in
Current site
Google Scholar
PubMed Close
,
Bruce D. Gaynor F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California

Search for other papers by Bruce D. Gaynor in
Current site
Google Scholar
PubMed Close
,
Travis C. Porco F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California

Search for other papers by Travis C. Porco in
Current site
Google Scholar
PubMed Close
, and
Thomas M. Lietman F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California

Search for other papers by Thomas M. Lietman in
Current site
Google Scholar
PubMed Close
DOI:
https://doi.org/10.4269/ajtmh.15-0106
Volume/Issue:
Volume 93: Issue 5
Page(s):
1106–1109
Restricted access
Get Permissions

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.

Author Notes

* Address correspondence to Thomas M. Lietman, F.I. Proctor Foundation, Medical Sciences, University of California, 513 Parnassus Avenue, 3rd Floor, S334, San Francisco, CA 94143-0412. E-mail: tom.lietman@ucsf.edu

Financial support: This study was supported by funding from the Bill & Melinda Gates Foundation (OP1032340), the National Eye Institute-National Institutes of Health (U10 EY016214), Research to Prevent Blindness, and That Man May See.

Authors' addresses: Craig W. See, Kieran S. O'Brien, Jeremy D. Keenan, Nicole E. Stoller, Bruce D. Gaynor, Travis C. Porco, and Thomas M. Lietman, F.I. Proctor Foundation, Medical Sciences, University of California, San Francisco, CA, E-mails: craig.see@gmail.com, kieran.obrien@ucsf.edu, jeremy.keenan@ucsf.edu, nicole.stoller@ucsf.edu, bruce.gaynor@ucsf.edu, travis.porco@ucsf.edu, and tom.lietman@ucsf.edu.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2015
Received:
06 Feb 2015
|
Accepted:
15 Mar 2015
|
Published Online:
04 Nov 2015
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
  • 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: 962–968.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 883–888.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    WHO, 2005. Resolution WHA 58.2 malaria control. Fifty-eighth World Health Assembly. Geneva, Switzerland: World Health Organization, 16–25. Available at: http://apps.who.int/gb/ebwha/pdf_files/WHA58-REC1/english/A58_2005_REC1-en.pdf.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 1108–1111.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 585–592.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 536–541.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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 349–360.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Azzalini A, 1985. A class of distributions which includes the normal ones. Scand J Stat 12: 171–178.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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: 955–958.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Efron B, Greenland S, Gelman A, Kass RE, 2010. The future of indirect evidence. Stat Sci 25: 145–171.

  • 21.

    Malhotra-Kumar S, Coenen S, Klugman KP, Goossens H, 2009. 3-monthly azithromycin administration for trachoma. Lancet 374: 449, author reply 449–450.

  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 1773 1499 50
Full Text Views 521 17 1
PDF Downloads 189 15 1
 

 

 

 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save