{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:27:11Z","timestamp":1790260031168,"version":"4.1.0"},"reference-count":26,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,3,6]]},"abstract":"<jats:p>Mass drug administration (MDA) with azithromycin may reduce under-5 child mortality (U5M) in sub-Saharan Africa. Here, we conducted a pooled analysis of all published cluster-randomized trials evaluating the effect of azithromycin MDA on child mortality. We pooled data from cluster-randomized trials randomizing communities to azithromycin MDA versus control. We calculated mortality rates in the azithromycin and control arms in each study, and by country for multisite studies including multiple countries. We conducted a two-stage individual community data meta-analysis to estimate the effect of azithromycin for prevention of child mortality. Three randomized controlled trials in four countries (Ethiopia, Malawi, Niger, and Tanzania) were identified. The overall pooled mortality rate was 15.9 per 1,000 person-years (95% confidence interval [CI]: 15.5\u201316.3). The pooled mortality rate was lower in azithromycin-treated communities than in placebo-treated communities (14.7 deaths per 1,000 person-years, 95% CI: 14.2\u201315.3 versus 17.2 deaths per 1,000 person-years, 95% CI: 16.5\u201317.8). There was a 14.4% reduction in all-cause child mortality in communities receiving azithromycin MDA (95% CI: 6.3\u201321.7% reduction, <jats:italic>P<\/jats:italic> = 0.0007). All-cause U5M was lower in communities receiving azithromycin MDA than in control communities, suggesting that azithromycin MDA could be a new tool to reduce child mortality in sub-Saharan Africa. However, heterogeneity in effect estimates suggests that the magnitude of the effect may vary in time and space and is currently not predictable.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0846","type":"journal-article","created":{"date-parts":[[2019,1,3]],"date-time":"2019-01-03T07:00:24Z","timestamp":1546498824000},"page":"691-695","source":"Crossref","is-referenced-by-count":30,"title":["Mass Azithromycin Distribution to Prevent Childhood Mortality: A Pooled Analysis of Cluster-Randomized Trials"],"prefix":"10.4269","volume":"100","author":[{"given":"Catherine E.","family":"Oldenburg","sequence":"first","affiliation":[{"name":"Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California;"},{"name":"Department of Ophthalmology, University of California, San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M.","family":"Arzika","sequence":"additional","affiliation":[{"name":"The Carter Center, Niamey, Niger;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdou","family":"Amza","sequence":"additional","affiliation":[{"name":"Programme FSS\/Universit\u00e9 Abdou Moumouni de Niamey, Programme National de Sant\u00e9 Oculaire, Niamey, Niger;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teshome","family":"Gebre","sequence":"additional","affiliation":[{"name":"The Carter Center, Addis Ababa, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khumbo","family":"Kalua","sequence":"additional","affiliation":[{"name":"Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zakayo","family":"Mrango","sequence":"additional","affiliation":[{"name":"National Institute for Medical Research, Dar es Salaam, Tanzania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun Y.","family":"Cotter","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila K.","family":"West","sequence":"additional","affiliation":[{"name":"The Dana Center, Johns Hopkins University School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin L.","family":"Bailey","sequence":"additional","affiliation":[{"name":"The London School of Tropical Hygiene and Medicine, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M.","family":"Emerson","sequence":"additional","affiliation":[{"name":"The International Trachoma Initiative, Decatur and Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran S.","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis C.","family":"Porco","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California;"},{"name":"Department of Ophthalmology, University of California, San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy D.","family":"Keenan","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California;"},{"name":"Department of Ophthalmology, University of California, San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Lietman","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California;"},{"name":"Department of Ophthalmology, University of California, San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"PLoS Negl Trop Dis","first-page":"e0005402","article-title":"Progress and projections in the program to eliminate trachoma","volume":"11","author":"Emerson","year":"2017"},{"key":"b2","series-title":"N Engl J Med","first-page":"1962","article-title":"Mass treatment with single-dose azithromycin for trachoma","volume":"351","author":"Solomon","year":"2004"},{"key":"b3","series-title":"JAMA","first-page":"1142","article-title":"Effect of a single mass antibiotic distribution on the prevalence of infectious trachoma","volume":"295","author":"Chidambaram","year":"2006"},{"key":"b4","series-title":"Am J Trop Med Hyg","first-page":"846","article-title":"Impact of mass azithromycin distribution on malaria parasitemia during the low-transmission season 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comparison of antibiotic resistance in diarrheagenic and non-pathogenic Escherichia coli from young Tanzanian children","volume":"7","author":"Seidman","year":"2016"},{"key":"b25","series-title":"Int J Epidemiol","first-page":"1105","article-title":"Increased carriage of macrolide-resistant fecal E. coli following mass distribution of azithromycin for trachoma control","volume":"43","author":"Seidman","year":"2014"},{"key":"b26","author":"International Trachoma Initiative"}],"container-title":["The American Journal of Tropical Medicine and 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