Mass Azithromycin Distributions and Childhood Clinic Visits in Niger: A Community-Randomized Trial

Abstract

The community-randomized, placebo-controlled Macrolides Oraux pour Réduire les Décés avec un Oeil sur la Résistance (MORDOR) trial revealed that biannual mass azithromycin distributions to preschool children reduced child mortality in sub-Saharan Africa. Other benefits may also be possible. Surveillance of local health post records was assessed from the Niger study site from 2014 to 2016. Community-level data on all clinic visits, diagnoses, and antibiotic prescriptions recorded in the health post logbooks were retrospectively extracted for the period spanning from 12 months before baseline to 12 months after baseline. During the 12-month period after the communities were randomized in the MORDOR trial, a total of 5,229 clinic visits were documented in the azithromycin group, compared with 7,647 in the placebo group (incidence rate ratio [IRR]: 0.82; 95% CI: 0.79–0.85); 2,011 malaria diagnoses were documented in the azithromycin group, compared with 3,366 in the placebo group (IRR: 0.71; 95% CI: 0.46–1.39); and 2,218 courses of antibiotics were documented in the azithromycin group, compared with 3,297 in the placebo group (IRR: 0.81; 95% CI: 0.77–0.85). The reduction in clinic visits and clinic-prescribed antibiotics is consistent with a reduction in infectious diseases in the azithromycin-treated communities.