Evidence map›Paper›PMID 29694816›Full record

Trial reportThe New England journal of medicine2018

Azithromycin to Reduce Childhood Mortality in Sub-Saharan Africa.

Jeremy D Keenan, Robin L Bailey, Sheila K West, Ahmed M Arzika, John Hart, Jerusha Weaver, Khumbo Kalua, Zakayo Mrango, Kathryn J Ray, Catherine Cook and 6 more

6 registry-linked trialsAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The New England journal of medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 6 registered trials, which are not on this map. Cited by 228 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
228citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02047981 phase4completednot on this map

Evaluating Impact of Azithromycin Mass Drug Administrations on All-cause Mortality and Antibiotic Resistance: Mortality Trial

TypeinterventionalSponsorUniversity of California, San FranciscoRan2014 to 2018Enrolled190,238ConditionsChildhood MortalityArmsAzithromycin, Placebo
NCT04224987 phase4completednot on this mapstarted 2020, after this paper: background citation

Azithromycine Pour la Vie Des Enfants au Niger - Implémentation et Recherche: Essai mortalité et résistance (Azithromycin for Child Survival in Niger: Mortality Trial and Resistance Trial)

TypeinterventionalSponsorUniversity of California, San FranciscoRan2020 to 2024Enrolled864,493ConditionsMortality, Resistance Bacterial, Child, OnlyArmsAzithromycin, Placebo
NCT04716712 phase4active not recruitingnot on this mapstarted 2021, after this paper: background citation

Mortalite Infantile Reduite Par l'Administration de Masse de l'Azitromycine

TypeinterventionalSponsorUniversity of California, San FranciscoRan2021 to 2026Enrolled694,400ConditionsChild MortalityArmsAzithromycin, Placebo
NCT05288023 phase4terminatednot on this mapstarted 2022, after this paper: background citation

Azithromycine Pour la Vie Des Enfants au Niger - Implémentation et Recherche: Essai mortalité et résistance (Azithromycin for Child Survival in Niger: Programmatic Trial)

TypeinterventionalSponsorUniversity of California, San FranciscoRan2022 to 2024Enrolled169,707ConditionsResistance Bacterial, Morality, Child Health, ImplementationArmsAzithromycin for Oral Suspension
NCT06358872 phase4recruitingnot on this mapstarted 2024, after this paper: background citation

Azithromycine Pour la Vie Des Enfants au Niger II

TypeinterventionalSponsorUniversity of California, San FranciscoRan2024 to 2028Enrolled3,300,000ConditionsMortality, Antimicrobial ResistanceArmsAzithromycin for Oral Suspension
NCT07712263 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

Integrating the Guardian Spatial Emanator Within AVENIR II

TypeinterventionalSponsorUniversity of California, San FranciscoRan2026 to 2028Enrolled150,000ConditionsMalariaArmsSpatial Emanator
3 · Its place in the literature

Who cites it

228 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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  6. Antibiotics for trachoma.The Cochrane database of systematic reviews · 2019
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168 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors.

Jeremy D KeenanFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
Robin L BaileyFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
Sheila K WestFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
Ahmed M ArzikaFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
John HartFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
Jerusha WeaverFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
Khumbo KaluaFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
Zakayo MrangoFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
Kathryn J RayFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
Catherine CookFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
Elodie LebasFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
Kieran S O'BrienFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
Paul M EmersonFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
Travis C PorcoFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
Thomas M LietmanFrom the Francis I. Proctor Foundation (J.D.K., K.J.R., C.C., E.L., K.S.O., T.C.P., T.M.L.), the Departments of Ophthalmology (J.D.K., T.C.P., T.M.L.) and Epidemiology and Biostatistics (T.C.P., T.M.L.), and the Institute for Global Health Sciences (T.C.P., T.M.L.), University of California, San Francisco, San Francisco; London School of Hygiene and Tropical Medicine, London (R.L.B., J.H.); the Dana Center, Johns Hopkins University School of Medicine, Baltimore (S.K.W., J.W.); the Carter Center, Niamey, Niger (A.M.A.); Blantyre Institute for Community Outreach and the College of Medicine, University of Malawi, Blantyre (K.K.); National Institute for Medical Research, Dar es Salaam, Tanzania (Z.M.); and the International Trachoma Initiative, Decatur (P.M.E.), and Emory University, Atlanta (P.M.E.) - both in Georgia.
MORDOR Study Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWe hypothesized that mass distribution of a broad-spectrum antibiotic agent to preschool children would reduce mortality in areas of sub-Saharan Africa that are currently far from meeting the Sustainable Development Goals of the United Nations.

methodsIn this cluster-randomized trial, we assigned communities in Malawi, Niger, and Tanzania to four twice-yearly mass distributions of either oral azithromycin (approximately 20 mg per kilogram of body weight) or placebo. Children 1 to 59 months of age were identified in twice-yearly censuses and were offered participation in the trial. Vital status was determined at subsequent censuses. The primary outcome was aggregate all-cause mortality; country-specific rates were assessed in prespecified subgroup analyses.

resultsA total of 1533 communities underwent randomization, 190,238 children were identified in the census at baseline, and 323,302 person-years were monitored. The mean (±SD) azithromycin and placebo coverage over the four twice-yearly distributions was 90.4±10.4%. The overall annual mortality rate was 14.6 deaths per 1000 person-years in communities that received azithromycin (9.1 in Malawi, 22.5 in Niger, and 5.4 in Tanzania) and 16.5 deaths per 1000 person-years in communities that received placebo (9.6 in Malawi, 27.5 in Niger, and 5.5 in Tanzania). Mortality was 13.5% lower overall (95% confidence interval [CI], 6.7 to 19.8) in communities that received azithromycin than in communities that received placebo (P<0.001); the rate was 5.7% lower in Malawi (95% CI, -9.7 to 18.9), 18.1% lower in Niger (95% CI, 10.0 to 25.5), and 3.4% lower in Tanzania (95% CI, -21.2 to 23.0). Children in the age group of 1 to 5 months had the greatest effect from azithromycin (24.9% lower mortality than that with placebo; 95% CI, 10.6 to 37.0). Serious adverse events occurring within a week after administration of the trial drug or placebo were uncommon, and the rate did not differ significantly between the groups. Evaluation of selection for antibiotic resistance is ongoing.

conclusionsAmong postneonatal, preschool children in sub-Saharan Africa, childhood mortality was lower in communities randomly assigned to mass distribution of azithromycin than in those assigned to placebo, with the largest effect seen in Niger. Any implementation of a policy of mass distribution would need to strongly consider the potential effect of such a strategy on antibiotic resistance. (Funded by the Bill and Melinda Gates Foundation; MORDOR ClinicalTrials.gov number, NCT02047981 .).

Indexed as

Child MortalityMass Drug AdministrationAdministration, OralAnti-Bacterial AgentsAzithromycinChild, PreschoolCommunicable Disease ControlCommunicable DiseasesDrug Resistance, BacterialFemaleHumansInfantInfant MortalityMalawiMaleNigerAnti-Bacterial AgentsAzithromycin

Identifiers

PMID29694816
PMCPMC5849140

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.