Evidence map›Paper›PMID 31443654›Full record

Trial reportMalaria journal2019

The impact on malaria of biannual treatment with azithromycin in children age less than 5 years: a prospective study.

Evan M Bloch, Beatriz Munoz, Zakayo Mrango, Jerusha Weaver, Leonard E G Mboera, Tom M Lietman, David J Sullivan, Sheila K West

Registry-linked trialOpen access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Malaria journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02047981 (Evaluating Impact of Azithromycin Mass Drug Administrations on All-cause Mortality and Antibiotic Resistance), which is not on this map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
0.9field-weighted citation impact, top 23% of its field
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
3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. Article
  5. Review
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 2 countries.

Evan M BlochDepartment of Pathology, Johns Hopkins School of Medicine, 600 N. Wolfe St/Carnegie 446 D1, Baltimore, MD, 21287, USA. ebloch2@jhmi.edu.ORCID http://orcid.org/0000-0001-8181-9517
Beatriz MunozDana Center for Preventive Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Zakayo MrangoNational Institute for Medical Research, Kilosa, Tanzania.
Jerusha WeaverDana Center for Preventive Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Leonard E G MboeraNational Institute for Medical Research, Dar es Salaam, Tanzania.
Tom M LietmanFrancis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA.
David J SullivanJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Sheila K WestDana Center for Preventive Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Johns Hopkins University · USNational Institute for Medical Research · TZUniversity of California, San Francisco · US

Funding

Bill and Melinda Gates Foundation OPP1032340Bill and Melinda Gates Foundation OPP1201895
6 · The paper itself

Abstract

backgroundThe MORDOR study, a cluster randomized clinical trial, showed that single-dose azithromycin (20 mg/kg) administered biannually for 2 years to preschool children reduced mortality; a study was conducted to determine its effect on clinical symptomatic episodes of malaria as a potential mechanism for mortality benefit.

methodsA randomized control trial (RCT) was conducted, whereby 30 randomly selected communities in Kilosa District, Tanzania were randomized to receive 6-monthly treatment of children ages 1-59 months with single-dose azithromycin (20 mg/kg) vs. placebo. A prospective cohort study was nested within the RCT: children, aged 1 to 35 months at baseline, were randomly selected in each community and evaluated at 6-monthly intervals for 2 years. At each visit, the children were assessed for recent or ongoing fever and anti-malarial treatment; a rapid diagnostic test (RDT) for malaria was performed. The two major outcomes of interest were prevalence of RDT positivity and clinical malaria. The latter was defined as RDT-positivity with fever at time of evaluation and/or reported fever in the 3 days prior to evaluation. Methods that account for correlations at community level and within individuals over time were used to evaluate associations.

resultsAt baseline, the prevalence rates in the children in the azithromycin and placebo arms were 17.6% vs. 15.5% for RDT positivity (p = 0.76) and 6.1% vs. 4.3% (p = 0.56) for clinical malaria. There was a decline in both RDT-positivity and clinical malaria over time in both arms. The difference by treatment assignment was not significant for clinical malaria; it was significant for RDT-positivity with greater odds of decline in the placebo arm (p = 0.01).

conclusionsLack of evidence for a significant difference in the prevalence of clinical malaria in children at any visit following treatment suggests that the effect of single-dose azithromycin on malaria is at best transient and limited in scope. Chance overrepresentation of non-seasonal transmission in the communities in the azithromycin arm may account for higher rates of RDT-positivity and less decline over time. Trial registration Clinicaltrials.gov NCT02047981.

Indexed as

AntimalarialsAzithromycinChild, PreschoolFemaleHumansInfantMalariaMalePrevalenceProspective StudiesTanzaniaTime FactorsAntimalarialsAzithromycinAzithromycinChild mortalityClinical trialMalariaTanzania

Identifiers

PMID31443654
PMCPMC6708241
OpenAlexW2969908961

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

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.