Our long-term goal is to more precisely define the role of mass azithromycin treatments as an intervention for reducing childhood mortality. We propose a single multi-site (multi-country), cluster-randomized trial comparing communities randomized to oral azithromycin with those randomized to placebo. We hypothesize that mass azithromycin treatments will reduce childhood mortality.
We will assess childhood mortality over three years, comparing communities where children aged 1-60 months receive biannual oral azithromycin ("Azithromycin" arm) for two years, to communities where the children receive biannual oral placebo ("Control" arm) for two years. During the third year at the Niger site only, everyone will receive azithromycin. This is a cluster-randomized trial; at each site, communities within a contiguous area of 300,000 to 600,000 individuals will be randomized to azithromycin or placebo using simple random sampling. Niger contingency study: In the event that mass distributions of oral azithromycin are proven to reduce mortality in 1-60 month-old children, then we will treat all communities in Niger with mass azithromycin distributions to test whether the intervention continues to reduce childhood mortality after the initial 2 years of mass treatments.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
190,238
Children aged 1 month to 60 months per community will be offered weight or height-based, directly observed, oral azithromycin suspension every 6 months for 2 years. In Niger during year 3, all communities will be offered azithroymcin.
Children aged 1 month to 60 months per community will be offered weight or height-based, directly observed, oral placebo every 6 months for 2 years. In Niger during year 3, all communities will be offered azithroymcin.
UCSF Proctor Foundation
San Francisco, California, United States
Johns Hopkins University
Baltimore, Maryland, United States
College of Medicine at the University of Malawi, Blantyre
Blantyre, Malawi
The Carter Center, Niger
Niamey, Niger
All-cause Mortality Rate in Children Aged 1-60 Months
This is a single multi-site trial, with each country as a secondary analysis. Also, an interim analysis of efficacy and futility will be conducted according to a pre-specified plan in the Statistical Analysis Plan.
Time frame: 24 Months
All-cause Mortality Rate in Children Aged 1-60 Months
This was a pre-specified contingency study in Niger only in which all communities were treated with mass azithromycin during the third year of the study following the primary 24-month endpoint.
Time frame: 36 months
Cause-specific Mortality Rate in Children Aged 1-60 Months, as Assessed From Verbal Autopsy (Niger Only)
Deaths were assessed via biannual population census. A pre-specified outcome was cause of death, assessed by verbal autopsy.
Time frame: 24 Months
Cost-effectiveness of Mass Azithromycin Administration, Per Averted Childhood Death
Cost-effectiveness of Mass Azithromycin Administration, Per Averted Childhood Death during the 24 month phase
Time frame: 24 months
All-cause and Cause-specific Health Clinic Visits in 1-60 Month-old Children
We recorded clinic visits one year prior the study and during the first year of the study and collected outcomes of these visit.
Time frame: 24 months
Cause-specific Mortality Rate in Children Aged 1-60 Months, as Assessed From Verbal Autopsy (Tanzania Only)
At 6-monthly intervals a census of the communities was conducted, and for child deaths a verbal autopsy was performed to ascertain the cause using a standardized diagnostic classification. Mortality due to pneumonia or diarrhea by age group and arm are shown in the outcome measure data table below.
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Kongwa Trachoma Project
Kongwa, Tanzania
London School of Hygiene & Tropical Medicine
London, United Kingdom
Time frame: 24 Months
Cause-specific Mortality Rate in Children Aged 1-60 Months, as Assessed From Verbal Autopsy (Malawi Only)
Cause-specific mortality by intention-to-treat for the four main inferred causes of death in the study area.
Time frame: 24 Months