BackgroundMass azithromycin distribution reduces under-5 child mortality. Trachoma control programs currently treat infants aged 6 months and older. Here, we report findings from an infant adverse event survey in 1–5 month olds who received azithromycin as part of a large community-randomized trial in Niger.Methods and principal findingsActive surveillance of infants aged 1–5 months at the time of treatment was conducted in 30 randomly selected communities from within a large cluster randomized trial of biannual mass azithromycin distribution compared to placebo to assess the potential impact on child mortality. We compared the distribution of adverse events reported after treatment among azithromycin-treated versus placebo-treated infants. From January 2015 to February 2018, the caregivers of 1,712 infants were surveyed. Approximately one-third of caregivers reported at least one adverse event (azithromycin: 29.6%, placebo: 34.3%, risk ratio [RR] 0.86, 95% confidence interval [CI] 0.68 to 1.10, P = 0.23). The most commonly reported adverse events included diarrhea (azithromycin: 19.3%, placebo: 28.1%, RR 0.68, 95% CI 0.49 to 0.96, P = 0.03), vomiting (azithromycin: 15.9%, placebo: 21.0%, RR 0.76, 95% CI 0.56 to 1.02, P = 0.07), and skin rash (azithromycin: 12.3%, placebo: 13.6%, RR 0.90, 95% CI 0.59 to 1.37, P = 0.63). No cases of infantile hypertrophic pyloric stenosis were reported.ConclusionsAzithromycin given to infants aged 1–5 months appeared to be safe. Inclusion of younger infants in larger azithromycin-based child mortality or trachoma control programs could be considered if deemed effective.Trial registrationClinicalTrials.gov NCT02048007.

Trichiasis disables most women, even those reporting fewer or less-severe symptoms. While women in rural Niger often live in extreme poverty, trichiasis exacerbates the situation, making women unable to work and undermining their social status. It adds to family burden, as women lose the ability to meaningfully contribute to the household and require additional family resources for their care.

We conducted a survey in rural Niger to assess use, maintenance and acceptability of household latrines one year after a subsidized promotion project. Standard interviews were conducted with 200 randomly selected project participants and a visual latrine inspection. Before the project, 21.5% (43/200) of households had latrines. After the first year, 100% of these households had at least one latrine. Overall, 2577 household latrines were built in the 50 targeted villages. Latrines were 'always' used by 92.5% of adults and 55% of children in the households. The latrines were adequately maintained: superstructure 93%, covers 74.5%, clean 70%. The main perceived advantages of latrine ownership were proximity/easy access (59.5%) and privacy (22.5%). The project demonstrated that the implementation of a household latrine promotion project is acceptable and feasible in rural Niger. Future promotion projects may develop local sanitation expertise and focus on perceived benefits--proximity and privacy--rather than health.