Impact of Mass Azithromycin Distribution on Malaria Parasitemia during the Low-Transmission Season in Niger: A Cluster-Randomized Trial

Gaynor, Bruce D.; Amza, Abdou; Kadri, Boubacar; Nassirou, Baido; Lawan, Ousmane; Maman, Laouali; Stoller, Nicole E.; Yu, Stephen; Chin, Stephanie; West, Sheila K.; Bailey, Robin L.; Rosenthal, Philip J.; Keenan, Jeremy D.; Porco, Travis C.; Lietman, Thomas M.

doi:10.4269/ajtmh.13-0379

Cited by 31 publications

(39 citation statements)

References 33 publications

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“…The study area is malaria mesoendemic and affected by Plasmodium falciparum. 24 At this time, there was no seasonal malaria chemoprevention program in the study area. The only active malaria prevention program in the study area involved bed net distribution during this period.…”

Section: Methodsmentioning

confidence: 97%

Anthropometry and Malaria among Children in Niger: A Cross-Sectional Study

O’Brien

Amza

Kadri

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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The complex relationship between malnutrition and malaria affects morbidity and mortality in children younger than 5 years, particularly in parts of sub-Saharan Africa where these conditions occur together seasonally. Previous research on this relationship has been inconclusive. Here, we examine the association between anthropometric indicators and malaria infection in a population-based sample of children younger than 5 years in Niger. This cross-sectional study is a secondary analysis of a cluster-randomized trial comparing treatment strategies for trachoma in Niger. We included children aged 6-60 months residing in the 48 communities enrolled in the trial who completed anthropometric and malaria infection assessments at the final study visit. We evaluated the association between anthropometric indicators, including height-for-age -score (HAZ) and weight-for-age-score (WAZ) and indicators of malaria infection, including malaria parasitemia and clinical malaria. In May 2013, we collected data from 1,649 children. Of these, 780 (47.3%) were positive for malaria parasitemia and 401 (24.3%) had clinical malaria. In models of malaria parasitemia, the adjusted odds ratio (aOR) was 1.05 (95% confidence interval [CI]: 1.00-1.10) for HAZ and 1.07 (95% CI: 0.99, 1.15) for WAZ. In models of clinical malaria, the aOR was 1.07 (95% CI: 1.02-1.11) for HAZ and 1.09 (95% CI: 1.01-1.19) for WAZ. Overall, we did not find evidence of an association between most anthropometric indicators and malaria infection. Greater height may be associated with an increased risk of clinical malaria.

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Section: Methodsmentioning

confidence: 97%

Anthropometry and Malaria among Children in Niger: A Cross-Sectional Study

O’Brien

Amza

Kadri

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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“…Studies have also identified potential secondary benefits of mass azithromycin given for trachoma among children, including reductions in the prevalence of malaria and its sequelae. 11 – 14 These prior trachoma studies examined the short-term effects of a small number of mass distributions of azithromycin on malaria. Trachoma programs typically give multiple rounds of azithromycin over the course of several years, however, and the longer term effects of these mass distributions on malaria are unclear.…”

Section: Introductionmentioning

confidence: 99%

Mass Azithromycin and Malaria Parasitemia in Niger: Results from a Community-Randomized Trial

O’Brien

Cotter

Amza

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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Abstract.Studies designed to determine the effects of mass administration of azithromycin on trachoma have suggested that mass azithromycin distributions may also reduce the prevalence of malaria. These studies have typically examined the impact of a small number of treatments over short durations. In this prespecified substudy of a cluster-randomized trial for trachoma, we compared malaria parasitemia prevalence in 24 communities in Niger randomized to receive either annual or biannual mass azithromycin distributions over 3 years. The 12 communities randomized to annual azithromycin received three treatments during the high-transmission season, and the 12 communities randomized to biannual azithromycin received a total of six treatments: three during the high-transmission season and three during the low-transmission season. Blood samples were taken to assess malariometric indices among children in all study communities at a single time point during the high-transmission season after 3 years of the intervention. No significant differences were identified in malaria parasitemia, parasite density, or hemoglobin concentration between the annual and biannual treatment arms. When compared with annual mass azithromycin alone, additional mass azithromycin distributions given during the low-transmission season did not significantly reduce the subsequent prevalence of malaria parasitemia or parasite density after 3 years, as measured during the high-transmission season.

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“…48,49 Unintended benefits of mass azithromycin distribution for trachoma control have previously been shown for common childhood infectious illness, such as diarrhea, pneumonia, and malaria. [50][51][52][53] The present study suggests that weight gain benefits of empiric antibiotic use may be observed with some antibiotic classes but not others, a hypothesis that should be tested in future studies of programs using empiric antibiotic treatment with various antibiotic classes. If true, collateral weight gain benefits of empiric antibiotic treatment could represent an opportunity for intervention in regions with high burdens of malnutrition, but such benefits may depend on the class of antibiotics used.…”

Section: Discussionmentioning

confidence: 72%

Effect of Antibiotics on Short-Term Growth among Children in Burkina Faso: A Randomized Trial

Sié

Dah

Ouermi

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Antibiotics improve both weight and height gain in randomized trials of preschool children with preexisting morbidity. Here, we assess the effect of a short course of three different antibiotics (amoxicillin, azithromycin, and cotrimoxazole) on short-term linear and ponderal growth in a population-based sample of preschool children in rural Burkina Faso. We randomized households with at least two children in the Nouna district, Burkina Faso, to a 5-day course of amoxicillin, azithromycin, cotrimoxazole, or placebo. Within each antibiotic-randomized household, one child was randomly assigned to receive the antibiotic and the other to receive the placebo. Weight and height measurements were taken at baseline and 30 days following the last study medication dose. Weight-for-height (WHZ), height-for-age (HAZ), and weight-for-age (WAZ) scoreswere calculated based on the 2006 World Health Organization standards. Of the 124 households and 248 children enrolled, 229 had anthropometry measurements at 1 month and were analyzed. Children randomized to amoxicillin gained significantly more weight compared with both the placebo household (mean difference 317 g, 95% confidence interval [CI]: 115-519 g) and placebo sibling (mean difference 315 g, 95% CI: 147-482 g) controls. Growth velocity in g/kg/day, and WHZ and WAZ scores were higher in amoxicillin-treated children compared with placebo households and siblings. There were no differences in weight gain in children randomized to azithromycin or cotrimoxazole compared with placebo households or placebo siblings. There were no differences in height gain or HAZ across any of the study arms. Amoxicillin may have short-term growth-promoting effects in healthy children.

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Impact of Mass Azithromycin Distribution on Malaria Parasitemia during the Low-Transmission Season in Niger: A Cluster-Randomized Trial

Cited by 31 publications

References 33 publications

Anthropometry and Malaria among Children in Niger: A Cross-Sectional Study

Anthropometry and Malaria among Children in Niger: A Cross-Sectional Study

Mass Azithromycin and Malaria Parasitemia in Niger: Results from a Community-Randomized Trial

Effect of Antibiotics on Short-Term Growth among Children in Burkina Faso: A Randomized Trial

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