Sié Ali, Ouattara Mamadou, Bountogo Mamadou, Boudo Valentin, Ouedraogo Thierry, Dah Clarisse, Compaoré Guillaume, Lebas Elodie, Hu Huiyu, Porco Travis C, Arnold Benjamin F, O'Brien Kieran S, Lietman Thomas M, Oldenburg Catherine E
Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America.
PLOS Glob Public Health. 2024 Oct 28;4(10):e0003875. doi: 10.1371/journal.pgph.0003875. eCollection 2024.
Children with acute malnutrition are at high risk of morality. Mass azithromycin distribution reduces all-cause mortality among children aged 1-59 months, and effects may be greater in underweight infants. Here, we evaluate the efficacy of azithromycin for reducing all-cause mortality in children aged 6-59 months with acute malnutrition (mid-upper arm circumference, MUAC, < 12.5 cm). Communities in Nouna District, Burkina Faso were 1:1 randomized to biannual mass distribution of single dose azithromycin or placebo to all children aged 1-59 months. Mortality was assessed during each census and treatment round. MUAC measurements were collected for all children. We evaluated the effect of azithromycin on mortality in subgroups of children aged 6-59 months defined by acute malnutrition (MUAC < 12.5 cm versus MUAC ≥ 12.5 cm). In children with MUAC < 12.5 cm, mortality rates were 51% lower among those living in azithromycin communities compared to placebo (incidence rate ratio 0.49, 95% confidence interval, CI, 0.25 to 0.99; incidence rate difference -18.1 deaths per 1,000 person-years, 95% CI -37.0 to -0.01), which was greater than the reduction in mortality among children with MUAC ≥ 12.5 cm (P-value for interaction on the relative scale = 0.09; P-value for interaction of the additive scale = 0.03). Children with acute malnutrition may benefit from single dose azithromycin above and beyond those without acute malnutrition. Trial registration: ClinicalTrials.gov NCT03676764; https://clinicaltrials.gov/study/NCT03676764.
患有急性营养不良的儿童面临着很高的死亡风险。大规模分发阿奇霉素可降低1至59个月龄儿童的全因死亡率，对体重不足的婴儿效果可能更大。在此，我们评估阿奇霉素对降低6至59个月龄急性营养不良（中上臂围，MUAC，<12.5厘米）儿童全因死亡率的疗效。布基纳法索努纳区的社区按1:1随机分为两组，一组为每半年对所有1至59个月龄儿童单次大规模分发阿奇霉素，另一组为分发安慰剂。在每次人口普查和治疗轮次期间评估死亡率。收集所有儿童的MUAC测量值。我们评估了阿奇霉素对按急性营养不良定义的6至59个月龄儿童亚组（MUAC<12.5厘米与MUAC≥12.5厘米）死亡率的影响。在MUAC<12.5厘米的儿童中，与安慰剂组相比，生活在阿奇霉素社区的儿童死亡率降低了51%（发病率比0.49，95%置信区间，CI，0.25至0.99；发病率差异为每1000人年-18.1例死亡，95%CI-37.0至-0.01），这一降低幅度大于MUAC≥12.5厘米儿童的死亡率降低幅度（相对尺度上的交互作用P值=0.09；相加尺度上的交互作用P值=0.03）。患有急性营养不良的儿童可能比没有急性营养不良的儿童从单次剂量阿奇霉素中获益更多。试验注册：ClinicalTrials.gov NCT03676764；https://clinicaltrials.gov/study/NCT03676764 。
