title: Childhood mortality in a cohort treated with mass azithromycin for trachoma.
abstract: BACKGROUND
  Mass azithromycin distributions are used to clear ocular strains of chlamydia that cause trachoma, but treatments may also affect respiratory infections, diarrhea, and malaria. Here, we monitor a large cohort in which almost 90% of individuals received azithromycin. We assess whether receiving treatment is associated with reduced all-cause and infectious childhood mortality.
  
  
  METHODS
  As part of a clinical trial for trachoma, a census was conducted in 24 communities in rural Ethiopia. All individuals ≥1 year of age were eligible for single-dose oral azithromycin, although antibiotic coverage was not universal. A follow-up census was performed 26 months after treatment to estimate all-cause mortality among children 1-5 years of age, and verbal autopsies were performed to identify infectious mortality.
  
  
  RESULTS
  The cohort included 35,052 individuals ≥1 year of age and 5507 children 1-5 years of age, of whom 4914 received a dose of azithromycin. All-cause mortality was significantly lower among those 1-5-year-old children who received azithromycin (odds ratio [OR]=0.35 [95% confidence interval {CI}, 0.17-0.74]), as was infectious mortality (OR=0.20 [95% CI, 0.07-0.58]). When individuals were compared only with members of the same household, azithromycin treatment was still associated with reduced all-cause mortality in children 1-5 years of age (OR=0.40 [95% CI, 0.16-0.96]), although this relationship was not statistically significant for infectious mortality (OR=0.35 [95% CI, 0.10-1.28]).
  
  
  CONCLUSIONS
  This study demonstrated an association between mass oral azithromycin treatment and reduced all-cause and infectious childhood mortality. This relationship could not be attributed to bias at the level of the household. Mass azithromycin distributions may have benefits unrelated to trachoma.
authors.affiliation: F.I. Proctor Foundation, San Francisco, CA, USA. jeremy.keenan@ucsf.edu
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.forename: Berhan
authors.initials: B
authors.lastname: Ayele
authors.forename: Teshome
authors.initials: T
authors.lastname: Gebre
authors.forename: Mulat
authors.initials: M
authors.lastname: Zerihun
authors.forename: Zhaoxia
authors.initials: Z
authors.lastname: Zhou
authors.forename: Jenafir I
authors.initials: JI
authors.lastname: House
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Gaynor
authors.forename: Travis C
authors.initials: TC
authors.lastname: Porco
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage*; D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D015331:Cohort Studies; D005002:Ethiopia; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D008297:Male; D012424:Rural Population; D014141:Trachoma / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin