title: The Effect of Mass Azithromycin Distribution on Childhood Mortality: Beliefs and Estimates of Efficacy.
abstract: A cluster-randomized trial demonstrated that mass oral azithromycin distribution reduced childhood mortality 49.6% (Trachoma Amelioration in Northern Amhara [TANA]). The relative risk of childhood mortality was then estimated using two approaches: an expert survey and a Bayesian analysis. The survey asked public health experts to estimate the true effect of mass azithromycin distribution on childhood mortality. The Bayesian estimation used the TANA study's results and prior estimates of the efficacy of other effective population-level interventions. The experts believed mass azithromycin reduces childhood mortality (relative risk = 0.83, 95% credible intervals [CrI] = 0.70-1.00). The Bayesian analysis estimated a relative risk of 0.71 (95% CrI = 0.39-0.93). Both estimates suggest that azithromycin may have a true mortality benefit, though of a smaller magnitude than found in the single available trial. Prior information about nonantibiotic, population-level interventions may have informed the expert's opinions. Additional trials are needed to confirm a mortality benefit from mass azithromycin.
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
authors.forename: Craig W
authors.initials: CW
authors.lastname: See
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
authors.forename: Kieran S
authors.initials: KS
authors.lastname: O'Brien
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Stoller
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Gaynor
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
authors.forename: Travis C
authors.initials: TC
authors.lastname: Porco
authors.affiliation: F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California tom.lietman@ucsf.edu.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
mesh_terms: D000284:Administration, Oral; D017954:Africa South of the Sahara / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D001499:Bayes Theorem; D002675:Child, Preschool; D016000:Cluster Analysis; D003967:Diarrhea / Q000188:drug therapy / Q000401:mortality* / Q000517:prevention & control; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy / Q000401:mortality* / Q000517:prevention & control; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000401:mortality* / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014141:Trachoma / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin