Study on Antibiotics and Child Mortality in Sub-Saharan Africa

Background on Trachoma

A recent study investigated the impact of antibiotics on the death rate of children suffering from infectious diseases, specifically trachoma, in Sub-Saharan Africa. Trachoma, an infectious disease caused by a strain of chlamydia, is responsible for approximately 3% of global blindness. Populations in Sub-Saharan Africa remain at high risk for this disease. The infection leads to rough and swollen eyelids and can also affect animals such as koalas and crocodiles. Trachoma spreads through contact with the eye discharge of infected individuals and by eye-seeking flies. Untreated infections can result in blindness.

Populations at Risk

The populations most affected by trachoma are typically located in impoverished rural areas with inadequate hygiene and limited access to medications. To combat this, over 600 million doses of the antibiotic azithromycin have been distributed in Sub-Saharan Africa. While azithromycin has proven effective against trachoma and other diseases like malaria, pneumonia, and infectious diarrhea, it may also lead to side effects, such as gastrointestinal issues.

Effect of Azithromycin on Childhood Mortality

Previous research in Ethiopia indicated that the mass distribution of azithromycin could decrease childhood mortality related to trachoma. A recent study by American researchers, published in The New England Journal of Medicine, tested this hypothesis. The researchers administered the antibiotic orally in large quantities twice a year to assess its effect on mortality rates in children aged 1 to 59 months.

Study Design and Results

The randomized trial was conducted in 1,533 communities across three regions of Sub-Saharan Africa: Malawi, Niger, and Tanzania. Communities were randomly assigned to receive either azithromycin or a placebo, with treatments distributed biannually.

The initial census identified 190,238 children, with 323,302 individuals monitored throughout the study. In communities that received azithromycin, the annual death rate was 14.6 deaths per 1,000 person-years, compared to 16.5 deaths per 1,000 person-years in the placebo group. Overall, the mortality rate was 13.5% lower in the azithromycin communities, with regional differences noted: a 5.7% decrease in Malawi, 18.1% in Niger, and 3.5% in Tanzania.

Remarkably, the most significant reduction in mortality—24.9%—was observed in infants aged one to five months receiving the antibiotic. Researchers reported that serious side effects were rare and did not differ significantly between groups.

Implications for Public Health Policy

This study demonstrated that large-scale distribution of azithromycin can significantly lower the mortality rate among neonatal and preschool children in Sub-Saharan Africa, particularly in high-risk areas like Niger. However, the implementation of such policies must consider not only the costs and potential side effects but also the risk of developing antibiotic resistance, which could arise from increased use of antibiotics.

References

(1) Keenan JD, Bailey RL, West SK, Arzika AM, Hart J, Weaver J, Kalua K, Mrango Z, Ray KJ, Cook C, Lebas E, O’Brien KS, Emerson PM, Porco TC, Lietman TM; MORDOR Study Group. Azithromycin to Reduce Childhood Mortality in Sub-Saharan Africa. N Engl J Med. 2018 Apr 26;378(17):1583-1592. doi: 10.1056/NEJMoa1715474.
(2) Trachoma. World Health Organization website http://www.afro.who.int/health-topics/trachoma. Accessed June 22, 2018.