Does mass azithromycin distribution impact child growth and nutrition in Niger? A cluster-randomized trial

Abstract

Background: Antibiotic use on animals demonstrates improved growth regardless of whether or not there is clinical evidence of infectious disease. Antibiotics used for trachoma control may play an unintended benefit of improving child growth.

Methodology: In this sub-study of a larger randomized controlled trial, we assess anthropometry of pre-school children in a community-randomized trial of mass oral azithromycin distributions for trachoma in Niger. We measured height, weight, and mid-upper arm circumference (MUAC) in 12 communities randomized to receive annual mass azithromycin treatment of everyone versus 12 communities randomized to receive biannual mass azithromycin treatments for children, 3 years after the initial mass treatment. We collected measurements in 1,034 children aged 6-60 months of age.

Principal findings: We found no difference in the prevalence of wasting among children in the 12 annually treated communities that received three mass azithromycin distributions compared to the 12 biannually treated communities that received six mass azithromycin distributions (odds ratio = 0.88, 95% confidence interval = 0.53 to 1.49).

Conclusions/significance: We were unable to demonstrate a statistically significant difference in stunting, underweight, and low MUAC of pre-school children in communities randomized to annual mass azithromycin treatment or biannual mass azithromycin treatment. The role of antibiotics on child growth and nutrition remains unclear, but larger studies and longitudinal trials may help determine any association.

Figure 1. Participant flow.

For the PRET study, 235 communities were assessed in the Zinder region of Niger. 72 communities met the inclusion criteria. Of eligible communities, 48 were randomized to the PRET study. A total of 24 communities were enrolled in this substudy, with 12 communities randomized to annual treatment and 12 communities randomized to biannual treatment according to the study design. All 24 communities remained in this substudy. This figure summarizes the mean number of children aged 6–60 months at each time point by study arm. The children for the anthropometry assessment are the number of children (target age) present at month-36.