Table 3 Verbal autopsy data on infections in MDA of azithromycin to reduce childhood mortality studies

TANA

No statistically significant difference in cause of death in children aged 1‒9 was seen between the treated and untreated groups through verbal autopsy of 55 children with documented cause of death [5]

Two additional clusters in the TANA study (not reported in original study)

Treatment was associated with a 65% reduction in all-cause mortality and 80% reduction in infectious mortality (malaria, respiratory infection, diarrhea) in children 1‒5 years of age [25]

Azithromycin or placebo added to sulfadoxine-pyrimethamine plus amodiaquine during malaria-transmission season in Burkina Faso and Mali

No difference in mortality was seen between arms, but certain infections occurred with lower frequency in the azithromycin arm: gastrointestinal infections (15% lower), upper respiratory tract infections (15% lower), and nonmalarial febrile illnesses (20% lower) [26]

Random sample of 250 verbal autopsies from each site in MORDOR I

41% of deaths were due to malaria, 18% were due to diarrhea, and 12% were due to pneumonia. Causes of death differed significantly by site, with more deaths attributed to malaria in Niger and more to pneumonia in Tanzania [8]

Full verbal autopsies from Niger in MORDOR I

In the treatment group, 27.9% of deaths were due to malaria, 16.1% were due to pneumonia, and 14.9% were due to diarrhea. Similar numbers were seen in the control group

Mortality in communities that received azithromycin was about 20% lower for malaria and pneumonia, and 30% lower for dysentery and meningitis

The distribution of causes of death between the two groups did not differ significantly [32]

MORDOR I verbal autopsies in Malawi

Using two automated programs to conduct verbal autopsies, fewer HIV/AIDS deaths (30% less), pneumonia deaths (20‒40% less), and diarrheal deaths (30% less) were seen in the MDA-azithromycin arm compared to placebo [33, 86]

MORDOR I sub-study in Malawi*

Malaria parasitemia and gametocytemia did not change significantly between treatment and placebo groups at 12 and 24 months. Age and parasitemia were positively associated, suggesting that benefits may not be due to malaria [87]

Pooled data from TANA, PRET, and MORDOR I*

No convincing evidence that the baseline mortality rate modified the effect of azithromycin on mortality, suggesting that reduced infections may not have driven reduced mortality [88, 89]