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Maternal and child health
Is there a prospect for mass drug administration of azithromycin to reduce child mortality in sub-Saharan Africa?
  1. Agbessi Amouzou
  1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Agbessi Amouzou, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD 21205, USA; aamouzo1{at}

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Commentary on: Keenan JD, Bailey RL, West Sk, et al. Azithromycin to reduce childhood mortality in sub-Saharan Africa. N Engl J Med 2018;378:1583–92.


A recent study by Keenan and colleagues found positive effects of mass distribution of azithromycin (MDA) in children aged 1–59 months in reducing mortality rates in three countries in sub-Saharan Africa.1 Ending preventable child death remains an important goal for a sustainable development in low/middle-income countries. Effective strategies for accelerated reduction in child mortality are needed. The MDA for elimination of trachoma provided hints on possible effectiveness of the strategy in reducing child mortality. Keenan and his colleagues designed a community trial to test the strategy within few districts in Malawi, Niger and Tanzania.


The study used a blinded cluster randomised trial with MDA in intervention area and placebo in control area in one district in Malawi, and two districts in Niger and in Tanzania. The primary outcome was pooled mortality rate among children aged 1–59 months across the three countries. A total of 1533 communities were randomised into 767 intervention and 766 control areas. Average cluster size in children aged 1–59 months was higher in Malawi (259 vs …

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  • Contributors AA is the sole author of this manuscript.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.