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Peer-reviewedCC BY 4.0PLOS Global Public Health

Mass azithromycin distribution and nutritional status among children aged 1–59 months: A secondary analysis of a cluster randomized trial

  • Mamadou Ouattara1
  • Huiyu Hu2
  • Mamadou Bountogo3
  • Boubacar Coulibaly4
  • Valentin Boudo
  • Guillaume Compaoré
  • Clarisse Dah
  • Elodie Lebas
  • Kieran S. O’Brien
  • Benjamin F. Arnold
  • Thomas M. Lietman
  • Ali Sié
1 more authors
  • Catherine E. Oldenburg
4 affiliations
  1. 1Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
  2. 2Francis I Proctor Foundation, University of California, San Francisco, California, United States of America
  3. 3Department of Ophthalmology, University of California, San Francisco, California, United States of America
  4. 4Department of Epidemiology & Biostatistics, University of California, San Francisco, California, United States of America
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Abstract

Twice yearly distribution of azithromycin has been shown to reduce all-cause child mortality in several contexts. Azithromycin likely reduces mortality via reduction in clinical or subclinical infections. Treating infections may improve child nutritional status to further reduce mortality risk. Here, we used data from a placebo-controlled cluster randomized trial of azithromycin for prevention of child mortality in Burkina Faso to evaluate the effects of twice-yearly azithromycin on mid-upper arm circumference (MUAC) in children aged 1–59 months and weight-for-age Z-score (WAZ) in infants aged 1–11 months. The Child Health with Azithromycin Trial (CHAT) was a 1:1 cluster randomized trial of twice-yearly azithromycin compared to matching placebo for prevention of all-cause mortality in children aged 1–59 months. Measurements were collected every 6 months, including MUAC measurements in all children and weight measurements in infants aged 1–11 months to calculate weight-based dosing. We evaluated MUAC and WAZ at the community level and longitudinally at the individual child level, accounting for the cluster randomized design of the trial. 80,282 children aged 1–59 months, of whom 26,983 were infants aged 1–11 months, in 284 communities were included in analyses. At the community level, we found no evidence of a difference in mean MUAC or WAZ after 36 months or over time. There was no evidence of a difference in change over time in MUAC (P-value for interaction = 0.94) or WAZ (P = 0.18) at the individual level. We found no evidence to support an effect of twice-yearly mass azithromycin distribution on measures of undernutrition in children in this setting in Burkina Faso. Trial registration: ClinicalTrials.gov NCT03676764

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Cite

BibTeXRIS
BibTeX
@article{ouattara2026mass,
  title = {{Mass azithromycin distribution and nutritional status among children aged 1–59 months: A secondary analysis of a cluster randomized trial}},
  author = {Mamadou Ouattara and Huiyu Hu and Mamadou Bountogo and Boubacar Coulibaly and Valentin Boudo and Guillaume Compaoré and Clarisse Dah and Elodie Lebas and Kieran S. O’Brien and Benjamin F. Arnold and Thomas M. Lietman and Ali Sié and Catherine E. Oldenburg},
  journal = {PLOS Global Public Health},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pgph.0007473},
  url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007473},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Mass azithromycin distribution and nutritional status among children aged 1–59 months: A secondary analysis of a cluster randomized trial
AU  - Mamadou Ouattara
AU  - Huiyu Hu
AU  - Mamadou Bountogo
AU  - Boubacar Coulibaly
AU  - Valentin Boudo
AU  - Guillaume Compaoré
AU  - Clarisse Dah
AU  - Elodie Lebas
AU  - Kieran S. O’Brien
AU  - Benjamin F. Arnold
AU  - Thomas M. Lietman
AU  - Ali Sié
AU  - Catherine E. Oldenburg
PY  - 2026
DA  - 2026/10/13
JO  - PLOS Global Public Health
DO  - 10.1371/journal.pgph.0007473
UR  - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007473
AB  - Twice yearly distribution of azithromycin has been shown to reduce all-cause child mortality in several contexts. Azithromycin likely reduces mortality via reduction in clinical or subclinical infections. Treating infections may improve child nutritional status to further reduce mortality risk. Here, we used data from a placebo-controlled cluster randomized trial of azithromycin for prevention of child mortality in Burkina Faso to evaluate the effects of twice-yearly azithromycin on mid-upper arm circumference (MUAC) in children aged 1–59 months and weight-for-age Z-score (WAZ) in infants aged 1–11 months. The Child Health with Azithromycin Trial (CHAT) was a 1:1 cluster randomized trial of twice-yearly azithromycin compared to matching placebo for prevention of all-cause mortality in children aged 1–59 months. Measurements were collected every 6 months, including MUAC measurements in all children and weight measurements in infants aged 1–11 months to calculate weight-based dosing. We evaluated MUAC and WAZ at the community level and longitudinally at the individual child level, accounting for the cluster randomized design of the trial. 80,282 children aged 1–59 months, of whom 26,983 were infants aged 1–11 months, in 284 communities were included in analyses. At the community level, we found no evidence of a difference in mean MUAC or WAZ after 36 months or over time. There was no evidence of a difference in change over time in MUAC (P-value for interaction = 0.94) or WAZ (P = 0.18) at the individual level. We found no evidence to support an effect of twice-yearly mass azithromycin distribution on measures of undernutrition in children in this setting in Burkina Faso. Trial registration: ClinicalTrials.gov NCT03676764
SN  - 2767-3375
ER  -