A5006338001- Child Nutrition and Water Access
- Global Maternal and Child Health
- Pneumonia and Respiratory Infections
- Reproductive tract infections research
- Tuberculosis Research and Epidemiology
- Gut microbiota and health
- Poverty, Education, and Child Welfare
- Child and Adolescent Health
- Pharmaceutical studies and practices
- Cervical Cancer and HPV Research
- Syphilis Diagnosis and Treatment
- Influenza Virus Research Studies
- Parasites and Host Interactions
- Vaccine Coverage and Hesitancy
- Food Security and Health in Diverse Populations
- Viral gastroenteritis research and epidemiology
- Birth, Development, and Health
- Respiratory viral infections research
- Parasitic Infections and Diagnostics
- Clostridium difficile and Clostridium perfringens research
- Antibiotic Resistance in Bacteria
- Epigenetics and DNA Methylation
- Vibrio bacteria research studies
- Malaria Research and Control
- Urinary Tract Infections Management
Centre de Recherche Médicale et Sanitaire
2021-2025
United Nations Children's Fund Niger
2017-2025
National Hospital Niamey
2018-2024
Direction de la Météorologie Nationale du Niger
2021
The Carter Center
2020
Carter Center
2019
We hypothesized that mass distribution of a broad-spectrum antibiotic agent to preschool children would reduce mortality in areas sub-Saharan Africa are currently far from meeting the Sustainable Development Goals United Nations.
Mass distribution of azithromycin to preschool children twice yearly for 2 years has been shown reduce childhood mortality in sub-Saharan Africa but at the cost amplifying macrolide resistance. The effects on gut resistome, a reservoir antimicrobial resistance genes body, twice-yearly administration longer period are unclear.
Trial in NigerTo the Editor: Mass administration of azithromycin reduced childhood mortality trials MORDOR (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) I 1,2 and II (conducted by Keenan et al., published this issue Journal 3 ).However, antibiotic resistance remains a major concern, did not include assessments morbidity.We randomly selected 3371 children aged 1 to 59 months from same pool 30 Nigerien communities involved (Fig. S1 Supplementary Appendix, available...
The MORDOR I trial (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) showed that in Niger, mass administration of azithromycin twice a year for 2 years resulted 18% lower postneonatal childhood mortality than placebo. Whether this benefit could increase with each or wane owing to antibiotic resistance was unknown.In the Niger component trial, we randomly assigned 594 communities four twice-yearly distributions either placebo children 1 59 months age. In II, all these...
Antibiotic exposure can alter the gut microbiome. We evaluate effects of azithromycin on microbiome diversity children from an antibiotic-naive community in Niger. A population-based sample 80 aged 1–60 months Dosso region Niger was randomized to receive a single dose either oral or placebo. Fecal samples were collected immediately before treatment and 5 days after for 16S rRNA gene sequencing. The prespecified outcome α-diversity (inverse Simpson's index), with secondary outcomes β γ...
Burkina Faso has a seasonal malnutrition pattern, with higher prevalence during the rainy season when crop yields are low. We investigated association between dietary diversity and nutritional status among children aged 6-59 mo low yield in rural to assess role of lean on childhood status.Caregivers reported past 7 d, consisting 11 food groups, summed into scale. Anthropometric measurements were taken from all children. Height-for-age (HAZ), weight-for-height (WHZ) weight-for-age (WAZ)...
BackgroundTwice-yearly mass distribution of azithromycin to children is a promising intervention reduce childhood mortality in sub-Saharan Africa. The World Health Organization recommended restricting infants 1 11 months age mitigate antimicrobial resistance, although this more limited treatment had not yet been tested.MethodsWe randomly assigned rural communities Niger four twice-yearly distributions for 59 (child group), and placebo 12 (infant or age. Census workers who were aware the...
Community-level interventions in cluster randomized controlled trials may alter the gut microbiome of individuals. The current method estimating community diversities uses data obtained from multiple individual's specimens. Here we propose randomly pooling a number samples same into one sample before sequencing to estimate community-level diversity. We design and analyze an experiment compare diversity (gamma-diversity) estimates derived 16S rRNA gene 1) individually sequenced specimens vs....
The Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) trial found that biannual mass distribution of azithromycin to children younger than 5 years in Niger reduced the primary outcome all-cause mortality by 18%. We aimed determine causes among deceased using verbal autopsy.In this 2-year cluster-randomised controlled trial, 594 community clusters were randomly allocated (1:1 ratio) receive distributions either oral (approximately 20 mg per kg bodyweight) or...
Trachoma, caused by ocular Chlamydia trachomatis infection, is targeted for global elimination as a public health problem 2030. To provide evidence use of antibodies to monitor C. transmission, we collated IgG responses Pgp3 antigen, PCR positivity, and clinical observations from 19,811 children aged 1-9 years in 14 populations. We demonstrate that age-seroprevalence curves consistently shift along gradient transmission intensity: rising steeply populations with high levels infection active...
Background Mass azithromycin distributions have been shown to reduce mortality in preschool children, although the factors mediating this reduction are not clear. This study was performed determine whether mass distribution of azithromycin, which has modest antimalarial activity, reduces community burden malaria. Methods and findings In a cluster-randomized trial conducted from 23 November 2014 until 31 July 2017, 30 rural communities Niger were randomized 2 years biannual either (20 mg/kg...
Background Randomized controlled trials found that twice-yearly mass azithromycin administration (MDA) reduces childhood mortality, presumably by reducing infection burden. World Health Organization (WHO) issued conditional guidelines for in high-mortality settings sub-Saharan Africa given concerns antibiotic resistance. While prolonged MDA has been shown to increase resistance small randomized trials, the objective of this study was determine if macrolide and non-macrolide gut increases...
Introduction Biannual (ie, every 6 months) mass drug administration of azithromycin has reduced childhood mortality in Niger, but its effects on specific respiratory pathogens are not fully elucidated. Methods Across 2 years the Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) study we evaluated 1468 nasopharyngeal swabs from children who presented for care with symptoms. Swabs were tested by quantitative PCR using a customised TaqMan Array Card that included...
Malnutrition is a risk factor for child mortality, with around 45% of deaths in children under 5 globally linked to malnutrition. Seasonality malnutrition has important implications the timing health programme activities, but evidence mixed on nature such patterns. Moreover, bulk existing focused wasting and stunting 6-59 months, despite increasing that younger also face high risk, underweight alone an predictor mortality. This study used data from cluster-randomised AVENIR trial which...
Objective Azithromycin has been shown to reduce all-cause child mortality. This subgroup analysis investigates azithromycin’s mortality impact by underweight status using Azithromycine pour la Vie des Enfants au Niger: Implementation et Recherche (AVENIR) trial data. Design The AVENIR randomised communities into three arms: azithromycin for children aged 1–59 months, infants 1–11 months or placebo. Weight-for-age z-score was used categorise subgroups of either moderate severe not and not....
Azithromycin mass drug administration (MDA) for 1- to 59-month-olds reduces child mortality. However, guidelines restrict eligibility 11-month-olds because of concerns about antimicrobial resistance. This cluster-randomized implementation trial was conducted in parallel with a larger efficacy and compared outcomes between these approaches. Rural communities Niger were randomly assigned receive biannual azithromycin MDA either or over 1 year. The primary outcome the community-level cost per...
Mass azithromycin distribution reduces under-5 child mortality. Trachoma control programs currently treat infants aged 6 months and older. Here, we report findings from an infant adverse event survey in 1-5 month olds who received as part of a large community-randomized trial Niger.Active surveillance at the time treatment was conducted 30 randomly selected communities within cluster randomized biannual mass compared to placebo assess potential impact on We events reported after among...
The risk of antibiotic resistance is complicated by the potential for spillover effects from one treated population to another. Azithromycin mass drug administration programs report higher rates among treatment arms in targeted groups. This study aims understand non-target groups these programs.
Abstract Background Mass distributions of oral azithromycin have long been used to eliminate trachoma, and they are now being proposed reduce childhood mortality. The observed benefit appears be augmented with each additional treatment, suggesting a possible community-level effect. Here, we assess whether 2 biannual mass treatments preschool children affect the community’s gut microbiome at 6 months after last distribution. Methods In this cluster-randomized controlled trial, aged 1–60 in...
In a large community-randomized trial, biannual azithromycin distributions significantly reduced postneonatal childhood mortality in sub-Saharan African sites. Here, we present prespecified secondary analysis showing that much of the protective effect was first 3 months postdistribution. Distributing more frequently than biannually could be considered if logistically feasible. Clinical Trials Registration. NCT02047981.
We examined whether baseline mortality risk, as a function of child age and site, modified the azithromycin mortality-reduction effect in Macrolide Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) clinical trial. used Cox proportional hazards model with an interaction term. Three models were representing three sources for baseline-risk covariate: two using external to MORDOR third leveraging data within MORDOR. All provided moderate evidence becoming stronger increasing (...
We evaluated the potential antiviral effects of azithromycin on nasopharyngeal virome Nigerien children who had received multiple rounds mass drug administration. found that respiratory burden non-severe acute syndrome coronaviruses was decreased with distributions. Clinical Trials Registration. NCT02047981.
Abstract The MORDOR trial in Niger, Malawi, and Tanzania found that biannual mass distribution of azithromycin to children younger than 5 years led a 13.5% reduction all-cause mortality (NCT02048007). To help elucidate the mechanism for reduction, we report IgG responses 11 malaria, bacterial, protozoan pathogens using multiplex bead assay pre-specified substudy 30 communities rural Niger placebo-controlled over three-year period ( n = 5642 blood specimens, 3814 ages 1–59 months). Mass...