Discussion
malaria, diarrheal disease
RESPIRATORY INFECTIONS, SECONDARY, DIARRHEAL DISEASE, MALARIA
In this secondary analysis of the MORDOR Niger cluster randomized trial, we evaluated associations among distance to a primary health center, child mortality, and the effectiveness of azithromycin MDA to reduce child mortality. Mortality among children aged 1 to 59 months increased sharply with distance from a primary health center, with a 5% increase in mortality found for every 1-km increase in distance. The effectiveness of azithromycin MDA to reduce child mortality also increased with distance. No association was demonstrated among those living closest to the primary health care centers, and increasing reductions in mortality were found as distance increased, from a 16% reduction at a distance of 5 km to a 28% reduction at 10 km.A similar association between distance to health care and mortality among children has been identified in several studies in low- and middle-income settings.Azithromycin is a broad-spectrum antibiotic, and its effectiveness in reducing child mortality in this setting likely has numerous mechanisms. Azithromycin MDA has been associated with reductions in morbidity and mortality related to diarrheal disease, respiratory infections, and malaria.Concern about the potential for azithromycin MDA to increase antimicrobial resistance has led to attempts to identify high-risk subgroups for targeting to limit antibiotic distributions.