Azithromycin for infants at risk of poor growth and development: A pooled secondary analysis of two randomized controlled trials.

Background: In 2023, the World Health Organization (WHO) revised its guidelines for management of severe acute malnutrition (SAM). The revised guidelines include a focus on infants at risk of poor growth and development. The guideline identifies evaluation of routine antibiotics for these infants as a priority research area.

Geographic spillover of antimicrobial resistance from mass distribution of azithromycin.

Large-scale, placebo-controlled, cluster-randomized trials in high-mortality settings in several African countries demonstrated a 14-18% reduction in childhood mortality following twice-annual mass drug administration (MDA) of azithromycin among children aged 1-59 months [1-3]. Azithromycin MDA also selects for antimicrobial resistance (AMR), particularly macrolide resistance in treated populations [4-6]. It is unknown whether the genetic selection of AMR from azithromycin MDA could spill over to neighboring untreated populations.

Using Model-Based Geostatistics to Refine Population-Based Estimates of Trachoma Prevalence: Update from a Technical Consultation.

To explore how model-based geostatistics (MBG) could support trachoma elimination efforts, a technical consultation was held on March 4 and 5, 2024 by the Centre for Health Informatics, Computing, and Statistics at Lancaster University, United Kingdom, a WHO Collaborating Centre on Geostatistical Methods for Neglected Tropical Disease Research. The meeting aimed to foster collaboration for sharing insights on using MBG for decision-making; showcase its applications in assessing trachoma elimination status; address challenges, such as setting the probability threshold for elimination and resolving conflicts between survey and MBG evidence; and discuss considerations for integrating MBG into Tropical Data. Participants, including trachoma program managers, experts, academics, donors, and statisticians, reviewed MBG applications, discussed ongoing studies, identified knowledge gaps, and planned future work.

Associations between floor material and E. coli contamination in rural Bangladeshi households.

Background: Soil floors are common in low-income countries and can harbor contamination from fecal waste. Soil/dust ingestion from floors or indirectly via hands, water and food can contribute to children's ingestion of fecal organisms. We assessed if finished (e.

Impact of Pregnancy and the Postpartum Period on Noninfectious Uveitis Flare-Ups.

Purpose: The course of noninfectious uveitis (NIU) in the context of the immunological changes that occur throughout pregnancy and the postpartum period is not well established. This study investigates the effect of pregnancy on the risk of NIU flare-ups and examines how the frequency of flare-ups varies across the trimesters of pregnancy and the postpartum period. These findings may help ophthalmologists identify high-risk periods and improve tailored counseling for patients.

Shingles vaccination in Medicare Part D and commercial enrollees after the inflation reduction act.

The impact of the 2022 United States Inflation Reduction Act policy on the recombinant zoster vaccine uptake in Medicare Part D enrollees remains unclear after cost-sharing was eliminated for vaccines recommended by the Advisory Committee on Immunization Practices. We implemented a difference-in-difference linear model with individuals aged 50 years and older from November 2021 to December 2024 from the Optum Labs Data Warehouse, a de-identified claims database, to compare the uptake in commercial and Medicare Part D enrollees following the policy change. Additionally, out-of-pocket costs were summarized.

Weather, Air Pollution, and Seasonality: Predictors of Pathogen-Associated Conjunctivitis Outbreaks in Kathmandu Valley, Nepal.

Conjunctivitis outbreaks can herald pandemics. However, their relationships with weather and air pollution factors are not well understood. Kathmandu in Nepal has defined wet-dry seasons and lies in a bowl-shaped valley that traps air pollutants with levels many-folds higher than recommended by World Health Organization (WHO).

Time to Progression to Proliferative Diabetic Retinopathy in Patients With Type 2 Diabetes.

Importance: Risk stratification of patients at risk of progression to proliferative diabetic retinopathy (PDR) enables earlier detection and more efficient allocation of health care resources.

Objective: To develop survival models to predict progression to PDR in patients with type 2 diabetes.

Design, Setting, And Participants: This prognostic study used deidentified electronic health record data from the University of California (UC) Health Data Warehouse (UCHDW) from March 1, 2012, to July 3, 2024.

Indirect Benefits of Seasonal Malaria Chemoprevention for Non-Malarial Pediatric Infections and Routine Antibiotic Use in Real-World Programmatic Settings: A Pre-Post Study Using Positive and Negative Controls.

Objective: To assess the benefits of Seasonal Malaria Chemoprevention (SMC), the monthly administration of sulfadoxine-pyrimethamine and amodiaquine during the high malaria season, beyond malaria prevention in real-world program settings.

Methods: We conducted a pre-post comparison of non-malarial diagnoses (pneumonia, diarrhea, acute malnutrition) and antibiotic prescription rates during SMC administration weeks versus a three-week post-intervention period in rural Burkina Faso. Data came from clinic surveillance at 51 health facilities, a population-based census, and National Malaria Control Program data on SMC timing.

Associations between floor material and contamination in rural Bangladeshi households.

Soil floors are common in low-income countries and can harbor contamination from unsafely managed human and animal fecal waste. Soil/dust ingestion directly from floors or indirectly via hands, drinking water and food can significantly contribute to children's ingestion of fecal organisms. We assessed if finished (e.

The Effect of Metagenomic Sequencing on Patient Clinical Outcomes for Intraocular Infections: A Multicenter Randomized Controlled Trial.

Objective: To determine whether the addition of an unbiased test, metagenomic sequencing of intraocular fluid, compared to standard-of-care diagnostics alone, leads to better patient outcomes in presumed infectious intraocular inflammatory eye diseases.

Design: A randomized controlled trial was conducted from May 2022 through February 2024.

Participants: Eligible participants had intraocular inflammation concerning for an infectious etiology, were 18 years or older, and had vision better than no light perception (NLP).

Spillover of Azithromycin Mass Drug Administration and Child Survival: A Secondary Analysis of a Cluster-Randomized Clinical Trial.

Importance: World Health Organization guidelines on azithromycin mass drug administration for child survival target infants aged 1 to 11 months, although prior studies included those aged 1 to 59 months. The AVENIR trial suggested that infants aged 1 to 11 months have lower mortality if children aged 12 to 59 months in the same household are also included.

Objective: To assess the possibility of a spillover effect by examining the association of azithromycin and mortality among children aged 1 to 11 months in subgroups defined by the presence of a child aged 12 to 59 months in the same household.

Exploring Heterogeneity in Treatment Effects: The Impact and Interaction of Asset-Based Wealth and Mass Azithromycin Distribution on Child Mortality.

Objective: To examine how child mortality among children aged 1-59 months varies by asset-based wealth status in rural Burkina Faso and to assess the interaction between mass azithromycin distribution and wealth status on child mortality at both the household and community levels.

Methods: We used data from a cluster-randomized trial and a population census data on household characteristics and assets. A wealth index score for each household, used to classify the population by wealth was generated using principal component analysis.

Characterizing trachoma elimination using serology.

Trachoma is targeted for global elimination as a public health problem by 2030. Measurement of IgG antibodies in children is being considered for surveillance and programmatic decision-making. There are currently no programmatic guidelines based on serology, which represents a generalizable problem in seroepidemiology and disease elimination.

Azithromycin mass drug administration to reduce child mortality in Niger (AVENIR II): a master protocol for a cluster-randomized adaptive platform trial to evaluate community-based health interventions.

Background: Trials have demonstrated that azithromycin mass drug administration (MDA) to children 1-59 months old reduces mortality, but increases antimicrobial resistance (AMR). The World Health Organization recommends that programs include mortality and AMR monitoring. Niger is expanding the azithromycin MDA for child survival program nationwide.

Malaria Parasitemia after Mass Distribution of Azithromycin to Prevent Child Mortality in Burkina Faso: Results from a Cluster Randomized Trial.

The twice-yearly mass distribution of azithromycin to children aged 1-59 months reduces all-cause child mortality. It has been suggested in some studies that mass azithromycin distributions may reduce malaria mortality and parasitemia; however, these studies have been conducted in the absence of seasonal malaria chemoprevention (SMC). Here, we evaluate malaria parasitemia in a cluster randomized trial of azithromycin versus a placebo in Burkina Faso, where SMC was being administered.

Assessing equity in effects of nutritional supplementation for child growth, development, and anemia.

Undernutrition in early childhood causes stunted growth, cognitive delays, and anemia, with effects often magnified among children from the poorest households. Small-quantity lipid-based nutrient supplements (SQ-LNS) are effective in addressing undernutrition and improving child development. As momentum builds to scale up SQ-LNS for children aged 6-24 months in the Global South, a key concern is achieving equity in its distribution and outcomes.

Biomarkers of environmental enteric dysfunction and neurodevelopmental outcomes among children in rural Bangladesh and Kenya: a prospective cohort study.

Background: Environmental enteric dysfunction (EED) may worsen undernutrition, with potential adverse effects on the developmental trajectories of millions of children in low-resource settings.

Objectives: This study aimed to assess associations between EED biomarkers and subsequent child development.

Methods: In a prospective cohort of 2646 children nested within 2 randomized trials in rural Bangladesh (n = 1374) and Kenya (n = 1272), EED was measured by markers of intestinal permeability (fecal alpha-1 antitrypsin; urinary lactulose and mannitol assessed through the dual sugar absorption test), inflammation (fecal myeloperoxidase and neopterin), and repair (fecal regenerating gene 1β).

Social Desirability Bias in a Randomized Controlled Trial That Included Breastfeeding Promotion in Western Kenya.

Background: Breastfeeding promotion is associated with improved measures of breastfeeding practice; however, most studies rely on participant-reported outcomes.

Objectives: This study aimed to evaluate the likelihood of bias in self-reported breastfeeding outcomes.

Methods: We used data from the WASH Benefits randomized controlled trial in Kenya (clinicaltrials.

The role of Seasonal Malaria Chemoprevention in the effect of Azithromycin on Child Mortality: A Secondary Analysis of the CHAT Cluster Randomized Clinical Trial.

Objective: Mass treatment with azithromycin (AZ) and administration of seasonal malaria chemoprevention (SMC) are both effective in reducing mortality among children under 5. However, it is not clear whether the benefit of AZ for mortality varies in the presence of routine SMC administration. The objective of this study was to examine whether the effect of mass AZ distribution on all-cause mortality among children less than 5 years of age varies with SMC administration season or SMC coverage.

Diagnostic Performance of a Handheld Electroretinography Test for Glaucoma.

Purpose: To evaluate the diagnostic performance of a sinusoidal flicker stimulus test at various frequencies using a handheld electroretinography (ERG) device in glaucoma versus control participants.

Design: A cross-sectional study conducted between June 2019 and October 2022 at the University of California, San Francisco.

Participants: Participants with glaucoma were recruited from glaucoma clinics if they had a diagnosis of open-angle glaucoma, as demonstrated by optic nerve damage or reproducible visual field defects.

Costs, Coverage, and Acceptability of Azithromycin Mass Administration to Children 1-11 Versus 1-59 Months Old to Reduce Mortality: A Cluster-Randomized Trial in Niger.

Azithromycin mass drug administration (MDA) for 1- to 59-month-olds reduces child mortality. However, guidelines restrict eligibility to 1- to 11-month-olds because of concerns about antimicrobial resistance. This cluster-randomized implementation trial was conducted in parallel with a larger efficacy trial and compared implementation outcomes between these approaches.

Pathways through which water, sanitation, hygiene, and nutrition interventions reduce antibiotic use in young children: a mediation analysis of a cohort nested within a cluster-randomized trial.

Background: Low-cost, household-level water, sanitation, and hygiene (WASH) and nutrition interventions can reduce pediatric antibiotic use, but the mechanism through which interventions reduce antibiotic use has not been investigated.

Methods: We conducted a causal mediation analysis using data collected between September 2013 and October 2015 from a cohort nested within the WASH Benefits Bangladesh cluster-randomized trial (NCT01590095). Among a subsample of children within the WASH, nutrition, nutrition + WASH, and control arms (N = 1409 children; 267 clusters), we recorded caregiver-reported antibiotic use at ages 14 and 28 months and collected stool at age 14 months.

Maternal experience of intimate partner violence, maternal depression, and parental stress are not associated with child telomere length in Bangladesh.

Shorter telomere length (TL) is associated with an increased risk for developing chronic or age-related diseases in adults. The process of telomere shortening is accelerated in response to stress and is well characterized in adult populations from high-income countries. Prior studies suggest the relationship between stress, shorter TL, and disease risk initiates in early life.