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Effect of azithromycin on post-discharge growth in Kenyan children
Hannah E Atlas1, Polycarp Mogeni2,3, Riffat Ara Shawon4
1Department of Global Health, University of Washington, Seattle, Washington, USA.
Insights
Azithromycin given at hospital discharge did not improve growth in Kenyan children. This study found no significant differences in height-for-age, weight-for-age, or weight-for-height z-scores after six months.
Area of Science:
- Pediatrics
- Global Health
- Infectious Diseases
Background:
- Children in low- and middle-income countries face high risks of poor growth after hospital discharge for acute illnesses.
- Linear growth faltering is a significant concern in this vulnerable population.
- Understanding interventions to improve post-discharge growth is crucial.
Purpose of the Study:
- To evaluate the impact of azithromycin on post-discharge growth in children in Kenya.
- To determine if azithromycin administered at hospital discharge improves linear growth and weight gain.
- To assess growth outcomes using height-for-age z-score (HAZ), weight-for-age z-score (WAZ), and weight-for-height z-score (WHZ).
Main Methods:
- A double-blind, placebo-controlled randomized trial (Toto Bora Trial, NCT02414399) was conducted.
- The study involved Kenyan children aged 1-59 months receiving a 5-day course of azithromycin or placebo at discharge.
- Growth parameters (HAZ, WAZ, WHZ) were assessed monthly for 6 months post-discharge.
Main Results:
- No statistically significant differences in 6-month post-discharge growth (HAZ, WAZ, WHZ) were observed between azithromycin and placebo groups.
- Stratified analyses by age, nutritional status, and diagnosis also showed no treatment effect.
- While mean HAZ declined in all children, monthly WAZ and WHZ gains were similar across groups, with older children showing greater weight gains.
Conclusions:
- Azithromycin administered at hospital discharge did not result in statistically significant improvements in post-discharge growth among the studied children.
- Further research may be needed to identify effective interventions for improving growth in children after hospitalization in resource-limited settings.
Introduction:
Children discharged following hospitalisation for acute illnesses in low- and middle-income settings are at increased risk of poor growth, particularly linear growth faltering. We aimed to determine the effect of azithromycin administered at hospital discharge on post-discharge growth.
Methods:
Using data from the Toto Bora Trial (NCT02414399), a double-blind, placebo-controlled randomised trial of a 5-day course of azithromycin in Kenyan children aged 1-59 months, we assessed differences in mean monthly change in growth (height-for-age z-score (HAZ), weight-for-height z-score (WHZ), weight-for-age z-score (WAZ)) in the 6 months following hospital discharge.
Results:
This analysis included 1276 children who survived to 6 months post-discharge (640 randomised to azithromycin and 636 to placebo). At discharge, 285 (22%) of children were stunted, 64 (5%) were wasted and 156 (12%) were underweight. There was no difference in 6-month post-discharge growth (mean difference: HAZ, 0.010 (95% CI -0.005 to 0.025); WAZ, 0.003 (95% CI -0.013 to 0.019); WHZ, -0.003 (95% CI -0.025, 0.019)) between treatment groups. Further, no differences in mean monthly change in HAZ, WAZ or WHZ were observed between randomisation groups when stratified by age, nutritional status at discharge or discharge diagnosis. Mean monthly change in HAZ declined among all children in the 6 months post-discharge, irrespective of the treatment group (azithromycin group: -0.038 (95% CI -0.049 to -0.028); placebo group: -0.048 (95% CI -0.059 to -0.038). Mean monthly change in WAZ did not differ significantly by treatment group (0.025 (95% CI 0.013 to 0.037) in the azithromycin group and 0.022 (95% CI 0.011 to 0.033) in placebo (p=0.688)). Monthly WAZ and WHZ gains were similar in both groups, with greater weight gains among older children (6-11, 12-23, 24-59 months).
Conclusion:
We did not observe statistically significant improvements in post-discharge growth among children receiving azithromycin at hospital discharge.
Trial Registration Number:
NCT02414399.
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