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wilson interval - TitleWords in its title
title:mandelbrot - SummaryWords in its Summary, the paper’s abstract
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published:2026-10-01..2026-10-15 - ImportanceIts importance score, such as 70 or more
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cites:doi:10.1214/ss/1009213286 - IsRetracted, a correction, or scored
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- Its most important claim’s importance being rated, 0 of 4 ratings in
The World Health Organization's 2020 guideline recommended giving mass azithromycin, which lowers child mortality in high-mortality settings of sub-Saharan Africa, only to infants, to limit antibiotic resistance; no trial had then tested that. Under a pre-registered plan we pooled every randomized trial by whom it treated. Treating all children under five lowered their mortality by 14.1% (CI 7.4% to 20.3%), consistently across trials. In the three trials that treated only infants, infant mortality was not detectably lower (rate ratio 0.971, CI 0.867 to 1.086), an interval that excludes the effect of treating all children. Infants had lower mortality when all children were treated, though a between-trial comparison of the two strategies fell short of significance, and giving azithromycin to individual infants at clinic visits showed no effect. The infant-only approach has not lowered mortality in any trial that tested it; treating all children under five has.
- Published, Reproduced: In 5 placebo-controlled comparisons from 3 cluster-randomized trials (MORDOR in Niger, Malawi and Tanzania; AVENIR in Niger; CHAT in Burkina Faso), twice-yearly mass azithromycin to every child 1 to 59 months old lowered mortality among children 1 to 59 months by 14.1% (rate ratio 0.859, 95% CI 0.797 to 0.926; Holm-corrected p = 0.015; I² = 0%), and the reduction held with a common-effect model (0.859, 0.813 to 0.908) and with any one comparison left out (largest p = 0.044).
- Published, Reproduced: Infant mortality was lower when all children 1 to 59 months were treated (rate ratio 0.823, 95% CI 0.707 to 0.958; 3 comparisons) than when only infants were (0.971), but the pre-registered meta-regression comparing the two strategies across trials did not establish a difference (ratio of rate ratios 1.187, 95% CI 0.974 to 1.447; p = 0.074; Holm-corrected p = 0.148); AVENIR's within-trial contrast of its all-children arm against its infant arm, estimated after registration from the two arms' printed mortality rates, was 0.830 (0.717 to 0.959).
- Published, Reproduced: Across the 8 mass-distribution comparisons against placebo, mortality fell more where the control arm's mortality rate was higher: the log rate ratio changed by -0.078 per unit of the log control rate (95% CI -0.144 to -0.013; p = 0.027), allowing for strategy, in a pre-specified descriptive analysis resting on few comparisons, one of whose rates comes from birth histories.