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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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- 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 the 3 cluster-randomized trials that gave azithromycin twice a year to infants 1 to 11 months old only, the approach the World Health Organization recommended in 2020 (AVENIR's infant arm in Niger, LAKANA in Mali, MIRAMA in Burkina Faso), infant mortality was not detectably lower than with placebo (rate ratio 0.971, 95% CI 0.867 to 1.086; p = 0.370), an interval that rules out a reduction larger than 13.3% and so excludes the 14.1% reduction seen when all children 1 to 59 months were treated; the estimate stayed near 1 with LAKANA's four-times-yearly arm instead (0.948, 0.856 to 1.050), without MIRAMA (0.963, 0.656 to 1.413), and with the 2 individually randomized infant trials added (0.969, 0.881 to 1.066).
- Published, Reproduced: Giving azithromycin individually to every infant at a visit (the CHAT well-infant visit trial and NAITRE, both in Burkina Faso) did not detectably lower infant mortality: the pre-registered random-effects estimate from these 2 trials was uninformative (rate ratio 0.956, 95% CI 0.147 to 6.225), and a common-effect estimate added after registration was 0.963 (0.760 to 1.222).
- 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).