Research

Tampere University and the Bill and Melinda Gates Foundation are reducing infant mortality in Mali

äitejä ja lapsia malissa
Approximately 35,000 babies in 710 villages in rural Mali will participate in the drug trial.
Tampere University is coordinating a large-scale trial in Mali, West Africa, to determine whether the mass administration of azithromycin antibiotic to asymptomatic children can reduce the high mortality rate of 1-11-month-old babies. The Bill and Melinda Gates Foundation is investing $20 million in a four-year study that starts in November 2019.

Azithromycin is a broad-spectrum antibiotic often used to treat children and adults who suffer from different infections. In countries where the eye disease trachoma occurs, azithromycin has been administered in mass campaigns to the entire population in order to reduce the disease burden.

“One such campaign found that infant mortality decreased in areas where azithromycin mass administration was used. More recent research has shown that countries with high infant mortality rates can under certain circumstances achieve a significant reduction in mortality by targeting the azithromycin campaign specifically to children,” says the principal investigator of the study, Professor of Paediatrics Per Ashorn from the Faculty of Medicine and Health Technology.

In the trial conducted in Mali, the study medicine will be given to infants under the age of one year. Some babies will receive azithromycin at three-month intervals and some twice a year while some will be given a placebo.

“We believe that azithromycin treatment can reduce infant mortality in the area by 15 to 30 per cent,” says Ashorn.
Currently, between six and seven Malian children in one hundred die before their first birthday and every tenth child dies before they are five years old.

“We will also investigate the potential side effects of antibiotic medication. The most serious concern is the possible increase of antibiotic-resistant strains of bacteria, which is why we will closely monitor the development of resistance in the researched area,” Ashorn says.

The study will also analyse the effects of the medication on intestinal microbiota, molecular-level mechanisms whereby the medication could reduce mortality, and the general feasibility of a mass-drug administration campaign in the Malian health care system.

The study will be conducted in 710 villages in rural Mali. Each village is estimated to have approximately 60 infants under the age of one year. Ashorn assumes that of the total 42,000 babies in the villages, roughly 35,000 will participate in the study. The trial will entail one million house calls and 250,000 doses of the medication and placebo.

The Impact of azithromycin MDA on mortality among young children in Mali project is conducted in international co-operation. The study coordinated by Tampere University includes researchers from Mali, United Kingdom and the United States. The Global Health Group at Tampere University was invited as coordinator of the project because of the group’s research accomplishments, expertise on antibiotics, long-term experience from Africa, and wide-ranging co-operation networks.

The Bill and Melinda Gates Foundation is also funding related studies in Niger and Burkina Faso.

Inquiries:
Per Ashorn, per.ashorn@tuni.fi
Professor of Paediatrics
Chief Physician of the Department of Paediatrics at Tampere University Hospital

Ulla Ashorn, ulla.ashorn@tuni.fi
Senior Researcher Fellow

Photograph: Ulla Ashorn