Background
Methods
Study design
Sample collection
DNA extraction and PCR
Outcomes
Statistical analysis
Ethical review
Results and discussion
Study participants
Mothers | Azithromycin arm (N = 414) | Placebo arm (N = 415) | |
---|---|---|---|
Characteristics |
n (%) |
n (%) | |
Age | (Median, IQR) | 26.0 (22.0,30.0) | 25.0 (22.0,30.0) |
Ethnicity | Madinka | 161 (40.1) | 187 (45.8) |
Fula | 77 (19.2) | 64 (15.7) | |
Jola | 68 (17.0) | 56 (13.7) | |
Other | 95 (23.7) | 101 (24.8) | |
Season of deliverya
| Rainy | 141 (34.1) | 143 (34.5) |
Mode of delivery | Vaginal | 404 (97.6) | 410 (98.8) |
Caesarean | 10 (2.4) | 5 (1.2) | |
Multiple pregnancy | Yes | 5 (1.2) | 9 (2.2) |
Hours from rupture of membrane to deliveryb
| (Median, IQR) | 0.4 (0.1,1.8) | 0.3 (0.1,1.3) |
Newborns | Azithromycin arm (N = 419) | Placebo arm (N = 424) | |
Characteristics |
n (%) |
n (%) | |
Gender | Female | 207 (49.4) | 198 (46.7) |
Apgar score at birth | 0–6 | 14 (3.3) | 11 (2.6) |
7–10 | 402 (96.6) | 408 (97.4) | |
Weightc
| (Median, IQR) | 3.1 (2.8,3.5) | 3.1 (2.9,3.4) |
Outcomes | |||
Stillbirths | 7 (1.7) | 6 (1.4) | |
Deaths during the follow up period | 8 (1.9) | 8 (1.9) |
Incidence of purulent conjunctivitis
Characteristic | Azithromycin arm (N = 419) n (%) | Placebo arm (N = 424) n (%) | OR (95% CI) |
p-value |
---|---|---|---|---|
Purulent discharge | 18 (4.3) | 22 (5.2) | 0.82 (0.44,1.54) | 0.628 |
Any bacteria detected | 5 (1.2) | 16 (3.8) | 0.31 (0.12,0.82) | 0.025 |
Any gram-positive | 4 (1.0) | 14 (3.3) | 0.28 (0.10,0.82) | 0.029 |
S. aureus
| 4 (1.0) | 12 (2.8) | 0.33 (0.11,0.98) | 0.074 |
S. pneumoniae
| 0 (0.0) | 2 (0.5) | 0.00 (0.00,1.94) | 0.499 |
Any gram-negative | 1 (0.2) | 6 (1.4) | 0.17 (0.00,1.06) | 0.123 |
H. influenzae
| 0 (0.0) | 3 (0.7) | 0.00 (0.00,1.29) | 0.249 |
M. catarrhalis
| 0 (0.0) | 3 (0.7) | 0.00 (0.00,1.29) | 0.249 |
N. gonorrhoeae
| 1 (0.2) | 1 (0.2) | 1.01 (0.00, NA) | 1.00 |
C. trachomatis
| 0 (0.0) | 0 (0.0) | – | – |
Bacterial co-infectiona
| 0 (0.0) | 4 (0.9) | 0.00 (0.00,0.97) | 0.124 |
Aetiology
Risk factors
Characteristic | Both trial arms | Placebo arm only | ||||||
---|---|---|---|---|---|---|---|---|
N |
n (%) | OR (95%CI) |
p-value | N |
n (%) | OR (95%CI) |
p-value | |
>18 h membrane rupture to birth | ||||||||
No | 384 | 2.3 | 1 | 205 | 2.9 | 1 | ||
Yes | 459 | 2.6 | 1.12 (0.47,2.68) | 0.829 | 219 | 4.6 | 1.59 (0.57,4.45) | 0.45 |
Gender | ||||||||
Female | 405 | 1.7 | 1 | 198 | 2.5 | 1 | ||
Male | 438 | 3.2 | 1.88 (0.75,4.70) | 0.191 | 226 | 4.9 | 1.97 (0.67,5.79) | 0.307 |
Apgar score | ||||||||
0 | 12 | 0.0 | NA | 6 | 0.0 | NA | ||
1–6 | 13 | 0.0 | NA | 5 | 0.0 | NA | ||
7–10 | 810 | 2.6 | NA | 1 | 408 | 3.9 | NA | 1 |
Low birth-weight (<2.5 kg) | ||||||||
No | 786 | 2.5 | 1 | 392 | 3.8 | 1 | ||
Yes | 55 | 1.8 | 0.71 (0.09,5.39) | 1 | 30 | 3.3 | 0.87 (0.11,6.79) | 1 |
Bacteria in the vaginal swab prior to intervention | ||||||||
No | 615 | 2.3 | 1 | 302 | 3.3 | 1 | ||
Yes | 228 | 3.1 | 1.36 (0.54,3.41) | 0.468 | 122 | 4.9 | 1.51 (0.54,4.25) | 0.412 |
Season | ||||||||
Dry | 557 | 2.0 | 1 | 280 | 2.9 | 1 | ||
Wet | 286 | 3.5 | 1.80 (0.75,4.29) | 0.242 | 144 | 5.6 | 2.00 (0.73,5.44) | 0.184 |
Tetracycline at birth | ||||||||
No | 99 | 3.0 | 1 | 47 | 6.4 | 1 | ||
Yes | 743 | 2.4 | 0.79 (0.23,2.75) | 0.728 | 377 | 3.4 | 0.52 (0.14,1.91) | 0.404 |
Mothers’ years of schooling | ||||||||
< 1 year | 424 | 2.6 | 1 | 210 | 3.8 | 1 | ||
1+ years | 398 | 2.5 | 0.97 (0.41,2.30) | 1 | 203 | 3.9 | 1.04 (0.38,2.81) | 1 |
Ethnicity | ||||||||
Madinka | 352 | 2.3 | 1 | 189 | 3.7 | 1 | 0.691 | |
Wollof | 94 | 1.1 | 0.46 (0.06,3.74) | 47 | 2.1 | 0.57 (0.07,4.71) | 0.691 | |
Jola | 127 | 5.5 | 2.51 (0.89,7.06) | 59 | 6.8 | 1.89 (0.53,6.70) | 0.691 | |
Fula | 144 | 2.8 | 1.23 (0.36,4.15) | 66 | 4.5 | 1.24 (0.31,4.93) | 0.691 | |
Other | 106 | 0.9 | 0.41 (0.05,3.31) | 0.23 | 56 | 1.8 | 0.47(0.06,3.93) | 0.691 |