{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Department of Global Health, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Hannah E Atlas"
    },
    {
      "affiliations": [
        "Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya",
        "Global Health, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Polycarp Mogeni"
    },
    {
      "affiliations": [
        "Department of Epidemiology, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Riffat Ara Shawon"
    },
    {
      "affiliations": [
        "Department of Global Health, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Kirkby D Tickell"
    },
    {
      "affiliations": [
        "Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya"
      ],
      "name": "Lucy Bunyige"
    },
    {
      "affiliations": [
        "Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya"
      ],
      "name": "Irene Monchari"
    },
    {
      "affiliations": [
        "Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya"
      ],
      "name": "Susan Oongo"
    },
    {
      "affiliations": [
        "University of Washington, Seattle, Washington, USA"
      ],
      "name": "Mame M Diakhate"
    },
    {
      "affiliations": [
        "Division of Poverty, Health, and Nutrition, International Food Policy Research Institute, Washington, District of Columbia, USA"
      ],
      "name": "Rebecca L Brander"
    },
    {
      "affiliations": [
        "Homa Bay Teaching and Referral Hospital, Homa Bay, Kenya"
      ],
      "name": "Meshack Liru"
    },
    {
      "affiliations": [
        "Kisii Teaching and Referral Hospital, Kisii, Kenya"
      ],
      "name": "George Bogonko"
    },
    {
      "affiliations": [
        "Paediatrics and Child Health, University of Nairobi College of Health Sciences, Nairobi, Kenya"
      ],
      "name": "Ruth Nduati"
    },
    {
      "affiliations": [
        "Departments of Biostatistics and Global Health, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Barbra A Richardson"
    },
    {
      "affiliations": [
        "Departments of Global Health, Epidemiology, Medicine, and Pediatrics, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Grace John-Stewart"
    },
    {
      "affiliations": [
        "Department of Global Health, University of Washington, Seattle, Washington, USA",
        "Department of International Health, Johns Hopkins, Baltimore, Maryland, USA"
      ],
      "name": "Judd L Walson"
    },
    {
      "affiliations": [
        "Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya"
      ],
      "name": "Benson O Singa"
    },
    {
      "affiliations": [
        "Department of Global Health, University of Washington, Seattle, Washington, USA",
        "Department of Epidemiology, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Patricia B Pavlinac"
    },
    {
      "affiliations": [
        "Department of Global Health, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Christine J McGrath"
    }
  ],
  "title": "Effect of azithromycin on post-discharge growth in Kenyan children",
  "uid": "6aecc9d7-0e39-56a7-972a-f4eb1d8d7f02"
}