UCSF

Seasonal malaria chemoprevention (SMC) and mass azithromycin (AZ) distribution are two interventions shown to reduce child mortality in high-burden settings. While SMC is intended to prevent malaria through monthly administration of sulfadoxine-pyrimethamine and amodiaquine during the rainy season, it is unclear whether its benefit extends to non-malarial infections and overall child health. Additionally, although AZ has been effective in reducing child mortality, its effectiveness in the context of concurrent SMC use and the heterogeneity of its effects based on factors affecting access to treatment remains unclear.The objective of this dissertation is to evaluate how mass distribution of AZ and SMC can be optimized to reduce infections and mortality among children under five in sub-Saharan Africa, with the goal of guiding mass drug administration program implementation. This research combines national program records, clinic surveillance, and clinical trial data from 341 communities in Burkina Faso. Chapter 1 explores changes in non-malarial infections and antibiotic prescriptions following SMC to understand its indirect benefits and broader implications for reducing infections in real-world programmatic settings, including how its implementation may influence other interventions. Chapter 2 assesses the impact of concurrent administration of azithromycin and SMC on treatment outcomes, and whether the effect of AZ on all-cause child mortality varies by SMC season and coverage. Chapter 3 examines the presence of a wealth gradient in child mortality and investigates heterogeneity in AZ treatment effects in relation to wealth-related health disparities at both the household and community levels. With SMC being part of routine program delivery and mass distribution of azithromycin continuing to expand across sub-Saharan Africa, findings from this work provide insights into the broader impacts of these interventions and help offer guidance on optimizing their timing, targeting, and integration into health systems.