Promising reductions in childhood mortality reported in a trial of mass drug administration (MDA) of azithromycin (AZM) raised the question of where such an intervention could have the greatest impact if rolled out more widely. To that end, the Foundation engaged START to complete two objectives:
- Conduct a landscape analysis of chemoprevention intervention programs already being implemented to understand potential opportunities and lessons learned
- Map the projected roll-out and timelines for interventions to provide some guidance on the question of how long the MDA of AZM strategy would be useful and where
For the first objective, the START team compiled information regarding the burden of disease for selected conditions; programmatic policies and implementation data, and barriers and successes related to existing preventive programs. The team then used maps to visualize the overlap between childhood mortality, the burden of selected diseases, and intervention coverage.
To complete the second objective, the START team assessed two broad considerations: the opportunity to reduce mortality and the feasibility of implementing such a program, creating Opportunity and Feasibility Indices, respectively. The team only focused on countries with high childhood mortality or morbidity from diarrhea and pneumonia. A Country Ranking Index combined key variables from the previous two Indices and applied a scoring system to identify high-priority countries.
The final report summarized common barriers and success factors found in MDA programs and demonstrated how the three Indices could help identify where an AZM intervention could have the greatest impact.