Impact of latrine construction on mortality in Ethiopia: A cluster-randomized trial

Mass oral azithromycin distributions and latrine construction are used in trachoma programs to reduce the prevalence of the Chlamydia trachomatis that causes the disease. These interventions may have other benefits. Here, we monitor mortality in a large, cluster-randomized trial in which all communities received oral azithromycin and half of communities were randomized to receive household latrines

A single oral mass azithromycin treatment was offered to all individuals in 24 Ethiopian communities following a baseline census. Communities were then randomized to either intensive latrine promotion and construction, or to no latrine intervention. A follow-up census was performed two years later, and an abbreviated verbal autopsy performed for all deaths. We used logistic regression to predict age-specific mortality, including community level latrinization and individual azithromycin treatment as predictors, clustering by randomization unit and household. Individuals in communities randomized to latrine construction had 1.10-fold the odds of mortality (95% CI 0.85-1.42) as those randomized to no latrine intervention. Azithromycin treatment was associated with a reduction in mortality risk, with the degree of reduction dependent on age group: OR 0.23 (95% CI 0.12-0.45) in children ages 1-5 years, 0.42 (95% CI 0.12-1.43) in children ages 6-10 years, and 0.57 (95% CI 0.42-0.78) in individuals older than 10 years. In this study, latrine construction did not reduce all-cause mortality but did reduce mortality in those below ten years of age. Children who received azithromycin had significantly lower mortality than those in the same household who did not receive azithromycin.