Figure 1.

Schematic showing potential direct and indirect effects in the 3 treatment arms. Each box represents a community in one of the three treatment arms, stratified by age group (0–5 y on top, 8–12 y on bottom) and infection status at baseline (infected on bottom, not infected on top). Circles represent uninfected children and stars represent infected children. Red symbols receive antibiotic treatment and blue symbols do not. Arrows represent potential indirect effects of treatment through reduced transmission. Children in the mass drug administration (MDA) communities experienced both the direct and indirect effects of antibiotics. In the targeted communities, the infected children experienced both direct and indirect effects of antibiotics, but the uninfected children could only benefit from indirect effects. The delayed-treatment communities received no antibiotics at all. Primary analysis 1 assessed whether the overall effect (ie, the direct and indirect effects at the community level) of targeted treatments was superior to no treatment; secondary analyses (SA) 1A and 1B assessed whether the indirect effects of targeted treatment were superior to no treatment. Primary analysis 2 and SA 2 assessed whether the indirect effects of targeted treatments were noninferior to the overall effect (ie, community-level direct and indirect effects) of mass azithromycin.