By Adamu Yusuf
As global public health leaders, policymakers, researchers and advocates prepare for the 18th World Congress on Public Health in Cape Town, Nigeria’s SARMAAN project has highlighted the importance of delivering evidence-based child-survival interventions at scale.
The Safety and Antimicrobial Resistance of Mass Administration of Azithromycin in Children 1–59 Months in Nigeria (SARMAAN) programme has reached more than 16 million children across 11 participating states in northern Nigeria.
The achievement, according to the programme, demonstrates the potential of combining scientific evidence, government leadership, community engagement, frontline health workers and safety monitoring to improve child-survival outcomes.
The development comes as Nigeria continues to record gradual improvements in child health. Under-five mortality declined from 132 deaths per 1,000 live births recorded in the 2018 Nigeria Demographic and Health Survey to 102 deaths per 1,000 live births in the 2023–24 survey.
However, the figure remains significantly higher than the Sustainable Development Goal target of 25 deaths per 1,000 live births.
Lead Investigator of SARMAAN and Director of Research at the Nigerian Institute of Medical Research (NIMR), Professor Oliver Ezechi, said the project had demonstrated that safety monitoring and antimicrobial-resistance surveillance could be integrated into mass drug administration at scale.
“What the data from SARMAAN shows is that safety monitoring and antimicrobial resistance surveillance can be built directly into a mass drug administration project at scale, not layered on afterward,” he said.
SARMAAN Champion and paediatrician, Dr. Zainab Shinkafi-Bagudu, said the success of the programme depended on effective collaboration among health workers, caregivers, communities and government institutions.
“True equity is when an intervention can reach all children, regardless of where they live,” she said.
In Jigawa State, First Lady and SARMAAN Champion, Hadiza Umar Namadi, stressed the importance of maintaining community trust in sustaining public health interventions.
She said the programme’s achievements went beyond statistics, noting that mothers, caregivers and communities had opened their doors and trusted those delivering the intervention.
Another SARMAAN Champion and paediatrician, Professor Robinson Daniel Wammanda, said the scale of the programme required a well-planned and effectively implemented delivery system.
“What is important about the SARMAAN experience is the use of multiple platforms to successfully reach these children at this scale,” he said.
The programme has also engaged government stakeholders on ways to align its lessons and achievements with broader child-health priorities, with discussions focusing on institutional ownership, integration into existing health systems and sustainable financing.
As SARMAAN moves beyond its current phase, its organisers say the evidence, systems and partnerships developed through the programme could provide a foundation for strengthening sustainable child-survival interventions in Nigeria and other high-burden settings.
The SARMAAN Project is part of the regional REACH (Resiliency through Azithromycin in Children) Network. It uses a government-led, multi-partner approach to implement mass administration of azithromycin, with a focus on scalability, sustainability and health-system strengthening.
Editing by Khadija Kubau
