Nigeria’s Safety and Antimicrobial Resistance of Mass Administration of Azithromycin in Children 1–59 Months (SARMAAN) programme has reached more than 16 million children across 11 northern states.
The milestone comes as public health leaders, policymakers, researchers and advocates prepare for the 18th World Congress on Public Health, scheduled to hold in Cape Town, South Africa, from September 6 to 9, 2026.
The programme is part of the regional REACH Network and is designed to accelerate efforts to reduce under-five mortality in high-burden states through mass administration of azithromycin.
Speaking ahead of the congress, SARMAAN Lead Investigator and Director of Research at the Nigerian Institute of Medical Research, Professor Oliver Ezechi, said the programme had demonstrated that large-scale drug administration could be combined with rigorous safety monitoring and antimicrobial-resistance surveillance.
Professor Ezechi said safety monitoring was integrated into the project from the outset, rather than being added after implementation.
He noted that the experience showed that scientific rigour and large-scale healthcare delivery could complement each other.
The programme has relied on community mobilisation, engagement with caregivers, trained frontline health workers, state government leadership and continuous safety monitoring to reach children in participating communities.
SARMAAN Champion and paediatrician, Dr Zainab Shinkafi-Bagudu, said achieving equity in child health required systems capable of reaching children irrespective of where they lived.
She stressed the importance of collaboration among health workers, caregivers, communities and government institutions in delivering interventions at scale.
In Jigawa State, First Lady and SARMAAN Champion, Hadiza Umar Namadi, said the success of the programme was also dependent on the trust established between communities and healthcare workers.
She said sustaining that trust required continuous engagement, respect for communities and strong government leadership.
Another SARMAAN Champion and paediatrician, Professor Robinson Daniel Wammanda, said the programme’s success was linked to the use of multiple delivery platforms to reach children across the participating states.
Meanwhile, stakeholders are exploring ways to align the lessons and gains of SARMAAN with broader child-health priorities and existing government planning structures.
Discussions at state level are increasingly focusing on institutional ownership, integration of effective child-survival interventions and sustainable financing beyond individual project cycles.
The programme’s organisers said Nigeria’s under-five mortality rate had 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.
Despite the improvement, Nigeria’s current rate remains significantly above the Sustainable Development Goal target of 25 deaths per 1,000 live births.
The SARMAAN project says its experience demonstrates the importance of combining evidence-based interventions, government leadership, community participation, safety systems and sustainable health delivery platforms in the effort to improve child survival.
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