CHUKS OKOH
Sixteen million children across 11 participating states in northern Nigeria have been reached through the Safety and Antimicrobial Resistance of Mass Administration of Azithromycin in Children 1–59 Months in Nigeria (SARMAAN) programme.
This major milestone demonstrates what becomes possible when evidence, government leadership, community engagement, frontline delivery, and rigorous safety monitoring work together around a shared child-survival objective.
This milestone is more apparent as Nigeria’s own health indicators show slow but real progress: under-five mortality has fallen from 132 to 102 deaths per 1,000 live births between the 2018 Nigeria Demographic and Health Survey and the 2023–24 survey.
This progress can be directly attributed to improvements in immunization coverage, exclusive breastfeeding, antenatal care attendance, skilled birth attendance, and treatment-seeking for childhood illness. At 102 deaths per 1,000 live births, Nigeria still remains more than four times above the Sustainable Development Goal target of 25 per 1,000 live births, underscoring why delivery models capable of working at scale, like SARMAAN’s, are drawing close attention.
Reaching millions of young lives is an important achievement. Doing so while maintaining systems for safety monitoring, data collection, supervision, and scientific evaluation provides a deeper contribution to the evidence needed to inform future child-survival policy and practice.
For Professor Oliver Ezechi, Lead Investigator of SARMAAN and Director of Research at the Nigerian Institute of Medical Research (NIMR), this combination of implementation and evidence is central to the project’s value. “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 noted. “The experience demonstrates that rigorous science and large-scale delivery do not have to compete; they can strengthen one another.”
The project has been largely successful through a combination of efforts to reach young boys and girls where they live, reliant on caregivers having sufficient information and confidence to allow trained personnel into their communities and homes.
Pediatrician and SARMAAN Champion Dr. Zainab Shinkafi-Bagudu emphasized that each child’s health outcome is determined by how effectively their needs are met by the systems surrounding and supporting them. “Reaching young people at this scale requires health workers, caregivers, communities, and government systems to work together. True equity is when an intervention can reach all children, regardless of where they live,” she said.
SARMAAN implementation has relied heavily on community engagement, mobilisation, and frontline delivery alongside state leadership and coordination. Repeated rounds of implementation have reinforced an important lesson: communities are not simply recipients of public health interventions; they are partners that jointly decide the fate of these interventions in their localities.
In Jigawa State, First Lady and SARMAAN Champion Her Excellency Hadiza Umar Namadi reflected on the importance of that relationship. “The numbers are important, but behind them are mothers, caregivers, and communities who have opened their doors and placed their trust in the people delivering this intervention,” she noted. “Sustaining that trust requires continuous engagement, respect for communities, and strong government leadership. That is how public health programmes become part of the communities they are designed to serve.”
From supervised administration and personnel training to safety monitoring, pharmacovigilance, and mechanisms for responding to concerns, the SARMAAN experience reinforces the principle that scale and safety must advance together.
Pediatrician and SARMAAN Champion Professor Robinson Daniel Wammanda stressed that when an intervention reaches young populations on this level, the delivery platform must be carefully designed. “What is important about the SARMAAN experience is the use of multiple platforms to successfully reach populations at this scale,” he said.
