SARMAAN reaches 16m children in 11 northern states

By Chioma Obinna

More than 16 million children aged 1–59 months in 11 northern states have been reached through Nigeria’s large-scale Safety and Antimicrobial Resistance of Mass Administration of Azithromycin in Children, SARMAAN, intervention, as global health leaders turn attention to strategies for reducing childhood deaths.

The programme, which combines mass administration of azithromycin with safety monitoring and antimicrobial resistance surveillance, is being highlighted at the 18th World Congress on Public Health in Cape Town, South Africa, as an example of how scientific evidence can be translated into large-scale public health action.

The World Congress, holding from September 6 to 9, 2026, is focusing on equity, inclusion, sustainability and the translation of evidence into effective public health interventions.

The SARMAAN experience comes against the backdrop of Nigeria’s continuing child-survival challenge.
Although under-five mortality has 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, the figure remains more than four times the Sustainable Development Goal target of 25 deaths per 1,000 live births.

Health experts say further reductions will require interventions capable of reaching children in underserved and hard-to-reach communities.

Lead Investigator of SARMAAN and Director of Research at the Nigerian Institute of Medical Research, NIMR, Prof. Oliver Ezechi, said the programme had demonstrated that scientific rigour could be incorporated 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.
“The experience demonstrates that rigorous science and large-scale delivery do not have to compete; they can strengthen one another,” Ezechi said.

Beyond the number of children reached, organisers said community mobilisation and trust had been central to the programme’s implementation.

Caregiver engagement, training of frontline health workers, state government leadership and sustained interaction with communities have helped drive acceptance of the intervention.

SARMAAN Champion, paediatrician and global health leader, Dr Zainab Shinkafi-Bagudu, said equity must remain central to child-survival programmes.

“Reaching children 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.
In Jigawa State, First Lady and SARMAAN Champion, Hadiza Umar Namadi, said sustaining community confidence would be critical to the programme’s long-term success.

“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.

“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,” she said.

The programme also incorporates supervised drug administration, training of personnel, safety monitoring and pharmacovigilance, while antimicrobial resistance surveillance is used to monitor the potential consequences of repeated mass administration of antibiotics.

According to paediatrician and SARMAAN Champion, Prof. Robinson Daniel Wammanda, the programme’s scale was made possible by the use of multiple delivery platforms.

“What is important about the SARMAAN experience is the use of multiple platforms to successfully reach these children at this scale,” he said.

SARMAAN is part of the regional REACH, Resiliency through Azithromycin in Children, Network and is designed to support efforts to reduce under-five mortality in high-burden states.

The government-led, multi-partner initiative combines mass administration of azithromycin with systems for monitoring safety and antimicrobial resistance.

As the programme moves beyond its current phase, attention is shifting towards sustainability, institutional ownership and the integration of lessons from the intervention into broader child-health planning.

Discussions at state level are also focusing on how interventions that demonstrate impact can move beyond project cycles towards stronger government ownership, appropriate integration and sustainable financing.