Under-five mortality (U5MR) remains a significant global health challenge, particularly in low- and middle-income countries. Nigeria is one of the five sub-Saharan African countries with the highest under-five mortality rate, at 115 deaths per 1,000 live births, primarily due to infectious diseases. The government and multilateral agencies have implemented several measures to reduce these figures, addressing common causes of childhood illnesses and death.

Despite interventions such as the polio program and seasonal malaria chemoprevention (SMC), high childhood morbidity and mortality indices persist, threatening the attainment of Sustainable Development Goal 3 (SDG 3). Funded by the Bill and Melinda Gates Foundation (BMGF), the Safety and Antimicrobial Resistance of Mass Administration of Azithromycin in Children 1-11 Months in Nigeria (SARMAAN I) was initiated by the Nigerian government, in collaboration with implementing partners. The pilot study was conducted in Jigawa, Kebbi, Kano, Sokoto, Akwa Ibom, and Abia states.

Following the World Health Organization’s guidelines and findings from the AVENIR study in Niger, the Mass Drug Administration of Azithromycin (MDA AZM) was scaled up to children 1-59 months in 11 states with high infant and under-five mortality rates between 2024 and 2027, starting with Sokoto state. SARMAAN II integrates into existing child survival interventions, including the SMC, Neglected Tropical Diseases (NTD), and polio platforms, enhancing cost-effectiveness and program strength.

On April 20, 2024, SARMAAN II was launched in Sokoto state, attended by the Executive Secretary, representatives from the deputy governor, state Ministry of Health (SMoH), funder (BMGF), and implementing partners (NIMR, SightSavers, eHA, and SCIDaR). The four-day implementation saw azithromycin distributed to children 1-59 months across the 23 LGAs of the state. Integrated with the polio program, the Community Drug Distributors (CDDs) administered azithromycin alongside the polio vaccine, ensuring a robust integration model and strengthening the polio program.

The success of SARMAAN II in reducing infant and under-five mortality highlights the power of medical innovation and global health collaboration. Ongoing research, community engagement, and sustainable healthcare practices are essential to ensure the benefits of azithromycin reach those most in need, paving the way for healthier futures for children worldwide.


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