Last Updated: 09/04/2026
Safety and antimicrobial resistance of mass administration of azithromycin in children in Nigeria (SARMAAN II)
Objectives
- Evaluate the coverage, equity and impact of MDA-AZM on child health outcomes.
- Explore and understand the implementation processes, challenges and successes of MDA-AZM co-administration.
- Co-design context-specific implementation strategies and deliver MDA-AZM through integration with polio, NTD and SMC campaigns.
- Increase MDA-AZM coverage in five northern states reaching approximately nine million children aged 1–59 months old each year.
Nigeria has made significant strides in reducing child mortality, from 126 to 105 deaths per 1,000 live births (a 17 percent decrease) between 2015 and 2023.[1] However, preventable childhood illnesses, including malaria, pneumonia and diarrhoea, still pose a considerable threat to child health. Nigeria accounted for 24 percent of malaria cases and 30 percent of malaria deaths globally in 2024.[2] Mass drug administration of the antibiotic medicine azithromycin (MDA-AZM) has the potential to decrease the incidence of all three illnesses and set Nigeria back on track to meet targets. The World Health Organization (WHO) recommends MDA-AZM for children aged 1–11 months in areas of sub-Saharan Africa with high infant mortality rates.[3] Implementation requires continuous monitoring for adverse effects and resistance, and strengthening of other child survival interventions.[3]
The Nigeria Institute for Medical Research (NIMR), in partnership with Malaria Consortium and other partners, conducted the Safety and Antimicrobial Resistance of Mass Administration of Azithromycin in Children (SARMAAN I) study between 2021 and 2023 to evaluate the risks and benefits of MDA-AZM in children aged 1–11 months. SARMAAN I provided evidence on the operational feasibility, acceptability and practicality of delivering azithromycin through different platforms.
Following data from Niger which suggested that MDA-AZM has optimal impact when given to all children under five,[4] SARMAAN II takes an ‘implementation +’ approach, targeting children aged 1–59 months across eleven states. Scale-up across four states commenced in 2024, with lessons learnt informing subsequent scale-up in an additional seven states in 2025.
Malaria Consortium is supporting implementation in Adamawa, Gombe, Jigawa, Kaduna and Kebbi, using a dual platform approach to administer twice-yearly doses of AZM. The first dose uses the structure of the seasonal malaria chemoprevention (SMC) programme, while being administered separately from SMC. The second dose is being delivered six months later using existing neglected tropical disease (NTD) structures. Simultaneously, Malaria Consortium is overseeing partner organisations AFENET in Katsina, Yobe and Zamfara and MITOSATH in Bauchi state, who are leveraging the polio eradication programme and NTD MDA structures, respectively, to deliver AZM.
Feb 2024 — Feb 2028
$18.33M
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