Nigeria's research institute tackles child mortality with mass drug administration study

The Nigerian Institute of Medical Research(NIMR) has conducted a mass drug administration of Azithromycin to “over four million children” in the country, as part of a major study aimed at tackling child mortality.

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The study, known as Safety and Antimicrobial Resistance of Mass Administration of Azithromycin in Nigeria (SARMAAN), targets children aged one to 11 months in communities with high infant mortality rates.

Presenting findings from the project on Tuesday during a media briefing, the NIMR’s Director of Research and principal investigator for the SARMAAN project, Oliver Ezechi, said the first phase (SARMAAN I) was conducted across six states: Kano, Kebbi, Jigawa, Sokoto, Abia, and Akwa Ibom.

Mr Ezechi, a consultant obstetrician-gynaecologist, noted that the intervention aims to reduce Nigeria’s under-five death rate, which remains among the highest in the world, by testing the safety and effectiveness of giving Azithromycin routinely to infants in high-risk communities.

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He added that the study also monitored potential antimicrobial resistance (AMR) linked to the repeated use of the antibiotic.

“This project is about using evidence to drive solutions to one of our most pressing public health challenges, child survival,” he said.

Why Azithromycin?

Azithromycin is a broad-spectrum antibiotic primarily known to treat bacterial infections.

The World Health Organisation (WHO) recommends its periodic use in high-risk regions as part of integrated child survival strategies, particularly where infant mortality exceeds 60 per 1,000 live births and under-five mortality exceeds 80 per 1,000.

However, concerns about AMR remain in countries like Nigeria. Mr Ezechi explained that SARMAAN I directly addressed these concerns through NIMR’s data collection on AMR trends.

Over three cycles of population-based AMR testing, the resistance rates declined from 41.1 per cent in cycle one to 26.5 per cent in cycle three, countering fears that mass drug administration would exacerbate AMR.

Mr Ezechi’s presentation showed that NIMR recorded an impressive coverage per state, with Akwa Ibom achieving the highest with 99 per cent, Kebbi, Sokoto and Abia states at 97 per cent respectively, followed by Kano and Jigawa at 94 and 94 per cent respectively.

He admitted that one of the key drivers of success was early engagement with traditional and religious leaders.

Safety concerns, next phase

The director also noted that the safety profile was positive, with 98 per cent of treated children having no adverse effects, and only two per cent reported vomiting and passage of stool.

Mr Ezechi noted that with the outcomes from SARMAAN I, the Nigerian government, through NIMR, has initiated SARMAAN II, expanding the target age from one to 11 months to one to 59 months.

This phase will involve over nine million children in seven states: Kano, Kaduna, Katsina, Kebbi, Sokoto, Jigawa, and Bauchi.

Achievements, Challenges

Beyond the successful drug administration, researchers say the project has facilitated progress in Nigeria’s efforts to reduce child mortality.

Speaking on the key achievements of SARMAAN, Abideen Salako, a Research Fellow and Consultant Paediatrician at NIMR, said the initiative has helped establish that mass azithromycin administration is safe and does not exacerbate antimicrobial resistance.

So far, over 3.5 million doses of azithromycin have been administered to children across 96 local government areas in eight states under both SARMAAN I and II phases.

Mr Salako noted that the programme also demonstrated strong community acceptance, fostered state-level ownership, and created direct and indirect employment opportunities for Nigerians involved in implementation.

One major obstacle, according to Folahanmi Akinosolu another research fellow at NIMR, is the poor recognition of the role research plays in national development.

Mr Akinosolu, who is a Public Health specialist, explained that some states initially refused to participate even after identifying a high disease prevalence.

“We had to return to the same policymakers up to six times to advocate before they agreed,” he said.

The research team also faced weak infrastructure, security concerns, especially in areas deemed unsafe for fieldwork and human resource constraints.

“We had to transport biological samples from northern states to Lagos because local labs were not well-equipped,” said Mr Salako. “This not only increased costs but also delayed results.”

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About the research team

The SARMAAN project is spearheaded by NIMR’s Centre for Reproductive and Population Health Studies (CRePHS), led by Mr Ezechi.

The centre works in collaboration with the Federal Ministry of Health and partners like Sightsavers, eHealth Africa, Malaria Consortium, and Corona Management Systems.

CRePHS’s broader work spans HIV/AIDS, cervical cancer, and reproductive health.

Mr Ezechi also noted that the centre has other programmes, including a capacity-building initiative for young researchers called Emory-Nigeria HIV Research Training Programme.