The federal government has intensified the fight against infant deaths across the country as renewed offensive has begun in 10 high-burden states where over 4 million doses of azithromycin drug have been administered.

Azithromycin is an antibiotic widely used to treat bacterial infections in countries where child mortality rate exceeds 60 per 1,000 live births and in children aged one to 59 months in high-burden states.

The lifesaving drug is recommended for vulnerable children under the age of five to reverse the trend.

Nigeria is facing a deepening child survival crisis as it grapples with one of the highest infant mortality rates in the world.

Latest data from Statista showed that for every 1,000 live births in Nigeria in 2023, approximately 55 infants do not survive their first year. This staggering figure reflects a persistent national health crisis, driven by preventable and treatable conditions.

Health experts and government officials have identified neonatal disorders, malaria, and lower respiratory infections as the top three causes of infant deaths in the country. These preventable and treatable conditions continue to claim thousands of young lives annually, especially in underserved regions where access to quality healthcare remains poor.

The director of research at the Nigerian Institute of Medical Research (NIMR) and consultant obstetrician-gynaecologist, Professor Oliver Ezechi, at a press conference, organised by NIMR in Lagos said, infant mortality in Nigeria is still unacceptably high.

The leading causes include neonatal disorders, lower respiratory tract infections and malaria, Ezechi averred, adding that many of these deaths are avoidable if timely interventions are introduced.

This spurred the World Health Organisation (WHO) to issue guidelines recommending mass administration of azithromycin in countries where child mortality exceeds 60 per 1,000 live births and to children aged one to 59 months in high-burden states.

In response to WHO’s call, the Federal Ministry of Health commissioned NIMR to conduct a nationwide evaluation and pilot implementation of the azithromycin mass administration, under a national child survival project known as “Saving Antibiotics for Resistant Microbes through Administration of Azithromycin in Nigeria (SARMAAN).” The strategy, with support from Bill and Melinda Gates Foundation and other international development partners, is already showing promising signs of impact in its pilot phase.

“The initial phase, SARMAAN 1, covered six states – Kano, Kebbi, Jigawa, Sokoto, Abia and Akwa Ibom, over a two-year period. During this phase, NIMR administered 1.8 million doses of azithromycin to children aged 1–11 months across 52 local government areas (LGAs),” Ezechi revealed.

For instance, in Abia State, 29,531 children were treated with azithromycin; 26,622 children in Akwa Ibom; 726,715 children in Jigawa; 19,893 in Kano; 547,993 in Kebbi and 39,647 in Sokoto State.

Findings from SARMAAN 1 revealed that the intervention was safe, well-tolerated, and did not worsen antimicrobial resistance profiles, one of the primary concerns initially raised by medical experts; additionally, the intervention was found to be most cost-effective when integrated into existing child survival platforms such as immunisation campaigns, the director stated.

Following the success of SARMAAN 1, the government expanded the programme under SARMAAN II, both in scope and scale. The second phase includes 10 high-burden northern states: Kano, Kebbi, Kaduna, Katsina, Bauchi, Borno, Gombe, Sokoto, Jigawa and Zamfara. The age group was also expanded to include children from 1 month to 59 months.

“As of the latest report, SARMAAN II has administered 2,467,196 doses of azithromycin in Kebbi and Kaduna states alone, reaching more than two million children across 44 LGAs,” Ezechi disclosed.

A consultant paediatrician and research fellow at NIMR, Dr. Abideen Salako, said, “We not only increased the geographical reach but also boosted the program’s scientific rigour to detect actual changes in under-five mortality rates. So far, the results have been encouraging.”

Perhaps one of the programme’s most compelling outcomes has been the high level of community acceptance. Parents and caregivers, particularly mothers in rural areas, have enthusiastically welcomed the initiative.

“In many communities, caregivers are now the biggest advocates. They are the ones encouraging others to participate because they have seen firsthand the reduction in respiratory tract infections, diarrhea, and other illnesses in their children,” Salako said.

Beyond health benefits, the programme has also provided employment opportunities to hundreds of Nigerians, both directly and indirectly. From health workers and research assistants to logistics personnel and data collectors, SARMAAN has created jobs at a time when economic hardship continues to grip the nation.

“This initiative is improving lives and livelihoods. It is a health project, but it is also a development programme,” Salako added.

Despite its promising results, the SARMAAN project has faced significant hurdles. According to a public health specialist and Research Fellow at NIMR, Dr. Folahanmi Akinsolu, the biggest obstacles have been logistical, infrastructural, and political.

“We have had to deal with weak health systems, limited laboratory infrastructure, poor road networks, and in some cases, outright rejection by state authorities,” Akinsolu noted.

In one state, officials declined participation entirely, despite data showing a high prevalence of infant deaths. In others, NIMR had to return for up to six rounds of advocacy to secure buy-in from policymakers.

“Many stakeholders don’t yet understand research’s critical role in sustainable development. That’s a barrier we must overcome,” he stressed.

The project has also been challenged by insecurity in the northern region. In some local governments, field researchers were attacked, and certain areas had to be declared no-go zones due to safety concerns.

“The terrain is difficult, and sometimes you travel for hours just to reach one remote village. But we must persist,” Akinsolu added.

Moreover, the shortage of skilled human resources has necessitated continuous training and retraining of field personnel. “You can’t afford to collect bad data. It will compromise the entire project,” Akinsolu warned.

Despite the obstacles, SARMAAN is beginning to draw international attention as a model of how local research institutions can implement large-scale, evidence-based interventions. Global partners like the University of Washington and Duke University have joined the effort, offering technical support and capacity-building collaborations.

“We are finally at a point where Nigerian research is contributing meaningfully to the global scientific conversation,” Ezechi stated.

What sets the SARMAAN project apart is its emphasis on state and community ownership. Local governments, traditional rulers, and community health workers are actively involved in planning and implementation, a factor that has increased transparency, accountability, and sustainability.

“We are not just flying in from Abuja or Lagos. We are on the ground with the communities. They lead, and we follow,” Salako explained.

As SARMAAN II continues, Akinsolu hopes it would produce clear evidence of a reduction in under-five mortality by the end of the four-year cycle. Baseline data collection and antimicrobial surveillance have been concluded in several states, including Kano, Kaduna, Sokoto and Bauchi.

If results remain positive, the Federal Ministry of Health may consider integrating mass azithromycin administration into Nigeria’s national child health policy permanently.

“We cannot afford to lose any more children to preventable causes. Every Nigerian child deserves a chance to survive and thrive,” Akinsolu affirmed.

As Nigeria battles to improve its global health standing, initiatives like SARMAAN offer a glimpse into what is possible when science, community and political will align.

“This is not just about drugs. It’s about dignity, about survival and about giving our children a future,” Ezechi added.