Evidence for the Future: SARMAAN II and the Pursuit of Safer Child Health Interventions

By Joyce Shinyi

Progress in public health rarely arrives as a single headline. It often builds through design, proper execution, and a commitment to evidence. SARMAAN II represents that kind of progress. The study, formally known as Safety and Antimicrobial Resistance of Mass Administration of Azithromycin in Children 1–59 months in Nigeria, advances the work initiated under SARMAAN I, which focused on children 1–11 months. While Phase I demonstrated large-scale delivery across some states, Phase II is designed to understand what that intervention means in terms of safety, antimicrobial resistance, and long-term use of azithromycin for young children.

This evolution is important as global discourse continues around the role of antibiotics in child survival. Questions persist around benefit, risk, feasibility, and equity. SARMAAN II positions Nigeria to contribute clarity using data generated within Nigerian communities. SARMAAN II is being implemented across eleven northern Nigerian states: Sokoto, Kano, Katsina, Kebbi, Kaduna, Jigawa, Bauchi, Adamawa, Gombe, Yobe, and Zamfara. The geographic spread strengthens the ability to produce evidence across varied population and health system contexts. 

The programme is led by the Nigerian Institute of Medical Research (NIMR), supported by a broad group of implementing and technical partners including the Federal and State Ministries of Health, the Nigeria Centre for Disease Control, the National Primary Health Care Development Agency, the World Health Organization, UNICEF, Sightsavers, Malaria Consortium, and eHealth Africa. Funding support is provided through consortium partners by the Gates Foundation. Each institution plays a defined role grounded in expertise, operational capacity, or scientific leadership.

eHealth Africa’s role

At eHealth Africa, our responsibility in SARMAAN II is straightforward: to build and maintain the digital and data systems that support accurate, timely, and trustworthy evidence. This includes digitised reporting tools, secure data infrastructure, structured training, and continuous field support to uphold data quality at every stage. Our work sits at the intersection of research and communities. Digital systems only work when the people behind them are trained, supported, and equipped to use them confidently. That combination of technology, supervision, and practical field discipline is what sustains data integrity throughout the study process.

As Darlington Okoye, SARMAAN Project Manager at eHealth Africa, explains; “With eHealth Africa involved, we digitised most of the case-report forms and built systems that ensure data remains clean at the point of collection. Digitisation has reduced lag time and strengthened real-time verification. Over time, we have also seen a clear improvement in the capacity of our research assistants as they continue to work with digital tools in the field.” These adjustments reinforce the precision required for credible scientific outputs.

Why SARMAAN II matters

Many programmes measure success in scale. SARMAAN II prioritises certainty. Certainty that interventions administered at population level are safe. Certainty that antimicrobial resistance risks are measured, not assumed. Certainty that policy decisions reflect Nigerian data and Nigerian experience. The significance of this work will be reflected not in speed, but in the quality of conclusions that can inform long-term child health policy.

The programme will continue strengthening digital processes, building field capacity, and multi-stakeholder coordination as implementation continues across  states. The objective extends beyond data capture to building durable systems, capability, and evidence that support informed decision-making in Nigeria’s health sector.