Infant and child mortality is a major development concern for Burkina Faso. At the start of the project in 2020, the final results of the 2019 general population and housing census (RGPH) had indicated that for every 1,000 live births, 55.9 infants died before reaching their first birthday, 33.3 at the age of one and 87.3 before their fifth birthday.

Recent studies in Tanzania, Malawi and Niger have shown that twice-yearly mass administration of azithromycin to pre-school children reduces mortality, with the greatest effect observed in Niger (18.1%).

Burkina Faso has a similar epidemiological profile to Niger and is therefore committed to implementing the “Infant Mortality Reduced by Mass Administration of Azithromycin” (MIRAMA) project.

The MIRAMA project has the following objectives:

• To reduce infant mortality among children aged between 1 and 11 months by 10% in intervention zones compared with placebo zones by the end of the project intervention period;
• To monitor antimicrobial resistance in the target population at baseline, after 1 year and after 2 years in both azithromycin-treated and placebo-treated areas;
• To evaluate the cost-effectiveness of coupling azithromycin/placebo with JAV+ (Vitamin A plus) campaigns per child treated;
• To establish the validity of morbidity rates collected from healthcare facilities as an indirect and inexpensive indicator for measuring mortality in children aged between 1 and 11 months.

The strategy for mass administration of azithromycin/ placebo in Burkina Faso is based on its being combined with JAV+ interventions. Consequently, the drug is administered door-to-door over a period of four days every six months by community distributors (CDs) and community-based health workers (CBHWs).

Specifically, in the three intervention regions, the aim is to:

• Support the organisation of preparatory meetings, advocacy and social mobilisation activities every six months as part of JAV+ activities;

• Administer azithromycin biannually to children aged between 1 and 11 months, alongside the distribution of vitamin A supplements, deworming, and screening for acute malnutrition;

• Contribute to supervision at the regional and district levels;

• Support Ministry of Health agents during each combined campaign;

• Provide support for data validation meetings at the regional and national levels.

The MIRAMA project is being implemented in all twenty health districts in three of the country’s regions: Centre-East, Hauts-Bassins and South-West.

The four combined campaigns planned and carried out in the pilot phase of the project produced the following results:

The poor performance of the first combined campaign was due, among other things, to the novelty of the approach, the insufficient number of distributors (CBHWs/CDs) and, above all, the need for written informed consent from beneficiaries and the short duration of the campaign (just 2 days). In addition to this, socio-political events on the second day of the campaign prevented effective implementation, especially in urban areas.

Learning from these shortcomings and implementing recommendations made at review meetings, study stakeholders were able to reverse the trend from the second campaign onwards.

University of California, San Francisco (UCSF), Centre de Recherche en Santé de Nouna (CRSN, Nouna Health Research Centre), General Directorate for Health and Public Hygiene (DGSHP), Family Health Department (DSF), Nutrition Division (DN).