Published in PLOS One on 2025-10-08, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Olusola Bukola Oresanya, Olujide Arije, Jesujuwonlo Fadipe, Kunle Rotimi, Abimbola Phillips, Kolawole Maxwell, Emmanuel Shekarau, Nneka Onwu, Eva S. Bazant
Source: PLOS One • DOI 10.1371/journal.pone.0315655
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Child mortality in Nigeria, significantly affected by malaria and malnutrition, remains a public health concern in the country. Seasonal Malaria Chemoprevention (SMC) and Vitamin A supplementation (VAS) are effective interventions that can be delivered through integrated health campaigns to reduce this mortality. This study assesses the cost implications of integrating these two interventions among under-5 children in Northeast Nigeria.
A cost analysis compared standalone SMC (Cycle 1 in July 2021) with SMC-VAS integrated campaign (Cycle 4 in October 2023) in two Local Government Areas (LGAs) in Bauchi State. The number of children reached by the SMC-only campaign was 168,820 and for the SMC + Vit A campaign, the number was 170,681. Data collection utilized a mixed-methods approach, drawing from primary and secondary sources, including programmatic, financial, and coverage records. Costs were categorized into distribution, Sulphadoxine-Pyrimethamine plus Amodaiquine (SPAQ) for SMC, Vitamin A, training, supplies, meetings, labor, supervision, and social mobilization costs. Sensitivity analyses evaluated the effect of a 10% fluctuation in the costs of distribution, labor, SPAQ, and supplies on the cost per child.
The total cost for the SMC standalone campaign was US$158,934, and the SMC-VAS integration was US$186,426. Distribution and drug costs were the largest contributors in the integrated and SMC-only campaign. The SMC-only cost per child was $0.94 and $1.18 when eligible children received both SMC and VAS. The integration of VAS into the SMC campaign cycle incurred an additional US$27,492 over Cycle 1 cost (US$186,426 – US$158,934). Fluctuations in distribution costs were the most influential component of the cost per child.
Integrating VAS with SMC campaigns increases the cost by US$0.24 per child, a modest increment considering the potential health benefits. The results support the feasibility of this integration, in terms of cost, to combat child mortality from malaria and malnutrition in Nigeria. Further research is recommended to explore the cost-effectiveness of this integrated distribution model.
Background
In spite of documented global gains in child survival, one in every thirteen children in sub-Saharan Africa still face huge health risks, especially mortality before their fifth birthday [1]. The leading causes of morbidity and mortality among under-five children are infectious diseases (malaria) and malnutrition with Nigeria being the third largest contributor to under-five mortality [1,2]. Nutrition-related factors heighten the risk of all cause childhood mortality [1,3].
Central to the effort to combat malnutrition among under-five children is Vitamin A supplementation (VAS) as one of the key strategies recommended [4]. It has been linked to significant reductions in morbidity and mortality among children aged 6–59 months across various regions including Africa Asia and Latin America [5]. VAS is cost effective in addressing global public health challenges among children [6,7]. However, VAS coverage in Nigeria stands at 45.3%, below the World Health Organization’s (WHO) recommended coverage of 80% [8], with children in northern Nigeria nearly three times less likely to access VAS compared to their counterparts in the South [8]. Moreover, distributing Vitamin A supplements through health facilities often results in unequal access due to several barriers including socio-cultural and economic factors [8,9].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Olusola Bukola Oresanya, Olujide Arije, Jesujuwonlo Fadipe, Kunle Rotimi, Abimbola Phillips, Kolawole Maxwell, Emmanuel Shekarau, Nneka Onwu, Eva S. Bazant. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Malaria and malnutrition in children under the Seasonal Malaria Chemoprevention (SMC) coverage in the health district of Nanoro, Burkina Faso
- Evidence brief: Concurrent coverage and determinants of vitamin A supplementation and deworming among children aged 12–59 months in 15 Sub-Saharan African countries
- Evidence brief: Economic evaluation of anti-malarial drug policies across presidential regimes in Nigeria: A comparative analysis from 1999 to present
