Expanding our partnership with Malaria Consortium to integrate Oral Rehydration Solution and Zinc into Seasonal Malaria Chemoprevention in Chad and Nigeria

Diarrhoea remains a major threat to young children's health, yet Oral Rehydration Solution and Zinc (ORSZ) - a simple, low-cost treatment - still isn't reaching the children who need it. At Clear Solutions, we're working to close that gap, including by exploring how ORSZ can be integrated into existing health programmes to reach more children efficiently and at scale.

Building on our successful 2025 pilot layering ORSZ onto Malaria Consortium's Seasonal Malaria Chemoprevention (SMC) platform in Chad, we're happy to announce that we're expanding our collaboration in 2026: scaling up across Chad and launching a new pilot in Nigeria's Kebbi and Sokoto states.

SMC is a community-based, highly effective malaria prevention programme that protects children aged 3-59 months during the high-transmission rainy season. Trained community distributors visit households door-to-door to provide antimalarial medicines and explain how they should be used - creating a natural opportunity to also hand caregivers ORSZ co-packs and counsel them on preparation, dosing and when to seek further care if a child develops diarrhoea. Although ORSZ will not be administered on the spot like SMC, providing it in advance at the household level could reduce delays in treatment initiation and improve its timely and appropriate use.

Our 2025 pilot in Chad showed that SMC is a promising platform for this approach, increasing ORS and zinc use by 74.1 and 68.9 percentage points respectively, while maintaining high SMC coverage (manuscript under review, 2026). In 2026, we are scaling up the model in Chad, while testing how it will perform in a different context in Nigeria.

By co-designing the programme, Malaria Consortium leads field delivery and evaluation, drawing on its established SMC infrastructure, while Clear Solutions leads ORSZ procurement and technical support for ORSZ adaptations in health worker and distributor training, caregiver education, as well as monitoring and evaluation.

This partnership is an important step toward building strong evidence that child-health platforms can deliver more than one life-saving intervention at a time, and toward showing whether high, equitable ORSZ coverage is achievable even in areas where access has historically been poor.

We thank the Malaria Consortium teams in Chad and Nigeria, the national malaria programmes, state and provincial health authorities, and all programme staff involved in designing and implementing these programmes.

Scaling up in Chad

Objectives To test whether the delivery model can sustain strong coverage and delivery quality when implemented across a much larger geographic area. Based on learnings from the 2025 campaign, an additional distribution day has been added to allow for sufficient time for caregiver education, and logistical support to carry around ORSZ co-packs has been put in place.

Where Mayo-Kebbi Est and Mayo-Kebbi Ouest provinces, covering all districts and health facilities

Size of the problem In Chad, diarrhoea causes an estimated 729 deaths per 100,000 children under five (GBD, 2023 (IHME)) . However, only 20% of cases are treated with ORS in Mayo-Kebbi Est and 17% in Mayo-Kebbi Ouest (DHS, Chad 2014).

Target population 463,871 children aged 0-59 months, 2 co-packs per child

Procurement ~1.1 million co-packs manufactured in Nigeria and transported by sea and truck to Chad

Distribution During 2 SMC cycles in August and October, with each child receiving 1 co-pack per cycle (i.e. 2 per child in total)

Surveys ORSZ questions integrated into End of Cycle and End of Round SMC surveys across 5 SMC implementing provinces by Malaria Consortium, with an increased sample size (End of Round survey) in Mayo-Kebbi Est and Mayo-Kebbi Ouest provinces

Piloting in Nigeria

SMC operations in Nigeria. Credit: Malaria Consortium

Objectives To optimise and learn from layering ORSZ onto SMC in the Nigerian context, including adapting training materials to Nigerian government standards, and to build a clearer picture of how delivery differs across countries and implementation contexts, informing future expansion and scaling decisions.

Where Argungu local government area (LGA) in Kebbi state and Silame LGA in Sokoto state

Size of the problem In 2023, diarrhoea caused an estimated 261 deaths per 100,000 live births in Kebbi and 315 in Sokoto among children under five1. Yet only 36.6% of children with diarrhoea in Kebbi and 48.4% in Sokoto received ORS (DHS Nigeria 2024).

Target population 123,768 children aged 0-59 months, 2 co-packs per child

Procurement ~273,000 co-packs manufactured in Nigeria and transported to Kebbi and Sokoto

Distribution During 2 SMC cycles in July and September, with each child receiving 1 co-pack per cycle (i.e. 2 per child in total)

Surveys Extensive ORSZ surveys in Argungu and Silame before distribution (baseline), after cycle 2 (1 month after first ORSZ distribution) and after cycle 4 (endline, 1 month after second ORSZ distribution), as well as integration of ORSZ questions into End of Cycle SMC surveys across all LGAs in Kebbi and Sokoto states.