title: The effect of an integrated multisector model for achieving the Millennium Development Goals and improving child survival in rural sub-Saharan Africa: a non-randomised controlled assessment.
abstract: BACKGROUND
  Simultaneously addressing multiple Millennium Development Goals (MDGs) has the potential to complement essential health interventions to accelerate gains in child survival. The Millennium Villages project is an integrated multisector approach to rural development operating across diverse sub-Saharan African sites. Our aim was to assess the effects of the project on MDG-related outcomes including child mortality 3 years after implementation and compare these changes to local comparison data.
  
  
  METHODS
  Village sites averaging 35,000 people were selected from rural areas across diverse agroecological zones with high baseline levels of poverty and undernutrition. Starting in 2006, simultaneous investments were made in agriculture, the environment, business development, education, infrastructure, and health in partnership with communities and local governments at an annual projected cost of US$120 per person. We assessed MDG-related progress by monitoring changes 3 years after implementation across Millenium Village sites in nine countries. The primary outcome was the mortality rate of children younger than 5 years of age. To assess plausibility and attribution, we compared changes to reference data gathered from matched randomly selected comparison sites for the mortality rate of children younger than 5 years of age. Analyses were done on a per-protocol basis. This trial is registered with ClinicalTrials.gov, number NCT01125618.
  
  
  RESULTS
  Baseline levels of MDG-related spending averaged $27 per head, increasing to $116 by year 3 of which $25 was spent on health. After 3 years, reductions in poverty, food insecurity, stunting, and malaria parasitaemia were reported across nine Millennium Village sites. Access to improved water and sanitation increased, along with coverage for many maternal-child health interventions. Mortality rates in children younger than 5 years of age decreased by 22% in Millennium Village sites relative to baseline (absolute decrease 25 deaths per 1000 livebirths, p=0·015) and 32% relative to matched comparison sites (30 deaths per 1000 livebirths, p=0·033).
  
  
  CONCLUSIONS
  An integrated multisector approach for addressing the MDGs can produce rapid declines in child mortality in the first 3 years of a long-term effort in rural sub-Saharan Africa.
  
  
  BACKGROUND
  UN Human Security Trust Fund, the Lenfest Foundation, Bill & Melinda Gates Foundation, and Becton Dickinson.
authors.affiliation: The Earth Institute, Columbia University, New York, York, NY 10027, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Pronyk
authors.forename: Maria
authors.initials: M
authors.lastname: Muniz
authors.forename: Ben
authors.initials: B
authors.lastname: Nemser
authors.forename: Marie-Andrée
authors.initials: MA
authors.lastname: Somers
authors.forename: Lucy
authors.initials: L
authors.lastname: McClellan
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Palm
authors.forename: Uyen Kim
authors.initials: UK
authors.lastname: Huynh
authors.forename: Yanis
authors.initials: Y
authors.lastname: Ben Amor
authors.forename: Belay
authors.initials: B
authors.lastname: Begashaw
authors.forename: John W
authors.initials: JW
authors.lastname: McArthur
authors.forename: Amadou
authors.initials: A
authors.lastname: Niang
authors.forename: Sonia Ehrlich
authors.initials: SE
authors.lastname: Sachs
authors.forename: Prabhjot
authors.initials: P
authors.lastname: Singh
authors.forename: Awash
authors.initials: A
authors.lastname: Teklehaimanot
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Sachs
mesh_terms: D017954:Africa South of the Sahara; D000383:Agriculture / Q000191:economics; D002662:Child Health Services / Q000191:economics; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D057217:Economic Development; D004493:Education / Q000191:economics; D005102:Health Expenditures; D040361:Healthy People Programs / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D012423:Rural Health; D019035:Rural Health Services / Q000191:economics