The Earth Institute, Columbia University, New York, York, NY 10027, USA.
Lancet. 2012 Jun 9;379(9832):2179-88. doi: 10.1016/S0140-6736(12)60207-4. Epub 2012 May 8.
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.
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.
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).
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.
UN Human Security Trust Fund, the Lenfest Foundation, Bill & Melinda Gates Foundation, and Becton Dickinson.
同时实现多个千年发展目标（MDGs）有可能补充基本的卫生干预措施，以加速儿童生存方面的进展。千年村项目是一种综合多部门的农村发展方法，在多个撒哈拉以南非洲地点开展。我们的目的是评估该项目对与千年发展目标相关的结果的影响，包括实施后 3 年的儿童死亡率，并将这些变化与当地对照数据进行比较。
从不同农业生态区选择了平均人口为 35000 人的村庄，这些地区贫困和营养不良程度高，基线水平高。从 2006 年开始，与社区和地方政府合作，在农业、环境、企业发展、教育、基础设施和卫生等领域同时进行投资，预计每人每年的成本为 120 美元。我们通过监测九个国家的千年村项目实施后 3 年的变化来评估与千年发展目标相关的进展。主要结果是 5 岁以下儿童的死亡率。为了评估合理性和归因，我们将变化与从随机选择的匹配比较地点收集的 5 岁以下儿童死亡率参考数据进行了比较。分析是基于方案进行的。这项试验在 ClinicalTrials.gov 注册，编号为 NCT01125618。
与千年发展目标相关的支出基线水平平均为每人 27 美元，到第 3 年增加到 116 美元，其中 25 美元用于卫生。在 3 年后，九个千年村项目报告了贫困、粮食不安全、发育迟缓以及疟疾寄生虫血症的减少。改善水和卫生设施的获得率有所提高，同时许多母婴健康干预措施的覆盖率也有所提高。与基线相比，5 岁以下儿童的死亡率在千年村项目中下降了 22%（每 1000 例活产减少 25 例死亡，p=0·015），与匹配的对照地点相比下降了 32%（每 1000 例活产减少 30 例死亡，p=0·033）。
在撒哈拉以南非洲农村的长期努力的头 3 年中，采用综合多部门方法实现千年发展目标可以迅速降低儿童死亡率。
联合国人类安全信托基金、伦费斯特基金会、比尔及梅林达盖茨基金会以及贝克顿·迪金森公司。
