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

  • The Lancet, Volume 379, No. 9832, Year 2012

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Study Justification:
The study aimed to assess the effects of the Millennium Villages project, an integrated multisector approach to rural development, on Millennium Development Goal (MDG)-related outcomes, specifically child mortality, in rural sub-Saharan Africa. The study aimed to determine if addressing multiple MDGs simultaneously could accelerate gains in child survival.
Highlights:
– The Millennium Villages project implemented simultaneous investments in agriculture, environment, business development, education, infrastructure, and health in rural areas across diverse agroecological zones in sub-Saharan Africa.
– The project operated in partnership with communities and local governments, with an annual projected cost of US$120 per person.
– After 3 years of implementation, 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.
– Child mortality rates decreased by 22 in Millennium Village sites relative to baseline (absolute decrease of 25 deaths per 1000 livebirths) and 32 relative to matched comparison sites (30 deaths per 1000 livebirths).
Recommendations:
– Implement an integrated multisector approach to rural development to address multiple MDGs simultaneously.
– Increase investments in agriculture, environment, business development, education, infrastructure, and health in rural areas.
– Strengthen partnerships with communities and local governments to ensure effective implementation.
– Focus on reducing poverty, food insecurity, stunting, and malaria parasitaemia.
– Improve access to improved water and sanitation, as well as maternal-child health interventions.
Key Role Players:
– Local communities
– Local governments
– Non-governmental organizations (NGOs)
– Health professionals
– Education professionals
– Agricultural experts
– Infrastructure experts
Cost Items for Planning Recommendations:
– Investments in agriculture
– Investments in environment
– Investments in business development
– Investments in education
– Investments in infrastructure
– Investments in health
– Training and capacity building
– Monitoring and evaluation
– Community engagement and participation initiatives

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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. Findings: 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). Interpretation: 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. Funding: UN Human Security Trust Fund, the Lenfest Foundation, Bill & Melinda Gates Foundation, and Becton Dickinson. © 2012 Elsevier Ltd.

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The study mentioned in the title and description highlights the effectiveness of an integrated multisector approach for improving child survival and achieving Millennium Development Goals (MDGs) in rural sub-Saharan Africa. Some of the innovations implemented in this project include:

1. Simultaneous investments: The project made investments in multiple sectors such as agriculture, environment, business development, education, infrastructure, and health. This integrated approach allowed for comprehensive improvements in various aspects of community development.

2. Partnership with communities and local governments: The project worked closely with communities and local governments to ensure that interventions were tailored to the specific needs and context of each village. This collaboration helped to build local capacity and ownership of the initiatives.

3. Increased spending on health: The project increased spending on health, with $25 per person allocated towards health interventions. This investment contributed to improvements in maternal-child health interventions and ultimately led to a decrease in child mortality rates.

4. Access to improved water and sanitation: The project focused on improving access to clean water and sanitation facilities. This is crucial for preventing waterborne diseases and improving overall maternal health outcomes.

5. Coverage of maternal-child health interventions: The project reported increased coverage of various maternal-child health interventions. This could include interventions such as prenatal care, skilled birth attendance, immunizations, and postnatal care, which are essential for ensuring the well-being of both mothers and children.

These innovations collectively contributed to the observed reductions in poverty, food insecurity, stunting, malaria parasitaemia, and child mortality rates in the Millennium Village sites.
AI Innovations Description
The recommendation from the study is to implement an integrated multisector approach to improve access to maternal health in rural sub-Saharan Africa. This approach involves simultaneous investments in agriculture, the environment, business development, education, infrastructure, and health. The Millennium Villages project, which followed this approach, reported reductions in poverty, food insecurity, stunting, and malaria parasitaemia, as well as increased access to improved water and sanitation. Additionally, coverage for many maternal-child health interventions improved. The project also observed a decrease in child mortality rates by 22 in Millennium Village sites compared to baseline and 32 compared to matched comparison sites. This recommendation suggests that addressing multiple Millennium Development Goals (MDGs) together can lead to rapid improvements in maternal health outcomes.
AI Innovations Methodology
Based on the provided description, it seems that the study assessed the effects of an integrated multisector approach called the Millennium Villages project on Millennium Development Goals (MDGs) related to child mortality in rural sub-Saharan Africa. The project involved simultaneous investments in agriculture, environment, business development, education, infrastructure, and health. The methodology used in the study involved monitoring changes in MDG-related outcomes, particularly child mortality rates, 3 years after the implementation of the project.

To simulate the impact of recommendations on improving access to maternal health, a similar methodology could be employed. Here is a brief description of a possible methodology:

1. Selection of study sites: Choose rural areas in sub-Saharan Africa with high baseline levels of maternal health challenges and limited access to healthcare services.

2. Identification of recommendations: Identify potential recommendations that could improve access to maternal health, such as increasing the number of healthcare facilities, training healthcare providers, improving transportation infrastructure, implementing community-based interventions, or utilizing telemedicine.

3. Implementation of recommendations: Implement the identified recommendations in the selected study sites. This could involve collaborating with local communities, governments, and relevant stakeholders to ensure effective implementation.

4. Monitoring and data collection: Monitor the changes in access to maternal health services, including indicators such as the number of healthcare facilities, availability of skilled birth attendants, utilization of antenatal care, and access to emergency obstetric care. Collect data on these indicators before and after the implementation of the recommendations.

5. Comparison with control sites: Select control sites that are similar to the study sites but did not receive the implemented recommendations. Collect data on the same indicators in these control sites for comparison purposes.

6. Analysis: Analyze the data collected from the study sites and control sites to assess the impact of the implemented recommendations on improving access to maternal health. Compare the changes in indicators between the study sites and control sites to determine the effectiveness of the recommendations.

7. Interpretation and conclusions: Interpret the findings of the analysis and draw conclusions regarding the impact of the recommendations on improving access to maternal health. Consider the limitations of the study and discuss the implications of the results.

By following this methodology, researchers can simulate the impact of recommendations on improving access to maternal health and assess their effectiveness in a specific context.


Statistics:
Citations: 57
Identifiers:
DOI: 10.1016/S0140-6736(12)60207-4
ISSN: 01406736
Research Areas:
Community Interventions, Disparities, Environmental, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care
Study Design:
randomised-control-trial
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