May 08 2012
Child Mortality Declines Sharply in Millennium Villages, Study Shows
This press release has been corrected and updated.
NEW YORK--In the African Millennium Villages, the mortality rate among children under the age of five dropped by 22% in just four years, and 32% compared to villages not participating in the program a new study published in The Lancet revealed this week. This finding, drawn from Project sites in nine sub-Saharan African countries, shows that the under-5 mortality rate (U5MR) is declining at a pace sufficient to achieve Millennium Development Goal (MDG) 4 for Child Mortality, though continued progress will be vital to achieve the MDGs.
The authors attribute these results to the effectiveness of an integrated multi-sector approach to sustainable development that has helped increase access to basic medical care and skilled deliveries, greater food security, and safer water while reducing rates of malaria, diarrhea, and other preventable diseases. The results show that communities in the Millennium Villages are on track to achieve the MDGs by 2015 if this progress can be continued. The results also demonstrate that, despite widespread questions at the start of the project, integrated and multi-sector strategies can be effectively implemented in impoverished settings in rural Africa. The progress was achieved through an increase in annual development spending per person from $27 to $116, of which about half came from external donors. That amount is well within internationally agreed levels of official development assistance, showing it is possible to build an integrated, multi-sector development program at very low cost.
Households in Millennium Villages Project sites were followed between 2006/07 and 2009/10 to measure the effectiveness of interventions in the health sector (such as the construction of clinics, the introduction of free basic health care, the distribution of bed-°©?nets, and immunization campaigns), as well as in agriculture, nutrition, water and sanitation, and infrastructure vis-à-vis child health. These results were then compared to nearby sites that did not follow the Project’s multi-sector investment approach. For this 10 year project, indicators suggest that progress has continued after 2009/10, since the deployment of community health workers. Results for subsequent years will be contained in follow up publications.
MDG 4, which calls for a two-thirds reduction in the rate of child mortality between 1990 and 2015, will be achieved in the Millennium Villages if the death rates among children under the age of five continue to decline at the rate observed in the Millennium Villages, according to the study published in The Lancet on May 8, 2012, under the title “The effect of an integrated multi-sector model for achieving the Millennium Development Goals and improving child survival in rural sub-Saharan Africa: a non-randomized controlled assessment.”
“These results demonstrate the feasibility of scaling up basic public health delivery in low-income settings,” said Jeffrey Sachs, Director of the Earth Institute and Special Advisor to United Nations Secretary-General Ban Ki-moon on the MDGs. “With today’s technologies and good systems design, combined with modest amounts of donor assistance and partnerships with government and local 2 communities, it is possible to achieve the health MDGs even in remote and impoverished villages with initially high burdens of disease. The results are for the first three years of a 10-year project. We expect continued progress during the remaining years of the project, and the communities are working hard to achieve the MDGs.”
Today, approximately one out of every eight children in sub-Saharan Africa dies before their fifth birthday from preventable causes. This rate is roughly fifteen times higher than in developed economies and can and should be remedied in the face of effective, low-cost solutions of the sort described in today’s paper. The lessons from the Millennium Villages Project will help to inform national, regional, and global efforts to scale-up progress to the health MDGs.
High child mortality on the continent results mainly from diarrhea, pneumonia, malaria, and HIV infection, accompanied by under-nutrition. These conditions are linked to weak and under-financed health systems, drug shortages, and health clinic user fees, all of which represent critical obstacles to universal coverage.
In the nine countries involved in the study (Ghana, Kenya, Malawi, Mali, Nigeria, Rwanda, Senegal, Tanzania, and Uganda), child mortality in the Villages dropped 32%, relative to matched comparison sites where the same number of households with similar characteristics were surveyed.
“This study compares Project results with outcomes in nearby villages. The reference villages had generally similar characteristics to the Millennium Village sites at baseline, and were on average 40 km away to minimize direct spillovers from Project sites. A similar sampling strategy was used in both sites which were surveyed at the same time and by the same field teams,” said Paul Pronyk, Director of Monitoring and Evaluation for the Millennium Villages Project and lead author of the report.
The design for this study was approved by ethical review committees at Columbia University and by all host country governments. The evaluation protocol outlining the Project’s overall assessment process has been externally peer reviewed and registered with The Lancet (protocol 09PRT-8648) and with the U.S. National Institutes of Health (protocol NCT01125618). The research was supported by the United Nations Human Security Trust Fund, the Lenfest Foundation, the Bill and Melinda Gates Foundation, and the global medical company Becton Dickinson.
Pronyk PM, Muniz M, Nemser B, et al. The effect of an integrated multi-°©?sector model for achieving the Millennium Development Goals and improving child survival in rural sub-°©?Saharan Africa: a non-randomized controlled assessment. The Lancet 379 (9827) May 8, 2012. DOI:10.1016/S0140-6736(12)60207-4
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Note to editors: * Project sites come from the following countries: Nigeria, Mali, Senegal, Ghana, Uganda, Kenya, Rwanda, Tanzania, Malawi
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