[Show abstract][Hide abstract] ABSTRACT: 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.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to develop a model for impacting decisions on agricultural biotechnology practices in food production among African policymakers. The research focused on three African countries, namely, South Africa, Malawi and Ghana. Taking into consideration the different stages and levels of engagement in biotechnology, these countries were assumed to be representative of the current heterogeneous environment of Africa regarding biotechnology adoption. Policymakers, primarily government officials, civil servants and activists, journalists, business leaders, religious leaders, farmers' leaders, and extension workers were involved as respondents and discussants in the study. Of the total number of 174 respondents, 69 were from Ghana, 76 from Malawi, and 29 from South Africa. The research instrument entitled "Communication Factors Affecting Africa Policymakers' Decisions about Agricultural Biotechnology" was designed to provide scales by which to measure understanding, knowledge, and perceptions of agricultural biotechnology, three important constructs of the overall study. These three constructs were used to design questions for 12 specific scales to measure African policymakers' socio-demographic characteristics (gender, age, education level, occupation, geographic location); worldviews and values (moral values, labeling, regulation, consumers' rights, willingness to pay); information sources (interpersonal, print, and electronic forms); understanding of agricultural biotechnology practices; perceptions of agricultural biotechnology use in food production; and attitudes toward agricultural biotechnology policies. Significant differences occurred in policymakers' understanding of biotechnology, perceptions about biotechnology, and attitudes when compared by country of origin. Respondents from Malawi had significantly less knowledge about agricultural biotechnology, held significantly lower perceptions about agricultural biotechnology, and held significantly lesser attitudes about agricultural biotechnology than did respondents from Ghana or South Africa. No significant differences existed in policymakers' understanding, perceptions, or attitudes toward biotechnology when compared by gender. The study revealed that significant moderate positive relationships occurred between the dependent variables worldviews and values, and understanding, and attitudes. These associations suggested the existence of some level of complementarities between worldviews and values, and understanding, and attitudes of African policymakers toward biotechnology for agricultural development. Other findings showed significant moderate associations between the independent variable education level and worldviews and values, and low positive associations between occupation and worldviews and values, understanding, and attitudes toward biotechnology. On the other hand, no significant associations occurred between the dependent variables and gender or country of origin in this study. In conclusion, the study showed that a critical gap exists in the understanding of biotechnology between policymakers in Africa. Educating the African public in general and those of low educational backgrounds in particular, is strongly recommended. Taking into consideration the differences in understanding agricultural biotechnology, it is further suggested that a need exists to adopt a target group approach in educating Africa policymakers about biotechnology. Another recommendation resulting from this study is the need for close collaboration between university scientists and mass media professionals as a means for raising the public's levels of trust for media, as well as accessing university scientists to the societies which they serve.