Child Survival Clinical Trial
Official title:
A Pair-matched Community Intervention Trial to Assess the Impact of an Integrated Health and Development Intervention on Child Survival and the Millennium Development Goals in 10 Sub- Saharan African Countries
The Millennium Villages Project involves the coordinated and simultaneous delivery of a
package of proven interventions in health, agriculture, infrastructure and education. The
project works in partnership with governments in 10 African countries in areas where
progress towards achieving the Millennium Development Goals has been insufficient.
The Project evaluation will test the following hypotheses:
1. That after 5 years of operation, villages exposed to the MVP intervention will have a
lower rate of under-5 mortality and parallel gains in MDG-related secondary outcomes
when compared to similar villages not receiving the intervention.
2. That the coordinated delivery a multi-sector package of health and development
interventions implemented through a broad-based local partnership is feasible in a
diversity of sub-Saharan African contexts, and;
3. The intervention package can be delivered at a scalable cost of $40 per person per year
in the health sector and $110 per person per year in total
Design and population The design is a pair-matched community intervention trial. Village
clusters with high levels of malnutrition were selected from rural areas in ten sub-Saharan
African countries to reflect a diverse range of agro-ecological zones, farming systems,
disease profiles, and infrastructure challenges. MVP sites represent 80 villages in 14
clusters across 10 countries, covering nearly 500,000 people. For each intervention cluster,
a matched comparison cluster has been selected at random to participate in the evaluation.
Outcomes The primary outcome is the under-5 mortality rate. Secondary outcomes are levels of
coverage with essential maternal-child health interventions and related MDG indicators for
poverty, nutrition, education, and environmental health.
Sample size calculation The assessment follows 6000 households across intervention and
matched comparison villages at baseline, and after 3 and 5 years of intervention exposure.
With 10 paired clusters, the study is powered to detect a 40% difference in the U5MR between
the two groups.
Analysis plan The analysis will use a two-staged pair-matched cluster level analysis, and
will be complemented with multilevel modeling. Reporting will adhere to Transparent
Reporting of Evaluations with Non-randomized Designs (TREND) guidelines.
Implementation science A portfolio of qualitative implementation science (process
evaluation) will complement the quantitative assessment, and involves interviews with
implementers, partners, and project beneficiaries. This analysis will address questions
about: the feasibility of the interventions; the timing and sequence of their introduction;
key contextual barriers and facilitators to implementation; and potential synergies achieved
from the integrated multisector approach.
Economic costing study One project hypothesis is that an annual per capita investment of
$110 is required to achieve the MDGs. The aim of the economic costing study is to document
the absolute and relative contribution of project partners (MVP, government, donors, and the
community) to all priced and non-priced cluster-level activities, as well as the
sector-specific breakdown of these inputs.
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