In many countries, especially in sub-Saharan Africa, Millennium Development Goal 4 is unlikely to be achieved. In 2010 there were 7.6 million deaths of children under 5 years of age. The problems are such that a multifaceted approach is needed. The Millennium Villages project, in nine countries in sub- Saharan Africa, provides investments in agriculture, the environment, business development, education, infrastructure, and health (Lancet 2012;379:2179–88; see also Comment, ibid: 2131–3). Village sites selected in East and West Africa included, on average, around 35 000 people with high levels of poverty and undernutrition. The projected cost, starting in 2006, was US $120 per person per year. The actual average spending was $25 at baseline and $116 by year 3 ($25 on health). There were reductions in poverty, food insecurity, stunting, and malaria prevalence in the Millennium Village sites after 3 years. Access to improved water and sanitation was increased and more provision of many maternal-child health interventions was achieved. Under-5s mortality fell by 22% in Millennium Village sites and by 33% relative to matched comparison sites. The integrated multisector approach was associated with rapid reductions in child mortality.

Optimal treatment for the infants of mothers who are diagnosed with …