Abstract
While social marketing can increase uptake of health products in developing countries, providing equitable access is challenging. We conducted a 2-year evaluation of uptake of WaterGuard, insecticide-treated bednets (ITNs), and micronutrient Sprinkles in Western Kenya. Sixty villages were randomly assigned to intervention and comparison groups. Following a baseline survey (BL), a multifaceted intervention comprising social marketing of these products, home visits by product vendors from a local women’s group (Safe Water and AIDS Project, or SWAP), product promotions, and modeling of water treatment and safe storage in was implemented in intervention villages. Comparison villages received only social marketing of WaterGuard and ITNs. We surveyed again at one year (FU1), implemented the intervention in comparison villages, and surveyed again at two years (FU2). At BL, <3% of households had been visited by a SWAP vendor. At FU1, more intervention than comparison households had been visited by a SWAP vendor (39% versus 9%, P<0.0001), and purchased WaterGuard (14% versus 2%, P<0.0001), Sprinkles (36% versus 6%, P<0.0001), or ITNs (3% versus 1%, P<0.04) from that vendor. During FU2, 47% and 41% of original intervention and comparison households, respectively, reported ever receiving a SWAP vendor visit (P=0.16); >90% those reported ever purchasing a product from the vendor. WaterGuard (P=0.02) and ITNs (P=0.005) were purchased less frequently by lower-SES than higher-SES households; Sprinkles, the least expensive product, was purchased equally across all quintiles.
Highlights
In 2005, 1.4 billion people in the developing world lived on less than $1.25 per day [1]
By Follow-Up Survey 1 (FU1), 39% of respondents in intervention villages and 9% of respondents in comparison villages reported ever having received a household visit by a Safe Water and AIDS Project (SWAP) vendor (P < 0.0001), and among these, a greater percentage of respondents from intervention than comparison households purchased a product from a SWAP vendor (95% versus 88%, P = 0.01)
All study households had little or no exposure to SWAP; after the first year of the intervention, households in intervention villages showed higher levels of exposure to and product purchasing from SWAP vendors compared with the comparison group
Summary
In 2005, 1.4 billion people in the developing world lived on less than $1.25 per day [1] Children living in these regions experienced the highest global burden of morbidity and mortality from acute respiratory infections, diarrhea, malaria, and malnutrition, and the poorest access to health services and improved water sources [2]. Social marketing in developing countries has created product awareness through advertising and improved product access through widespread distribution, it has limitations. Among these are the requirement for individuals or families to have at least some disposable income, and the difficulty in ensuring availability of products to communities beyond the reach of existing commercial distribution networks [3, 12, 13]. Access to socially marketed products is frequently uneven and inequitable [9, 14]
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