Abstract
SummaryBackgroundMedia campaigns can potentially reach a large audience at relatively low cost but, to our knowledge, no randomised controlled trials have assessed their effect on a health outcome in a low-income country. We aimed to assess the effect of a radio campaign addressing family behaviours on all-cause post-neonatal under-5 child mortality in rural Burkina Faso.MethodsIn this repeated cross-sectional, cluster randomised trial, clusters (distinct geographical areas in rural Burkina Faso with at least 40 000 inhabitants) were selected by Development Media International based on their high radio listenership (>60% of women listening to the radio in the past week) and minimum distances between radio stations to exclude population-level contamination. Clusters were randomly allocated to receive the intervention (a comprehensive radio campaign) or control group (no radio media campaign). Household surveys were performed at baseline (from December, 2011, to February, 2012), midline (in November, 2013, and after 20 months of campaigning), and endline (from November, 2014, to March, 2015, after 32 months of campaigning). Primary analyses were done on an intention-to-treat basis, based on cluster-level summaries and adjusted for imbalances between groups at baseline. The primary outcome was all-cause post-neonatal under-5 child mortality. The trial was designed to detect a 20% reduction in the primary outcome with a power of 80%. Routine data from health facilities were also analysed for evidence of changes in use and these data had high statistical power. The indicators measured were new antenatal care attendances, facility deliveries, and under-5 consultations. This trial is registered with ClinicalTrial.gov, number NCT01517230.FindingsThe intervention ran from March, 2012, to January, 2015. 14 clusters were selected and randomly assigned to the intervention group (n=7) or the control group (n=7). The average number of villages included per cluster was 34 in the control group and 29 in the intervention group. 2269 (82%) of 2784 women in the intervention group reported recognising the campaign's radio spots at endline. Post-neonatal under-5 child mortality decreased from 93·3 to 58·5 per 1000 livebirths in the control group and from 125·1 to 85·1 per 1000 livebirths in the intervention group. There was no evidence of an intervention effect (risk ratio 1·00, 95% CI 0·82–1·22; p>0·999). In the first year of the intervention, under-5 consultations increased from 68 681 to 83 022 in the control group and from 79 852 to 111 758 in the intervention group. The intervention effect using interrupted time-series analysis was 35% (95% CI 20–51; p<0·0001). New antenatal care attendances decreased from 13 129 to 12 997 in the control group and increased from 19 658 to 20 202 in the intervention group in the first year (intervention effect 6%, 95% CI 2–10; p=0·004). Deliveries in health facilities decreased from 10 598 to 10 533 in the control group and increased from 12 155 to 12 902 in the intervention group in the first year (intervention effect 7%, 95% CI 2–11; p=0·004).InterpretationA comprehensive radio campaign had no detectable effect on child mortality. Substantial decreases in child mortality were observed in both groups over the intervention period, reducing our ability to detect an effect. This, nevertheless, represents the first randomised controlled trial to show that mass media alone can change health-seeking behaviours.FundingWellcome Trust and Planet Wheeler Foundation.
Highlights
Scenario-based projections suggest that, to achieve the Sustainable Development Goal (SDG) target of 25 or fewer under-5 deaths per 1000 livebirths by 2030, about two-thirds of all sub-Saharan African countries will need to accelerate progress in reducing under-5 deaths.[1]
Using a repeated cross-sectional, clusterrandomised design, we report on the effect of the campaign on child mortality and family behaviours after 32 months of campaigning
Randomisation and masking Of 19 distinct geographical areas, 14, each centred around a community FM radio station, were selected by Development Media International (DMI) based on their high listenership and minimum distances between radio stations to exclude populationlevel contamination
Summary
Scenario-based projections suggest that, to achieve the Sustainable Development Goal (SDG) target of 25 or fewer under-5 deaths per 1000 livebirths by 2030, about two-thirds of all sub-Saharan African countries will need to accelerate progress in reducing under-5 deaths.[1]. Evidence before this study Four reviews, done before this study, concluded that targeted, well executed mass media campaigns can have small to moderate effects on health knowledge, beliefs and attitudes, but on behaviours as well (Grilli et al, 2001; Hornick, 2002; Noar, 2006; Bala et al, 2008). Development Media International’s (DMI) experiences in delivering mass media campaign corroborate this crucial implementation principle and indicate that implementation at sufficient scale and intensity is the most important (Head et al, 2015). Using the Lives Saved Tool, DMI predicted that a sustained, comprehensive campaign of sufficient scale and intensity could reduce under-5 mortality by between 16% and 23% during the third and subsequent years of campaigning through increases in coverage of key life-saving interventions (Head et al, 2015)
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