Large‐scale television campaign associated with higher prevalence of exclusive breastfeeding in Vietnam

Abstract

BackgroundFew studies, especially in lower middle‐income countries, have examined the role of mass media interventions on infant and young child feeding (IYCF) practices, critical for optimal child growth and development. To improve IYCF practices in Vietnam, Alive & Thrive (A&T) invested in a nationwide TV campaign (from November 2011 to December 2014) to promote optimal IYCF practices. The campaign focused on broadcasting short TV spots that convey small, doable actions in a persuasive, attractive manner. During the same period, A&T introduced standardized IYCF counseling services in government health facilities across 15 of 63 provinces. The aim of this study was to examine the association between exposure to breastfeeding TV spots and exclusive breastfeeding (EBF) practice and its determinants in two settings: areas with and without facilities offering IYCF counseling services (referred as A&T‐I and A&T‐NI, respectively).MethodsData were collected in four provinces from 11,722 mothers of children under 6 months old in five cross‐sectional surveys — one before and four after the launch of the campaign. The study outcomes were EBF and its determinants — knowledge, beliefs, social norms, and self‐efficacy. Exposure to the campaign was assessed in two ways: any exposure to the TV spots and dose of exposure. Dose was based on the number of messages recalled from the TV spots: unexposed / did not recall; recalled 1–2 messages; and recalled ≥ 3 messages. Post‐campaign EBF prevalence and the score of its determinants at different levels of exposure were compared with those from baseline using multiple logistic and linear regression models.FindingsEBF prevalence increased significantly from 24% to 55% in A&T‐I communes, but remained unchanged in A&T‐NI communes. Compared to baseline, exposure to the TV spots was associated with higher EBF in A&T‐I communes (OR: 3.3; 95% CI: 2.7, 4.1) and A&T‐NI communes (OR: 1.3; 95%: 1.03, 1.7). The more messages mothers recalled the more likely respondents were to practice EBF. In A&T‐I communes, all dose categories were associated with higher odds of EBF compared to baseline: unexposed/did not recall (OR: 2.4; 95%CI: 1.9, 3.1); recalled 1–2 messages (OR: 3.1; 95%: 2.5, 4.0); and recalled ≥ 3 messages (OR: 4.7; 95%CI: 3.8, 5.8). In A&T‐NI communes, mothers who could recall ≥ 3 messages were twice as likely to EBF as those at baseline (OR: 2.0; CI: 1.5, 2.6). Population attributable fraction (PAF) analysis using data from the A&T‐NI sample showed that if all mothers with an infant under 6 months were exposed to A&T breastfeeding TV spots and recalled at least one message, there would have been an increase of 13.5 percentage points in EBF prevalence or additional 144,769 infants with EBF in 3 years. In any A&T‐I and A&T‐NI areas, findings from bivariate and multiple analyses consistently showed that scores of knowledge, beliefs, social norms, and self‐efficacy were significantly higher after than before the mass media campaign. Regression coefficients (β) were greater in mothers who recalled more messages; and those who live in A&T‐I. Based on exposure to TV spots (58%) and the estimated number of women aged 15–35 years during the intervention period, the TV spots reached an estimated 9,350,000 women at a cost of 0.19 USD per woman.ConclusionExposure to large‐scale breastfeeding promotion campaign on TV is associated with an increase in EBF, which makes it a viable delivery platform to be used in conveying IYCF messages and improving practices at scale.Support or Funding InformationBill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360