Results from the first randomised controlled trial to show that mass media can change behaviours were published in two papers in BMJ Global Health on Tuesday 17/07/18. The first paper shows the impact of the campaign on treatment-seeking behaviours and models its impact on mortality. The second paper indicates that this is one of the most cost-effective ways to save children’s lives. The trial was run by DMI and evaluated by the London School of Hygiene and Tropical Medicine.
The campaign was broadcast on seven radio stations (with a radii of approx. 50km), shown in blue, between 2012-2015. Seven other radio station areas acted as control zones, shown in red. The campaign used DMI’s ‘Saturation+’ methodology, broadcasting radio spots 10 times a day, 365 days a year. It promoted health-seeking behaviours, including ante-natal care attendance, health facility deliveries and primary care consultations for malaria, pneumonia and diarrhoea.
Routine data from health facilities were analysed for evidence of changes in treatment-seeking. Year 1 of the campaign saw increases in children with malaria, pneumonia and diarrhoea taken to health facilities of 56%, 39% and 73% respectively, compared to control zones (all p<0.001).
Lives Saved Tool (LiST) calculations showed that this corresponded to a mortality reduction of 9.7% in year 1, and that approximately 3,000 lives were saved over the course of the three year campaign.
Overall, data from over 600,000 consultations was evaluated and there were no intervention effects on any categories for which there was no campaigning (e.g. coughs and colds).
Mortality predictions for Burkina Faso and other countries were used to calculate the cost-effectiveness of these interventions. Using Disability-Adjusted Life Years (DALYs) as the metric (equivalent to the cost of one year of healthy life added), the results show that mass media campaigns based on Saturation+ principles are among the most cost-effective methods available for saving children’s lives.
The authors calculated that scaling up campaigns in Burkina Faso, Burundi, Niger, Malawi and Mozambique would cost between $7 to $27 per DALY in 2018-20. (For reference, $7-$27 per DALY equates to approximately $196-$756 per life saved.)
The authoritative source for cost-effectiveness comparisons, the Disease Control Priorities, Third Edition, compares the relative magnitudes of the cost-effectiveness estimates for all health interventions. For reproductive, mother and child health interventions the cost per DALY ranges from $2,900 down to $5. Saturation-based media campaigns are among the most cost-effective interventions available.
Roy Head of DMI who designed and led the study in partnership with LSHTM says: “What this study shows is that using mass media to drive people to health centres is actually more cost-effective than almost anything on earth in terms of saving children’s lives. And that makes sense – it reaches millions of people at a time – but this is the first time it has been shown in a scientific trial.”
Professor Simon Cousens, of LSHTM who led the evaluation adds: “Pneumonia, malaria, and diarrhoea are three of the biggest killers of children in Sub-Saharan Africa. Ensuring that these children get appropriate treatment is a global priority. This research provides evidence that mass media has an important role to play in persuading parents to seek life-saving treatment for children.”
The study was jointly funded by Wellcome and the Planet Wheeler Foundation. On Tuesday we celebrated the publication of the results at an event at the Wellcome Collection. Thank you for all the guests who joined us, many of whom this RCT would not have happened without.
Watch an animation of our RCT results, and the story of Mariéta, whose life was saved by the campaign.
Learn more about the results in the news, in Reuters, the New York Times, or our CEO's interview with the BBC World Service (starting at 36:52). More details are also available on our website.