Learn how we use evidence-based behaviour change campaigns to improve and save lives in low-income countries.
Learn about how DMI brings together two different worlds: demonstrable scientific practice and creative storytelling.
Location Child survival
Everybody knows mass media can reach millions of people. But does it actually change behaviours? Can it save lives? This study aimed to investigate, to the highest scientific standards, whether it can. It was ground-breaking: the first randomised controlled trial to show that mass media can change life-saving behaviours.
Child survival and maternal health – Encouraging parents to seek treatment for children with symptoms of malaria, pneumonia or diarrhoea. Promoting antenatal care and health facility deliveries.
152 x 1-minute radio spots, and 220 x 10-minute drama segments used for interactive radio shows, all in six languages.
Our radio campaign ran from March 2012 to January 2015 on seven radio stations across Burkina Faso.
2.4 million people
The mathematical model we created with the London School of Hygiene and Tropical Medicine (LSHTM) predicted that child mortality could be reduced cost-effectively in low-income countries simply by broadcasting radio messages on key life-saving behaviours. To put this prediction to the test, we worked in Burkina Faso, where a combination of localised radio stations and radio listening patterns meant we could identify 14 geographical areas in which we could run a randomised controlled trial (RCT). The areas were randomised and equally divided into intervention clusters where we broadcast the campaign, and control clusters where we did not.
We conducted hundreds of focus group discussions with families in different regions of Burkina Faso to understand the barriers to treatment-seeking for the major killers of children: malaria, diarrhoea and pneumonia. These barriers included lack of awareness of symptoms, concerns about costs, and how urgently they should act. We also gathered information to understand barriers to care-seeking among pregnant women. Our team in Burkina Faso used these findings to write and produce 152 dramatic radio spots. The spots helped caregivers recognise symptoms and seek prompt and affordable treatment at a health centre, encouraged pregnant women to attend antenatal care and highlighted the benefits of giving birth in a health facility.
We also worked with our radio station partners to create and broadcast interactive phone-in shows. This format presented listeners with stories they could relate to and invited them to discuss the key behaviours presented, allowing the community to engage with the content collectively and in depth
For 34 months we broadcast 1-minute radio spots 10 times per day, every day, on seven radio stations, all in six languages.
We also broadcast our interactive phone-in shows two hours per night, five nights per week on each station.
Watch the video
Can mass media save lives?
To measure the impact of the intervention, LSHTM researchers analysed routine health centre data from over 1.1 million consultations and deliveries to identify changes in care-seeking. The results were dramatic. Malaria, pneumonia and diarrhoea diagnoses increased by 56%, 39% and 73% respectively in the first year (all p<0.001). The number of antenatal care attendances and health facility deliveries also increased by 9% in years two and three of the campaign (p=0.026 and p<0.001 respectively). We used the Lives Saved Tool (LiST) to estimate that child mortality decreased by 9.7% in the first year of the intervention and an estimated 2,967 lives were saved over the 3 years. LSHTM health economists also calculated that at $196-$756 USD per life saved, it ranked as one of the most cost effective ways of saving a child’s life.
WATCH THE RESULTS OF OUR CHILD SURVIVAL RCT EXPLAINED
During the intervention period (03/2012 – 01/2015), the number of positive diagnoses of malaria in under-5s was significantly higher in areas where we broadcast than areas where we did not. It was 56 percent higher in the intervention areas in year one (p<0.001), 37 percent higher in year two (p=0.003) and 35 percent higher in year three (p=0.006).
During the intervention period (03/2012 – 01/2015), the number of positive diagnoses of chest infections in under-5s was higher in areas where we broadcast than in areas where we did not. It was 39 percent higher in the intervention areas in year one (p<0.001), 25 percent higher in year two (p=0.01), and 11 percent higher in year three (p=0.525).
During the intervention period (03/2012 – 01/2015), the number of positive diagnoses of diarrhoeal disease in under-5s was higher in areas where we broadcast than in areas where we did not. It was 73 percent higher in intervention areas in year one (p<0.001), 60 percent higher in year two (p=0.01) and 107 percent higher in year three (p<0.001).
We also tested whether our campaign motivated people (the “worried well”) to seek treatment for illnesses and symptoms we did not cover as part of our campaign. As seen by the below graph, our campaign did not have an effect on diagnoses of upper respiratory infections during the trial period, indicating our campaign helped the right people recognise the right symptoms and act accordingly.
We were unable to detect a statistically significant reduction in deaths in our survey. We were able to model this using the Lives Saved Tool (LiST) – the best modelling software for these scenarios. The LiST modelling detected a 9.7% reduction in mortality in the first year of the campaign, with 5.7% and 5.5% reductions in years two and three respectively. It suggests 2,967 lives were saved throughout the course of the campaign.
LSHTM health economists estimated that this intervention, when delivered at national scale, would cost $602 USD per life saved ($21 per Disability-Adjusted Life Year (DALY) averted) in Burkina Faso, and $196-$756 USD ($7-$27 per DALY averted) in other low-income countries, ranking it among the most cost-effective reproductive, maternal, newborn and child health (RMNCH) interventions available.
For more information about modelled reduction in mortality, read this published paper. For more information about the cost-effectiveness of our radio campaign, see this published paper.
Read our published papers to explore the RCT findings in depth.
We are grateful to LSHTM for evaluating the intervention. And to the Wellcome Trust and the Planet Wheeler Foundation for funding it.
We have taken this campaign to national scale in Burkina Faso and Mozambique, and aim to deliver child survival campaigns in Tanzania and other countries in Sub-Saharan Africa.